Medicines policy in Slovakia

IT SEEMS that there will never be enough funds in health-care budgets. Development of new medicines as well as new medicinal methods enabling treatment of more and more health problems continues to challenge the financial resources of the health-care sector. This makes it almost impossible to fill the gap between the amount of money needed and the funds actually available.

IT SEEMS that there will never be enough funds in health-care budgets. Development of new medicines as well as new medicinal methods enabling treatment of more and more health problems continues to challenge the financial resources of the health-care sector. This makes it almost impossible to fill the gap between the amount of money needed and the funds actually available.

This requires governments to face the challenge of formulating their health policies to provide as modern, sophisticated and effective health care as possible from the resources available. Policies regarding use of medicines have become one of the fundamental instruments to achieve this in many countries. And Slovakia is no exception.

The Slovak government adopted its Strategy on Medicines policy in December 2007 and it will apply through 2010. The aim of the strategy, as laid out in the document, is not to reduce spending on pharmaceuticals to the detriment of the health of patients but rather to secure economical and effective treatment.

“By its medicines policy the Slovak Health Ministry endeavours to secure as modern, quality and safe pharmacotherapy as possible under the effective use of public funds spent on medicines,” The Slovak Specator was told by Zuzana Čižmáriková, the spokesperson for the Health Ministry who added that in Slovakia total annual health-care costs amount to €3.3 billion, of which spending on medicines accounts for nearly one third.

The share of total health-care spending on pharmaceuticals differs in individual countries but when comparing these percentages it is necessary to take into consideration the base from which each of these is calculated.

Slovakia’s total health-care spending accounted for 7.7 percent of gross domestic product in 2007, according to the Health Data 2009 document published by the Organisation for Economic Cooperation and Development (OECD) in summer 2009. This share was lower than the average of 8.9 percent across all the OECD countries.

Slovakia also ranked well below the OECD average in terms of total per capita health-care spending, with expenditure of $1,555 in 2007 (adjusted for purchasing power parity), compared with the OECD average of $2,964.

In 2007, spending on pharmaceuticals accounted for 27.9 percent of total health-care spending in Slovakia, the second highest proportion among OECD countries and well above the OECD average of 17.1 percent. When putting these proportions into US dollars, the $434 per capita spent in Slovakia on pharmaceuticals was below the OECD per capita average of $507.

“We should compare comparables,” Tomáš Szalay from the Health Policy Institute told The Slovak Spectator, adding that many countries of the OECD have better economic performance than Slovakia and thus spend higher resources in absolute numbers.

Klaus Mittmann, a member of the Slovak Association of Research-Based Pharmaceutical Companies (SAFS) board of directors agrees, saying that percentages may sometimes be misleading.

“It depends what size of a base we are speaking about,” he told The Slovak Spectator. “Investments of individual countries in health care differ quite significantly. Not only because of the economic performance of the country but also because of historical traditions, while ruling political powers and their priorities influence the final figures too.”

Another significant aspect when looking at statistical data is to take into consideration other costs for health care.

“Spending on pharmaceuticals accounts for 27-29 percent of the total budget, but if the budget would be totally accounted, i.e. if, for example all acknowledged but unpaid treatments were incorporated, this percentage share would be much lower,” Vladimír Balogh, an advisor to the presidium of the Slovak Medical Chamber told The Slovak Spectator. “The important thing is that annual spending on pharmaceuticals per patient in Slovakia is in a different level and Slovakia is ranked among the countries with lower costs.”

According to Balogh, the current medicines policy in Slovakia stems from the existing situation and the government needs to effectively and purposefully make this part of health care treatment more economical.

The Health Ministry has adopted several measures to economise spending on pharmaceuticals and to slowdown cost increases. Čižmáriková listed referencing of medicine prices as the most effective measure. Under this scheme the price of certain drugs in Slovakia is compared with the arithmetical average of the six lowest prices at which these same drugs are sold in other EU states. The first two rounds of referencing have brought savings of around €150 million or over 10 percent.

The Health Ministry expects that the third round of referencing will bring savings of about €30 million for 12 months beginning on April 1, 2010 according to the TASR newswire.

HPI acknowledges the value of referencing and other measures but in general it perceives the medicines policy of the Health Ministry to be not transparent and unpredictable for the business environment.

The biggest health insurance company in Slovakia, the Všeobecná Zdravotná Poisťovňa (VšZP) recognises the impact of the health and drug policies made by the current government.

“It is important to remember that Slovakia’s policy on drugs is one of the most advanced in the EU as well as in all countries of the OECD,” Martin Višňanský, a member of VšZP’s board of directors and the director of the section on the strategy and politics of health, told The Slovak Spectator. “The system of reference pricing, transparent pricing proposal bids on the internet, as well as several other important tools and techniques used in the drug policies of Slovakia have been creating a more transparent, patient-focused and market-driven environment where demand is sufficiently matched with supply and creates value for all individual stakeholders once applied.”

During the earlier rounds, the Finance Ministry and the Health Ministry applied the process of referencing to 95 percent of the medications used in Slovakia as well as those which are entering the market now. Before the referencing process, prices of pharmaceuticals were 10 percent more expensive in Slovakia.

The next round of referencing is planned for the second half of 2010. But according to Martin Filko, an advisor to the Finance Ministry, the drug market in Slovakia is actually “cleaned up” and under the current set of conditions the potential of greater savings via referencing is to a large extent used up, the SITA newswire wrote.

SAFS was invited to participate in creation of the upcoming strategy for the government’s medicines policy that will extend to 2015.

“We appreciate the opportunity to cooperate by sharing the experience and knowledge of SAFS to contribute to a more efficient health-care system in a highly transparent and clear manner,” said Mittmann. “When speaking about health care we should not look at costs only but, rather, by applying health technology assessment we can understand costs within the strategy of medicines policy as an investment into a healthier, longer life for the Slovak population and therefore sustainable growth of the Slovak economy.”

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