title: The impact of repeated cost containment policies on pharmaceutical expenditure: experience in Spain.
abstract: The growth in expenditure on the financing of pharmaceuticals is a factor that accounts for a large part of the increase in public health spending in most developed countries. In an attempt to kerb this growth, many health authorities, particularly in Europe, have introduced numerous regulatory measures that have affected the market, especially on the supply side. These measures include the system of reference pricing, the reduction of wholesale distributors' and retailers' markups and compulsory reductions of ex-factory prices. We assess the impact of these cost containment measures on expenditure per capita, prescriptions per capita and the average price of pharmaceuticals financed by the public sector in Catalonia (Spain), from 1995 to 2006. We apply an autoregressive integrated moving average (ARIMA) time series model using dummy variables to represent the various cost containment measures implemented. Twelve of the 16 interventions analysed that were intended to contain the overall pharmaceutical expenditure were not effective in reducing it even in the short term, and the four that were effective were not so in the long term, thus amounting to a moderate annual saving.
authors.affiliation: Research Centre for Economics and Health (CRES), Department of Economics and Business, Universitat Pompeu Fabra, Ramon Trias Fargas 25-27, 34-08005 Barcelona, Spain. ivan.moreno@upf.edu
authors.forename: Iván
authors.initials: I
authors.lastname: Moreno-Torres
authors.forename: Jaume
authors.initials: J
authors.lastname: Puig-Junoy
authors.forename: Josep M
authors.initials: JM
authors.lastname: Raya
mesh_terms: D003363:Cost Control / Q000191:economics / Q000331:legislation & jurisprudence*; D016527:Drug Costs; D004345:Drug Industry / Q000191:economics / Q000331:legislation & jurisprudence; D011307:Drug Prescriptions / Q000191:economics*; D017850:Economics, Pharmaceutical; D033161:Government Regulation; D005102:Health Expenditures / Q000331:legislation & jurisprudence*; D006291:Health Policy; D006801:Humans; D004364:Pharmaceutical Preparations / Q000191:economics*; D011634:Public Health; D013030:Spain
chemical_list: D004364:Pharmaceutical Preparations
references.citation: Clin Ther. 2003 Apr;25(4):1262-75
references.pmid: 12809972
references.citation: Health Policy. 2000 Jan;50(3):197-218
references.pmid: 10827308
references.citation: Health Econ. 2007 Jun;16(6):627-43
references.pmid: 17238227
references.citation: J Health Serv Res Policy. 2006 Jan;11(1):13-20
references.pmid: 16378528
references.citation: Pharmacoeconomics. 2006;24(9):891-902
references.pmid: 16942123
references.citation: Health Aff (Millwood). 2009 Jan-Feb;28(1):w125-37
references.pmid: 19088100
references.citation: Eur J Health Econ. 2007 Sep;8(3):297-300
references.pmid: 17401592
references.citation: Ann Pharmacother. 2008 Nov;42(11):1563-72
references.pmid: 18827174
references.citation: Health Policy. 2004 Feb;67(2):149-65
references.pmid: 14720633
references.citation: Eur J Health Econ. 2003 Sep;4(3):151-7
references.pmid: 15609181
references.citation: Health Policy. 2003 May;64(2):163-72
references.pmid: 12694953
references.citation: Pharmacoeconomics. 2007;25(8):637-48
references.pmid: 17640106