【优质】Leadinginnovationinworldhealthcare.pptVIP

European issues in Cost Containment –the Italian case How cost containment policy in healthcare thwarts patient choice and innovation Content 1 What is the issue with healthcare? 2 How does the Italian healthcare system operate in this respect? 3 How to solve the problem? 1 What’s the Issue with Healthcare? Healthcare expenditure has steadily increased over time Cost containment: a major issue No structural solutions Major future concerns: Demographic trends Innovation Unsustainability of the welfare state European Trend: increasing state involvement Public arrangements for health insurance From self-regulation to state involvement Extending material and personal scope Values: solidarity (risk, income) Cost Containment: the Major Issue Charges and Co-Payments Restrictions (on what is reimbursed by the insurer) Budget Setting Controls NB! Italy has tried all cost containment tools! 2 The Italian Healthcare System: Overview NHS complex network of public and private providers. Financed mainly by public hand (71%) but covers only 45% of total healthcare expenditures. Providers are either public, private, or subcontractors for the NHS. NHS covers ‘all’ medical care but co-payments are significant The Italian Healthcare System: Financing General revenues (31%) Regional taxes on manufacturing (Irap) 1998: Irap replaced by pay roll taxes Pay-roll taxes (59,5%) Specific regional contributions (5,5%) Revenues of the healthcare sector (4,3%) Thus: main source of income: regional taxes on manufacturing and payroll taxes! And still those debts! Consumption of healthcare(% GDP - OECD) Consumption of medicines(% GDP - OECD) Consultations with prescription(% - OECD) 1994: The Italian Reference Price Redefined the Positive List Clustering based on broad population/ indication: product form not important Therapeutic added value for broad population against “golden standard” Nationwide Drug expenditure Budget “Free” pricing: based on costs estimates Introdu