Lessons from international experience in controlling pharmaceutical expenditure. I: influencing patients

Abstract

This is the first of three papers to review international policies to control spending on drugs and improve the efficiency of drug use. Policies can target three main groups: patients, prescribing doctors, and the drugs industry. In this paper we examine policies aimed at patients, particularly restrictions on reimbursement (such as prescription charges). Rigorous experimental and quasi-experimental studies suggest that policies to limit the level of reimbursement of drugs reduce the use of essential as well as non-essential drugs and may do more harm than good. Spending on drugs in the British NHS represents over 10% of the total NHS budget and has increased steadily over recent decades.1 2 Similar increases have occurred in health care systems throughout the developed world, and governments have adopted policies to control drug costs that affect both the supply of and demand for drugs. We reviewed recent policy in several developed countries to provide insights for British health policy. We assessed the impact of these policies on prescribing by examining evaluative studies with rigorous designs that we identified through a comprehensive search strategy. In this paper we examine the impact of policies intended to reduce patient demand for drugs. In future papers we consider policies aimed directly at prescribers and policies intended to regulate the activities of the drugs industry. Policies to control drug costs and to improve the cost effectiveness of drug use in the developed world are subject to frequent change. We used published descriptive studies and extensive contact with experts in relevant countries to ensure that our review was up to date and that policy initiatives were interpreted correctly. Where necessary, foreign language publications were translated to enable up to date analysis of policy. In order to assess the impact of such policies in practice, and gaps in knowledge, we …