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Ten years experience with models for financing of outpatient prescriptions

Artikel i vetenskaplig tidskrift
Författare Christine Sandheimer
Ingvar Karlberg
Publicerad i Health Policy and Technology
Volym 2
Nummer/häfte 4
Sidor 188-195
ISSN 2211-8837
Publiceringsår 2013
Publicerad vid Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa
Sidor 188-195
Språk en
Länkar dx.doi.org/10.1016/j.hlpt.2013.08.0...
Ämnesord Decentralised responsibility, Financial incentives, Pharmaceutical budget, Risk sharing, Sweden, article, budget, documentation, health care cost, health care financing, health care planning, health care system, health care utilization, human, mathematical model, outpatient, practice guideline, prescription, primary medical care, priority journal, socioeconomics, validation process
Ämneskategorier Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi

Sammanfattning

Background: Risk sharing mechanisms in health care balance between need and demand within the financial limits, acceptable from medical, political and ethical perspectives. Subsidising outpatients' medicines is part of the risk sharing. In order to stimulate a more cost-effective use of resources decentralisation of the financial responsibility for pharmaceuticals was introduced in Sweden in 2002. In this study we explored the development 10 years after the implementation. Method: The Swedish counties are responsible for all financing and provision of health care. In this study nine representative counties were included, each with its own set of models for devolution of financial responsibilities. Information was collected from written sources and supplemented by interviews with high level officials and administrators in each county. Results: Two main models were found; in the population based model the responsibility for subsidising pharmaceuticals is decentralised to the primary care units and their responsibility follows listed patients regardless of prescriber. In the other model each prescriber is financially responsible for own prescribing. In addition, over time mixed models were developed. Conclusions: Incentives for cost containment on an organisational level seem to be highly effective although there is no individual economic return involved. The prescriber based model seems to be more robust in terms of capping costs while the population based includes a higher level of service to the patient. The choices of principles were based on norms and responses from the users, and were not actively assessed by the counties in terms of cost efficiency. © 2013 Fellowship of Postgraduate Medicine.

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