How do regional sickness funds encourage more rational use of medicines, including the increase of generic uptake? A case study from Austria

摘要

Objective: To analyse similarities and differences between activities carried out by Austrian sickness funds to encourage more rational use of medicines, including increasing generics uptake.Methods: Semi-structured interviews with pharmacoeconomic unit staff of four regional sickness funds in Austria.Results: Sickness funds include a variety of activities. The main target group is prescribers, who are provided information and educational materials, and whose prescription patterns are monitored. All surveyed sickness funds encourage doctors to prescribe more generics as part of an overall strategy to improved rational prescribing. Sickness funds provide patient information; however, pharmacists are not considered to be a target group. In recent years, sickness funds responsible for primary care have launched joint initiatives with hospitals, e.g. training of hospital staff, with the aim of improving pharmacotherapy at the interface between outpatient (ambulatory) and hospital care.Discussion: All surveyed sickness funds carry out similar activities; however, the design of the individual measures differs between them as they have been adapted to meet regional differences.Conclusion: Sickness funds have initiated a number of regional activities. The effect of these activities could be reinforced if national policies were in place to support them. Examples include generics substitution and International Nonproprietary Name prescribing, regular analysis and publication of pharmaceutical spending and consumption, and improvement of pharmacotherapy at the interface between outpatient and hospital care.Submitted: 28 February 2013; Revised: 5 June 2013; Accepted: 7 June 2013; Published online first: 21 June 2013IntroductionRational use of medicines should ensure that patients receive ‘medications appropriate to their clinical needs, in doses that meet their own individual requirements for an adequate period of time, and at the lowest cost to them and their community’ [1]. Core policies defined by World Health Organization (WHO) to promote rational use of medicines [2] include clinical guidelines, essential medicines lists, Drug and Therapeutics Committees (DTC), training in undergraduate curricula and continuing medical education, independent information on medicines and public education, avoidance of perverse financial incentives, and sufficient and sustainable government expenditure.All European Union (EU) and European Economic Area (EEA) countries have reimbursement lists in place, usually in the form of positive lists [3–6], and Drug and Therapeutic Committees are a standard feature in European hospitals [7]. Public education programmes have been introduced in some countries [8], such as the antibiotics campaign in France [9] and the generics campaigns in France and Portugal [10–13].Rational use of medicines, however, continues to be a challenge in many countries, including European countries [14]. The European Surveillance of Antibiotic Consumption project showed over- and misuse of antibiotics in European countries, with wide variation in type and volume of antibiotics prescribed [15]. Despite several interventions, patient adherence to medication remains poor [16–20]. Generic medicines help reduce the costs incurred by public payers [6, 21] and are, in accordance with the WHO Nairobi declaration [1], a way of supporting rational use of medicines. It seems, however, that generics policies are not fully exploited in some European countries [22–25]. Policies to promote generics uptake, which is defined as the increase in the use of generics compared with the originator or patent medicines within a substitutable class, include the promotion of generics substitution at all levels of the health system, and the promotion of generics acceptance by professionals, patients, and the general community [26–28].Austria’s healthcare systemAustria’s healthcare system is based on a social security system with compulsory insurance. The social in