IMPACT OF SELECTIVE FINANCING OF DRUGS ON PHARMACEUTICAL EXPENDITURE CONTROL IN THE PROVINCE OF VALLADOLID, SPAIN

In July 1993, public financing for 1692 drug specialities was stopped in Spain (a drug speciality is a medicine with a defined composition, particular pharmaceutical form and dosage, prepared for immediate use, ready and packaged for dispatching to the public, with uniform name, packaging and labelling which has been granted authorisation by the St ate Administration and registered in the Pharmaceutical Specialities R egister). We designed a study to assess the repercussions of this so-c alled 'selective financing' on expenditure control. The aims of the st udy were 2-fold: first, to forecast the consumption of drug specialiti es that are reimbursable on the Spanish National Health Service, had s elective financing not been applied; and, secondly, to estimate the im pact of selective financing on drug consumption. For short- and medium -term forecast estimates, time-series analysis was used, and was appli ed to monthly consumption data. The measures of consumption used were the number of prescriptions per 1000 patients, and cost [in Spanish pe setas (Pta; $US1 = Pta123.9, February 1996)] per 1000 patients. Data w ere analysed from January 1986 up to the introduction of selective fin ancing. We found that drug specialities excluded by selective financin g showed, overall, a negative increase (i.e. the consumption of drugs that were excluded under selective financing decreased). The repercuss ion forecast, both in terms of prescription numbers and cost, of the 1 3 excluded drug specialities that had the highest pre-selective financ ing consumption is decreasing compared with total consumption. The ass essment of the repercussions of selective financing up to December 199 4 was made by calculating the difference between actual expenditures a nd forecast expenditures in the absence of selective financing. This r epercussion, in prescriptions, was lower than the percentage of the 16 92 excluded drug specialities relating to total consumption in 1992. T he repercussion in cost, nevertheless, was greater than expected durin g the first year of selective financing application. This could be att ributable to average price containment of drug specialities due to cau ses other than selective financing itself. The economic impact of sele ctive financing after 1 year of application was reduced because of acc ommodation phenomena.