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398 Economic crisis, health systems and health in Europe: country experience
• SHI revenue from taxes on drug company turnover on covered products
increased by more than 20%, which helped to avoid further increases in SHI
contribution rates and decreased tax transfers (2012).
• A new tax earmarked for health was levied on statutory car insurance
premiums (2012).
• Greater use of EU grants, particularly for infrastructure improvement, are
expected to lead to a one-off increase in public spending on health in the years
from 2013 onwards.
Changes to health coverage
Population (entitlement)
• No response reported.
The benefits package
• Reduction of temporary sick leave benefits from 45 to 30 days for people
without insurance and reimbursement rates from 70% (60% for people
covered for less than two years) to 60% and 50%, respectively (2009).
• HTA introduced for all medical technologies (previously only applied to
innovative drugs) (2010).
• Reduction of the maximum daily benefit from €38 to €19 and abolished
payment of benefits to insurers for 30 days after losing a job (2011).
• Disability pensions for people under retirement age replaced by health
insurance benefits either in the form of rehabilitation benefit or of
disability benefit (2012).
User charges
• User charges abolished for GP visits, dentist visits, outpatient visits,
outpatient rehabilitation, not having the correct paperwork in outpatient
care (if admittance letter is needed), inappropriate use of inpatient beds and
inpatient daily charge (2008).
Changes to health service planning, purchasing and delivery
Prices of medical goods
• Introduction of new rewards for pharmacies switching to therapeutically
equivalent substitutes (2011).
• Introduction of new financial incentives to reward doctors for prescribing
cheaper substitutes (therapeutically equivalent) (2010).
• Introduction of a blind bidding system for reference pricing (2011); products with
bids 5% more expensive are penalized with a 15% lower reimbursement rate.