Web-economic-crisis-health-systems-and-health-web

416 Economic crisis, health systems and health in Europe: country experience
chronic renal pathology, compulsive gambling, epidural anaesthesia)
(proposed in 2012 but not yet implemented).
User charges
• By 2011 the number of regions applying co-payments for outpatient
prescriptions had risen to 16 (up from 12 in 2010).
• User charges for outpatient specialist visits and outpatient diagnostic
services (introduced for one fiscal year in 2007) abolished (2008) and
later reintroduced and increased (a minimum charge of €10) (2011).
• User charges increased for non-urgent treatment in emergency
departments (to a minimum charge of €25), with regions free to set the
actual amounts charged (2011).
• Most regions applied user charges based on household income.
Changes to health service planning, purchasing and delivery
Prices of medical goods
• Reduction of the value of public contracts for medical goods (excluding
pharmaceuticals) by 5% and allowed contracts to be withdrawn where the
price in one region is over 20% of the reference price (2012).
• Medical devices budget capped at 4.8% of NHS spending (2013, lowered to
4.4% from 2014).
Salaries and motivation of health sector workers
• No update or adjustment to salaries of public health care workers (2010
onwards).
• In regions with financial deficits, a limit of 5–10% of total health care work
is placed on new recruitment numbers (2008 onwards).
• In some regions, incentives for early retirement introduced (2008 onwards).
• Health care personnel expenditure (salaries etc.) for 2013–2015 cut by
1.4% (compared with 2004 levels).
Payment to providers
• Introduction of more stringent quasi-market contracts with private providers
in some regions (2008). For example, regions with deficits introduced more
informed commissioning of private providers and budget allocations were
strictly defined (see below).
• Performance measurement introduced and linked to payment of providers as
a cost-containment measure (2010).