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

432 Economic crisis, health systems and health in Europe: country experience
Changes to health coverage
Population (entitlement)
• Changed contribution rules to extend statutory coverage (2009) for the selfemployed
and those in other forms of employment (sportsmen, those receiving
income from copyright, business owners, agricultural workers, etc.) and
improved tax collection mechanisms.
The benefits package
• Reduction of the reimbursement rate for temporary sick leave benefits
from 85% of wages to 40% of wages in the first seven days and 80% after
the eighth day (2009).
• Introduction of a new version of the catalogue of pharmaceuticals
reimbursed by SHI (positive list for drugs) (2009) based on expanded
reference pricing and more strict requirements for generic pricing.
User charges
• Introduction of the option for patients to choose drugs with lower user
charges (2009).
Changes to health service planning, purchasing and delivery
Prices of medical goods
• First-line generics to be priced 30% below the original in order to be
covered and second- and third-line generics to be priced at least 10% less
than the first-line generic (2009).
• Introduction of price-volume agreements with producers (2009–2010).
• The reference price to be set based on the average of an expanded group
of eight European countries minus 5% (2009–2010).
• Drugs to be prescribed based on active ingredient (2009).
• Patients allowed to choose the drug with the lowest user charge (2009).
Salaries and motivation of health sector workers
• Health sector worker salaries decreased by 13% between 2008 and 2010,
with gradual recovery to 2009 levels in 2011 and moderate increase in
2012.
Payment to providers
• Reduction of health service reimbursement tariffs by 11% in 2009 and
by a further 8% in 2010. The tariffs subsequently increased but by the
end of 2012 they were still 9% lower than in 2008.