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458 Economic crisis, health systems and health in Europe: country experience
User charges
• No response reported.
Changes to health service planning, purchasing and delivery
Prices of medical goods
• A new law capped SHI spending on drugs at 17% of the SHI budget and
introduced a pay-back system for exceeding the budget (2011).
• A maximum margin for drugs sold by wholesalers and pharmacies was
established, with fixed pharmacy prices for covered drugs; discounts between
wholesalers and pharmacies were abolished and promoting pharmacies was
prohibited (2011).
Salaries and motivation of health sector workers
• There was a dynamic rise in pay in some medical specialties (e.g. cardiology,
ophthalmology) and stagnation in other fields (mainly from the introduction
of DRGs in 2008 leading to differences in pricing of various services).
Payment to providers
• A DRG-type payment system was implemented for some specialist ambulatory
services with the goal of shifting less severe cases from inpatient to outpatient
care and thus avoiding unnecessary hospitalizations and costs (2011).
• Further changes in the hospital DRG system promoted day care in place of
hospital admissions (mainly elimination of certain procedures from DRG
grouping algorithms for inpatient care episodes) (2013).
• Prices for several (previously overpaid) services were reduced, such as invasive
cardiology interventions and cataract surgery (2013).
Overhead costs: restructuring the Ministry of Health and purchasing agencies
• Decentralization of the National Health Fund was proposed (it was
centralized in 2003) in response to widespread criticism of its functioning
(various proposals in recent years).
• Institutionalization of costing of health care services and systematic monitoring
of health care quality indicators were proposed but are poorly developed at
present (2012).
Provider infrastructure and capital investment
• Financial assistance offered to local governments that decided to change the
legal form of hospitals from autonomous public entities into commercial code
companies (2009).
• The responsibility for negative financial results of hospitals to local
governments was strengthened (2011); local governments should (from 2013)