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462 Economic crisis, health systems and health in Europe: country experience
• The cost to all levels of government of ADSE and the other subfunds (for
the armed forces and for the police service) was reduced by 30% in 2012
and by a further 20% in 2013, with these subsystem funds becoming
self-financing by 2016.
• Government costs to be reduced by lowering the employer contribution
rate to 1.25% in 2013 and by adjusting the scope of health benefits.
Changes to health coverage
Population (entitlement)
• The ADSE was made optional for all civil servants (2011).
The benefits package
• Plans to introduce a minimum benefits package (MoU 2011).
User charges
• Introduction of user charges for antidepressants, antipsychotic drugs and
other drugs associated with the treatment of serious mental illnesses such
as schizophrenia, dementia, autism and bipolar disorder; a 5–10% coinsurance
was officially opposed by the Order of Medical Doctors (2010).
• Introduction of an exemption from user charges for people registered as
unemployed and their dependants (2011).
• Exemption from all user charges extended to children aged 12 years or
younger, pregnant women, transplant recipients, people with a disability
status of over 60%, military and ex-military (the latter with permanent
disability) and fire service workers (2011).
• Exemption from primary care user charges extended to fire service
workers; active blood donors; people who donate cells, tissue or organs;
people with chronic conditions; and public health services (2011).
• Introduction of user charges for over-the-counter drugs such as
paracetamol, antacids and antiviral drugs (2011).
• User charges increased for vaccines for yellow fever, Japanese encephalitis,
typhoid, meningitis and rabies tetravalent (from under €1 to €50–100
per vaccine), medical certificates (from under €1 to €20), statements
certifying incapacity (from under €1 to €50) and statements certifying
disability required by disabled people for access to fiscal benefits (from
under €1 to €100) (2011).