ocp192_en

3. Programme implementationinternational classification of diseases – ICD10 classification – and some prescription guidelineshave been introduced in the e-prescription system. The automatic blockage mechanism whichactivates when branded prescription reaches 15% is in place and appears effective. Nevertheless, thedispensing and use of generic medicines remains puzzlingly low at about 18%-20% in both volumeand value. As a result, the authorities have introduced an average target of 60% generic prescriptionfor doctors. But more should also be done to inform and encourage patients and pharmacies todispense the cheapest pharmaceuticals within each active substance. More focus should be put onintroducing additional compulsory prescription protocols into the system – a process that has so farbeen very slow to implement.• The authorities have also introduced a spending cap and an effective prescription budget for eachdoctor which is equal to 80% of last year's prescription value. This system is in place since January2014 and is effectively binding on a monthly basis. As the expected reduction of spending, in casethe 60% target of generic uptake is fulfilled, is more than 20%, this cap on doctor budget has to beseen as safety net to guarantee planned savings if other mechanisms fail.• Despite the observed progress, pharmaceutical expenditure was above the monthly target for 2013by about EUR 150 million. The excess spending will be clawed back from companies or offset withexisting debts. While the claw back mechanism will ensure that the spending on pharmaceuticalsremains in line with the budget, efforts must be pursued to strengthen the structural measures justoutlined in view of the 2014 target. The outcome of these measures needs to be carefully monitoredin the coming months. Indeed, from 2013 to 2014 about EUR 500-600 million in savings will needto be generated to achieve the target set in the MoU. For this, also EOF and EOPYY capacity mustbe reinforced to ensure pricing and reimbursement is timely and effective in delivering a costeffectiveuse of pharmaceuticals and the necessary savings.69. Important steps have been taken on the hospital sector to improve the monitoring of financial andactivity data and ensure that financial execution in in line with the budget. Hospital reorganisationis also continuing. Data for 2013 indicates that financial execution will be within the budget in accrualterms. Most hospitals have now been allocated internal controllers and analytical cost accounting hasbeen progressively introduced on the basis of an action plan. The implementation of diagnostic-relatedgroups (DRGs) is going according to plan, although proper DRGs will not be ready for testing prior to2015. Additional steps are planned in terms of hospital network rationalisation. This may be conduciveto a better distribution of staff and heavy equipment across hospitals with the transformation of someinpatient facilities into outpatient and long-term care facilities. Steps taken so far show thatreorganisation, if implemented, can lead to important and additional savings in the sector.70. Nevertheless more could be done regarding ESY facilities and hospital spending in a number ofareas.• Centralised procurement has produced substantial savings, but still covers a minor share ofpharmaceutical expenditure and the process appears somewhat stalled. The share of generics, whileseeing an important increase, remains below the target set for many hospitals. It needs to beextended to cover a wider share of hospital purchasing. A substantial number of tenders are in thepipeline but have suffered substantial delays. These should be launched as a matter of urgency.• Data suggests important variation across hospitals for a wide set of indicators (such as staff andbeds, operating costs, average length of stay discharges and surgeries, bed occupancy rates, and useof generics). This suggests that there is considerable room to realise savings. The benchmarkingexercise of October 2013 could be used to identify the reform potential in each hospital vis-à-vis itspeers and serve as the basis for streamlining the current hospital network. Hospital reorganisationshould also consider reforming emergency and on-call structures to increase efficiency and thequality of care and to reduce overtime. Staff mobility is still limited and further steps should betaken to ensure that staff is allocated to areas of need, most notably to less-urban areas.• Last but not least, considerable concerns remain that a large albeit still unclear number of peoplemay not have adequate access to healthcare services and goods, although access to health centresand emergency care is available to all. As a result of the rise in long-term unemployment, there maybe a large number of people who do not officially have access to the full range of health services. Theauthorities have been unable to provide a clear estimate of the number of uncovered people so far.While access to health centres, emergency care and care for chronic disease is still provided, uninsuredpeople may have limited access to medicines, diagnostics and elective hospital care, though authoritiesreport anecdotal evidence that hospitals provide the treatment and simply do not charge any payment.An important step taken by the authorities was the distribution of health vouchers to the long-term41