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Το 4ο Μνημόνιο (3η αναθεώρηση)

Αγαπητοί συνάδελφοι υποδεχθείτε την τρίτη και πιο πρόσφατη αναθεώρηση του Μνημονίου με ημερομηνία έκδοσης την 24 Φεβρουαρίου 2011.

Το κείμενο του μνημονίου περιέχεται ολόκληρο ΕΔΩ.

 

Η κριτική δική σας, εμείς το μόνο που η συνείδησή μας επιβάλει να πούμε είναι πως αφού την πρώτη φορά οι φράσεις του μνημονίου που μας οδήγησαν στην σημερινή κατάσταση αφορούσαν μόνο τη μείωση των ελάχιστων αμοιβών και την ελαστικοποίηση του ωραρίου και τελικά η κυβέρνηση προσέθεσε τα χίλια όσα δικά της θέματα επιπλέον κάνοντας ένα ανέντιμο πόλεμο, δυσκολευόμαστε τώρα να φανταστούμε τι θα επακολουθήσει και με ποιους τρόπους.

 

Το μήνυμα είναι ένα:
ΕΝΗΜΕΡΩΘΕΙΤΕ ΣΩΣΤΑ, ΣΥΣΠΕΙΡΩΘΕΙΤΕ ΓΥΡΩ ΑΠΟ ΤΟΥΣ ΣΥΛΛΟΓΟΥΣ ΣΑΣ, ΝΑ ΕΙΣΤΕ ΕΤΟΙΜΟΙ ΓΙΑ ΚΑΘΕ ΑΓΩΝΑ, ΟΛΟΙ ΜΑΖΙ ΕΝΩΜΕΝΟΙ!

Θα ξεκινήσουμε λέγοντας πως στο κείμενο γίνεται εκτενέστατη αναφορά για τα φαρμακεία και μάλιστα σε όλο το μήκος του θα βρείτε πόλλές αναφορές.

  1. Σελ. 11, Ο τομέας των φαρμάκων στην Ελλάδα είναι από τους περισσότερο υποσχόμενους τομείς εξαγωγών:

    Pharmaceuticals are among the most promising export sectors. Greek pharmaceuticals are characterised by both a growing market share and above-average world export growth over the last decade. The presence of multinational pharmaceutical companies in Greece offers the opportunity for knowledge spill-overs and access to R&D resources which have been scarce in Greece due to the large share of SMEs. Significant investments are underway in this sector and an effort to promote FDI and improve the R&D framework could help to further improve competitiveness.

  2. Σελ. 28, Μιλά για την αναβάθμιση των υπηρεσιών, τη λίστα, τη μείωση των τιμών των φαρμάκων:

    Important steps have recently been taken to reform the health sector in order to increase the efficiency and quality of health services delivery. The reform aims to ensure a more rational use of services and medical goods, reduce waste and corruption and increase productivity. Actions planned for 2011 are expected to generate at least about 1⁄2 percent of GDP in savings, including savings of more than EUR 2.2 billion in pharmaceutical expenditure. A number of other measures are being implemented in the area of pharmaceuticals. These measures aim at reducing unnecessary expenditure associated with over-prescription, over-pricing, waste and corruption: • An initial price list published in September 2010 led to reduction in the price of medicines of almost 20 percent leading to important savings. This policy action may have led to savings of more than EUR 750 million. The current price list is to be replaced by an updated and complete list inducing smaller but additional savings. • Another measure is the publication of a negative list of medicines not reimbursed by the social security funds and which could result in savings up to EUR 140 million within one year. This is to be coupled with the definition of prescription guidelines and the development of a reference price system establishing a reference price for reimbursement purposes. The government needs now to put these two measures into practice in the coming months to ensure further savings from the reduction in unnecessary prescription of medicines (up to EUR 300 million) and a reduction in the effective price paid by social security.

  3. Σελ. 29, για την αύξηση της χρήσης κατά 50% των γενοσήμων στην αγορά, την συνταγογράφηση με δραστική, την αντικατάσταση φαρμάκων με γενόσημα από τα φαρμακεία, την επέκταση της ηλεκτρονικής συνταγογράφησης, τα μέτρα που ελήφθησαν για την απελευθέρωση του επαγγέλματος του φαρμακοποιού και τη μείωση του κέρδους των αποθηκών:

    • The government has set the target of increasing the share of generics and off-patented medicines used in NHS hospitals to 50 percent. Further steps can be taken to ensure a faster and easier entry of generics in the market, ensuring prescription by active substance by doctors and generic substitution by pharmacies.
    • Steps have been taken to extend the pilot e-prescription system from OAEE to other social security funds. The pilot e-prescription system for medicines has led to a reduction in the number of prescriptions and contributed to a reduction in the average value per prescription. The extension of e-prescription has nevertheless faced delays due to the system complexity and the initial costs involved. E-prescription is now due to be extended to all funds by May 2011. E-prescription is expected to induce savings of EUR 1.4 billion.
    • A set of measures have been legislated to induce some liberalisation of the pharmacies sector (easing population-based restrictions, increasing opening hours, allowing new pharmacists to form partnerships with incumbents) and reduce the effective profit margin for pharmacies (through a system of rebates). The profit margin of wholesalers has been cut from 8 to 5.4 percent.
  4. Σελ. 44, Αναφορά στην επιτυχή μείωση της φαρμακευτικής δαπάνης κατά 350 εκατομμύρια ευρώ:

    reduction in pharmaceutical expenditure by social security funds by EUR 500 million owing to a reduction in pre-tax drug prices; and by hospitals by at least EUR 350 million.

  5. Σελ. 46, Νέα μέτρα που πρέπει να ληφθούν για την περαιτέρω μείωση της φαρμακευτικής δαπάνης μέσω καινούριων μειώσεων των τιμών:

    further reduction in pharmaceutical expenditure by social security funds by EUR 900 million owing to a further reduction in drug prices and new procurement procedures and by hospitals (also including expenditure in equipment) by at least EUR 350 million

  6. Σελ. 51-52, Για τον εκσυγχρονισμό του συστήματος υγείας και την προτροπή να κρατηθούν οι δαπάνες για την υγεία σε επίπεδα κάτω του 6% του ΑΕΠ, μέ ότι αυτό συνεπάγεται για φαρμακεία, αποθήκες, ταμεία κτλ:

    To modernise the healthcare system: Government adopts a comprehensive reform of the healthcare system and modifies the allocation of health-related tasks among ministries. The overarching objective is to keep public health expenditure at or below 6 percent of GDP, while maintaining universal access and improving the quality of care delivery. In the short-term, the main focus should be on macro-level discipline and cost-control. Regarding pharmaceuticals, the government implements measures yielding savings of at least EUR 2 billion relative to the 2010 level, at least EUR 1 billion of which would materialise already in 2011. This would bring average public spending on outpatient pharmaceuticals to about 1 percent of GDP (in line with the EU average) by the end of 2012. More specifically, the following measures are implemented by end of 2010: ensure full implementation of a uniform e-prescribing system, by extending the system currently used by OAEE to all the social security funds providing health insurance; define (through EOF) and publish prescription guidelines for physicians on the basis of international prescription guidelines;

    Ongoing. Parliament has adopted a first package of reforms proposed by the government in February 2011. Policies cover a number of areas including: pharmaceuticals reimbursement, reduction of profit margin of wholesalers and pharmacies, new population criteria for the establishment of pharmacies and working hours of pharmacies, public procurement of medical supplies and medicines merging of most of the existing health fund (under the new Health Agency EOPYY), allocation of healthcare tasks to the Ministry of Health.

    Ongoing. See below.

    Ongoing. There is progress but not yet a full implementation of a uniform and fully integrated e-prescribing system for medicines by the social security funds and health facilities. IKA is monitoring e-prescribing through scanning prescriptions. In the NHS, 60 hospitals have electronic patient prescription.

    Ongoing. EOF has proposed 30 guidelines to the relevant Ministry and until end March EOF will have produced about 100. Social security funds establish a process to regularly assess the information obtained through the e-prescribing system and vis-à-vis prescription guidelines. Assessment will be done through a common dedicated unit under the authority of Health Benefit Coordination Council (SYSPY) with support of IDIKA. Relevant sanctions and penalties will be enforced as a follow up to the assessment and as foreseen by existing rules and legislation; a yearly report on medicine prescription is published and feedback is provided to each physician on a regular basis (at least annually). The report and feedback analysis look at prescription behaviour with reference to the most costly and mostly used medicines. publish the complete price list for the medicines in the market, using the new pricing mechanism. This list will be published by December 2010 and replace the partial list introduced in September. It will be updated quarterly. announce that caps to the price reductions used when the price list was first introduced in September 2010 will be lifted by March 2011. apply the negative list of non-reimbursed medicines and the list of over-the-counter medicines prepared by the EOF. finalise the new positive list of reimbursed medicines using the new reference price system. using the information made available through e-prescribing and scanning, Government collect the agreed rebate from pharmaceutical companies; introduces a monitoring mechanism allowing for developments in pharmaceutical expenditure to be assessed on a monthly basis.

    Ongoing. OPAD, IKA and OAEE have each their own unit to assess information and elaborate reports.

    Ongoing. OPAD, OAEE and IKA are providing individual reports to physicians. The medical prescription is monitored only in 60 out of 130 NHS hospitals.

    Delayed. The December update of the new price list for medicines is still due. Postponed to March 2011.

    Not yet applicable. Still planned for March 2011. Observed. The negative price list of non-reimbursed medicines is to be published shortly.

    Ongoing, delayed. Technical work on the positive list of reimbursed medicines and the full reference price system has finished. However, until the price list is published (in March –see above), the reference price system can not be applied.

    Ongoing. Pharmaceutical companies have only paid a small amount of the total rebate due to social security funds. They brought a legal case against the government to deem illegal the request of the government to collect unpaid rebates over the last five years. Observed.The system to compile monthly data on NHS revenues, expenditure (including on pharmaceuticals) and activity has been finalised. Information is provided by 106 (out of 130) hospitals.

  7. Σελ. 59, Για το κλειστό επάγγελμα του φαρμακοποιού και τα μέτρα που ελήφθησαν. Στο τέλος υπάρχει η επίσημη παραδοχή πως το ποσοστό κέρδους του φαρμακείου ήταν 23,5% κι όχι 35% όπως διέδιδαν οι συκοφάντες και τελικά έπεσε στο 20%:

    Government proposes legislation to remove restrictions to competition, business and trade in restricted professions including: the legal profession, to remove unnecessary restrictions on fixed minimum tariffs, the effective ban on advertising, territorial restrictions on where lawyers can practice; the pharmacy profession, to promote more flexible opening hours and reduce minimum profit margins (see also measures to modernise the healthcare system); the notary profession, to reduce fixed tariffs and increase the number of notaries; architects, covering fixed minimum tariffs; engineers, covering fixed minimum tariffs; auditing services, covering fixed tariffs.

    Partially observed. On 31 December 2010, the government submitted draft legislation on closed professions. The draft was broadly in compliance with the requirement; restrictions to multidisciplinary activities and to commercial communications are expected to be regulated by Presidential Decree in the first quarter of 2011. The law as voted by Parliament on 17 February still requires assessment, as it deviates in some respects from, and is less ambitious than, the draft tabled by government. On pharmacies the Parliament adopted on 9 February 2011, legislation that: i) reduces the minimum number of inhabitants for the establishment of a pharmacy; ii) increases the number of pharmacies open on Saturday morning, Monday and Wednesday afternoon in urban areas and iii) indirectly reduces the profit margin of pharmacies by an average of 3.5 percent down to 20 percent from the current 23.5 percent.

  8. Σελ. 89, για τα μέτρα που επιβάλει ο νέος νόμος της Υγείας σχετικά με το επάγγελμα του φαρμακοποιού:

    A separate law, also to be legislated by end-February, will address the closed pharmacist profession. It will permit incorporation, increase operating hours, reduce fixed profit margins, and reduce the minimum population criterion for opening new pharmacies.

  9. Σελ. 99, για την αύξηση χρήσης των γενοσήμων, την τιμολόγηση φαρμάκων πλέον από τον ΕΟΦ, για την άμεση ή εμμεση με rebate μείωση του ποσοστού κέρδους των φαρμακείων στο 15-20%, την μείωση του κέρδους των αποθηκών, τη συνταγογράφηση και τον έλεγχό της, την υποχρέωση δημοσίευσης των δαπανών τουλάχιστον για τα μεγάλα ταμεία:

    Increasing use of generic medicines Government takes measures to ensure that at least 50 percent of the volume of medicines used by public hospitals by end of 2011 is composed of generics with price below that of similar branded products and off-patent medicines, in particular by making compulsory that all public hospitals procure pharmaceutical products by active substance. Pricing of medicines Government − moves the responsibility of pricing medicines to EOF and all other aspects of pharmaceutical policy to the Ministry of Health, to rationalise licensing, pricing and reimbursement systems for medicines; − under the new law, reduced the profit margin of pharmacies on retail prices directly to 15-20 percent, or indirectly by establishing a system of rebates for pharmacies with sales above a designated threshold. − reduces the profit margin of wholesale companies distributing pharmaceuticals by at least one third. − updates and publishes the complete price list for the medicines in the market, using the new pricing mechanism. Continue to regularly update it on a quarterly basis; − lifts the caps to the price reductions used when the price list was first introduced. Prescribing and monitoring Government − publishes the prescription guidelines for physicians defined by EOF on the basis of international prescription guidelines; − publishes the new positive list of reimbursed medicines using the new reference price system developed by EOF. Accounting and control By end February, Government starts publishing monthly data on healthcare expenditure for at the least the main social security funds (IKA, OAEE, OGA and OPAD) with a lag of three weeks after the end of the respective month (see annex 1).

  10. Σελ. 119, Για αυτό που φοβόμαστε, το κατ' απόκοπήν και τη συνολική διαμόρφωση του ποσοστού κέρδους σε επίπεδα όχι μεγαλύτερα του 15% (με υποχρέωση να υλοποιηθεί το πρώτο τρίμηνο του 2012 - Q1/2012):

    Pricing of medicines Starting from 2012, pharmacies profit margins should be calculated as a flat amount or flat fee combined with a small profit margin with the aim of reducing the overall profit margin to no more than 15 percent. Accounting and control Social security funds start publishing an annual report on medicine prescription. Individual prescription reports are regularly (at least annually) fed back to each physician. The annual report and the individual prescription reports look at prescription behaviour with particular reference to the most costly and most used medicines.

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