Impact of selective financing of drugs on pharmaceutical expenditure control in the province of Valladolid, Spain.

In July 1993, public financing for 1692 drug specialities was stopped in Spain (a drug speciality is a medicine with a defined composition, particular pharmaceutical form and dosage, prepared for immediate use, ready and packaged for dispatching to the public, with uniform name, packaging and labelling which has been granted authorisation by the State Administration and registered in the Pharmaceutical Specialities Register). We designed a study to assess the repercussions of this so-called 'selective financing' on expenditure control. The aims of the study were 2-fold: first, to forecast the consumption of drug specialities that are reimbursable on the Spanish National Health Service, had selective financing not been applied; and, secondly, to estimate the impact of selective financing on drug consumption. For short- and medium-term forecast estimates, time-series analysis was used, and was applied to monthly consumption data. The measures of consumption used were the number of prescriptions per 1000 patients, and cost [in Spanish pesetas (Pta; $US1 = Pta123.9, February 1996)] per 1000 patients. Data were analysed from January 1986 up to the introduction of selective financing. We found that drug specialities excluded by selective financing showed, overall, a negative increase (i.e. the consumption of drugs that were excluded under selective financing decreased). The repercussion forecast, both in terms of prescription numbers and cost, of the 13 excluded drug specialities that had the highest pre-selective financing consumption is decreasing compared with total consumption. The assessment of the repercussions of selective financing up to December 1994 was made by calculating the difference between actual expenditures and forecast expenditures in the absence of selective financing. This repercussion, in prescriptions, was lower than the percentage of the 1692 excluded drug specialities relating to total consumption in 1992. The repercussion in cost, nevertheless, was greater than expected during the first year of selective financing application. This could be attributable to average price containment of drug specialities due to causes other than selective financing itself. The economic impact of selective financing after 1 year of application was reduced because of accommodation phenomena.