Reforming pharmaceutical policies in the European Union: a "penguin effect"?

Pharmaceutical policies form a substantial part of health care services, from the point of view of both equity and efficiency goals. Expenditure on pharmaceuticals has been growing steadily over the last few decades, and countries are finding the financing of drugs increasingly difficult. This article surveys the changes in pharmaceutical policies in the E.U. countries from the mid-1980s through the 1990s. It focuses primarily on policies dealing with cost control of publicly funded pharmaceuticals. In their analysis of these changes, the authors classify policies (or "packages of measures"), map out their incidence in each country, and assess their impact on the control of public pharmaceutical spending. They conclude that the E.U. countries are taking up apparently similar measures--dressing like penguins in a row--despite the limited effectiveness and limited evaluation of many of the measures adopted. The authors also analyze the role of national and international actors (most prominently, the European Union) in defining public pharmaceutical policies; look at how innovative policy ideas could be connected with the economic, political, and social interests that mold public action in this field; and propose new lines of investigation.