De definitie van specialistische geneesmiddelen

Samenvatting Vanwege bekostigingsproblemen met bepaalde geneesmiddelen is er een afbakeningsdiscussie rond dit onderwerp ontstaan. Buiten het ziekenhuis worden soms geneesmiddelen gebruikt waarvan zorgverzekeraars vinden dat ze niet via de extramurale geneesmiddelfinanciering moeten worden bekostigd maar dat ze ten laste van het ziekenhuisbudget zouden moeten komen. Ziekenhuizen zijn bereid deze geneesmiddelen te betalen als ze er maar voor gecompenseerd worden. Tegen deze achtergrond is een mogelijke oplossing voor de financieringsproblematiek om extramuraal afgeleverde geneesmiddelen te scheiden in specialistische en generalistische middelen. Door de specialistische geneesmiddelen medisch-inhoudelijk, beleidsmatig en financieel onder de reikwijdte van het ziekenhuis te brengen kan de continuïteit in behandeling door de medisch specialist ook worden doorgetrokken naar de farmacotherapie, ongeacht waar de patiënt zich bevindt (intramuraal of extramuraal). Voor generalistische middelen zou de medisch-inhoudelijke, beleidsmatige en financiële praktijk niet anders zijn dan in de huidige situatie. etc ..

The Drug Reimbursement Decision-Making System in Iran

Background:  Previous studies of health policies in Iran have not focused exclusively on the drug reimbursement process. Objective: The aim of this study was to describe the entire drug reimbursement process and the stakeholders, and discuss issues faced by policymakers. Methods: Review of documents describing the administrative rules and directives of stakeholders, supplemented by published statistics and interviews with experts and policymakers. Results: Iran has a systematic process for the assessment, appraisal, and judgment of drug reimbursements. The two most important organizations in this process are the Food and Drug Organization, which considers clinical effectiveness, safety, and economic issues, and the Supreme Council of Health Insurance, which considers various criteria, including budget impact and cost-effectiveness. Ultimately, the Iranian Cabinet approves a drug and recommends its use to all health insurance organizations. Reimbursed drugs account for about 53.5% of all available drugs and 77.3% of drug expenditures. Despite its strengths, the system faces various issues, including conflicting stakeholder aims, lengthy decision-making duration, limited access to decision-making details, and rigidity in the assessment process. Conclusions: The Iranian drug reimbursement system uses decision-making criteria and a structured approach similar to those in other countries. Important shortcomings in the system include out-of-pocket contributions due to lengthy decision making, lack of transparency, and conflicting interests among stakeholders. Iranian policymakers should consider a number of ways to remedy these problems, such as case studies of individual drugs and closer examination of experiences in other countries

Orphan drugs expenditure in the Netherlands in the period 2006-2012

Background: The relatively low budget impact of orphan drugs is often used as an argument in reimbursement decisions. However, overall, the budget impact of orphan drugs can still be substantial. In this study, we assess the uptake and budget impact of orphan drugs in the Netherlands.Methods. We examined the number of orphan drugs, the number of patients and budget impact of orphan drugs in the Netherlands in the period 2006 to 2012, both for inpatient and outpatient orphan drugs. Budget impact was provided in absolute numbers and relative to total pharmaceutical spending.Results: The number of orphan drugs and patients treated increased substantially over the period studied. Overall, budget impact increased substantially over a period of six years, both in absolute terms (326% increase) as well as relative to total pharmaceutical spending (278% increase). Growth rates decreased over time. In 2012, 17% of available drugs had an individual budget impact of more than 10 million per year.Conclusions: Individual budget impact of or

Productivity and quality of Dutch hospitals during system reform

This study addresses the productivity of Dutch hospitals since the start of the health systems reform in 2005. We consider DEA based measures, which include efficiency and quality for the complete set of Dutch hospitals and present cross-sectional and longitudinal analysis. In particular, we consider how hospital efficiency has developed. As the reform created an environment of regulated competition, we pay special attention to relative efficiency. Our results suggest that the differences in efficiency among hospitals have become larger. In the years 2009–2010, the number of hospitals identified as (close to) efficient by DEA analysis decreased