[Do we spend too much on medications? Pharmaceutical expenditures, an absolutely essential item in European countries]

[Pharmaceutical expenditure among primary care physicians in the province of Cuenca (Spain)]

OBJECTIVE

To determine the factors related to pharmaceutical expenditure per primary care physician in the province of Cuenca, which could allow public health authorities to take decisions to curb expenditure. Determining these factors could also be of interest to primary care physicians, specialists, health authorities, health economists, and health management researchers.

METHODS

We performed a multiple linear regression analysis with three dependent variables to determine which factors explain variability in generic drug prescription, the referral rate, and pharmaceutical expenditure among primary care physicians.

RESULTS

Not being a resident physician, practicing in a town with more than 10,000 people and having a large patient list had a negative impact on the percentage of generic drugs prescribed. Physicians using electronic medical records and with a high referral rate to specialized care prescribed fewer generic drugs. The two most important factors explaining pharmaceutical expenditure were having a large patient list and a high percentage of patients aged more than 65 years old. Expenditure was reduced by greater prescription of generic drugs and was increased by a larger proportion of elderly patients on the patient list.

CONCLUSIONS

After controlling for the size of the patient list, the proportion of elderly patients and other factors, the percentage of generic drugs prescribed was one of the most important factors explaining pharmaceutical expenditure in primary care physicians.

[Health care expenditure in Spain compared with developed Europe, 1985-2001. The Spanish primary health care, the European Cinderella]

OBJECTIVE

To describe the evolution of the funds distribution in our health care system since the start of the primary care reform to 2001, in comparison with the European countries members of the Organisation for Economic Co-operation and Development (OECD).

DESIGN

A longitudinal descriptive and retrospective study.

PARTICIPANTS

European countries members of the OECD.

SETTING

Countries members of the OECD.

METHODS

The data come from the OECD database Health Data 2003. The data refer to period 1985-2001, and to a group of variables of health care expenditure by sectors and of income (Gross Domestic Product [GDP] per capita). We compare Spanish data series with those of the group of 22 European members countries of the OECD.

RESULTS

Europe increased public expenditure on out-patient care both as a percentage of public health care expenditure and as a percentage of GDP. Spain reduced public expenditure on out-patient care in both senses. Spanish public expenditure on in-patient care reduced a great part of its difference with Europe so that since 1995 it is found, as a percentage of GDP, in the European average and, as per capita, it is according with the Spanish income. In contrast, public expenditure on out-patient care as a percentage of GDP in Spain is very much lower than the European average and, as per capita, is very much lower than the Spanish income. The Spanish private expenditure on out-patient is found among the highest in Europe and, compared with Europe, exceeds very much Spanish income, in contrast with his homonymous public. The Spanish private expenditure on in-patient care is found among the lowest in Europe and, compared with Europe, is very much lower than Spanish income level.

CONCLUSIONS

With respect to public resources assigned, the reform of primary care in Spain has not been useful to approach Spanish primary health care level to Europe, in contrast with the Spanish hospital level. The difference between Spain and Europe in public expenditure on out-patient care as a percentage of GDP is, even, bigger than the one there was when the reform of Spanish primary care started.