Avtor/Urednik		Košir, Franc; Bagari, Nevenka
Naslov		Obvladovanje izdatkov zdravstvenega zavarovanja za zdravila, predpisana na recept
Prevedeni naslov		Commanding expenses of health insurance for prescribing drugs
Tip		članek
Vir		Zdrav Vestn
Vol. in št.		Letnik 69, št. Suppl 1
Leto izdaje		2000
Obseg		str. I-5-9
Jezik		slo
Abstrakt		Background. During the nineties, the containment of costs of medication and hospital treatment activities has evolved into a central issue with the operators of sick funds and creators of health care policies in all developed countries, and in particular in those where the health care programmes and services are financed predominantly out of public funds in combination with private funds. The medication cost containment measures are commonly divided to those addressing the price containment and those addressing consumption-prescribing containment. Superior results in this sphere are noted with those countries introducing combinations of regulation mechanisms in parallel, such as assigning costs to patients through increased copayment, modifying the regimes of issuing, introducing physician level budgeting systems, or promoting the prescribing and issuing of generics. Conclusions. In our contribution, we analyse the field of medication cost containment and the present situation in Slovenia, in comparison to developed countries. We suggest specificapproaches to the containment of medication prescribing and consumption, by means of limitations imposed on service providers under contract, and imposition of reference prices. The strategy of medication cost containment will further require, through appropriate amendment of regulations, an instatement of direct copayment by insured persons, or deductive franchises. According to experience in developed countries, such measures furthermore lead to a more rational pharmaco-therapeutical practice.
Izvleček		Izhodišča. Obvladovanje stroškov za zdravila in izdatkov za bolnišnično dejavnost je postalo v 90. letih v vseh razvitih državah, še posebej pa v tistih, ki financirajo programe in storitve zdravstvenega varstva v pretežni meri iz javnih sredstev v kombinaciji z zasebnimi, osrednje vprašanje financerjev in zdravstvene politike. Mere obvladovanja stroškov za zdravila se običajno delijo na tiste za obvladovanje cen in na tiste za obvladovanje porabe-predpisovanja zdravil. Uspešnejše so države, ki uvajajo več fleksibilnih regulacijskih mehanizmov v kombinaciji, bodisi da prevaljujejo stroške na bolnike z višjimi doplačili, spreminjajo režime izdaje, uvajajo budžetiranje na ravni zdravnika ali spodbujajo predpisovanje oz. izdajanje generikov. Zaključki. V prispevku analiziramo področje obvladovanja stroškov za zdravila in razmere v Sloveniji v primerjavi z razvitimi državami. Predlagamo določene pristope k omejevanju predpisovanja in porabe zdravil z uvajanjem limitiranja izvajalcev-pogodbenih partnerjev in uvedbo referenčnih cen. S spremembo zakonodaje pa bo v strategiji obvladovanja stroškov za zdravila na recept treba nujno uvesti neposredna doplačila zavarovanih oseb ali odbitne franšize, kar po izkušnjah razvitih držav pomeni hkrati racionalno farmakoterapijo.
Deskriptorji		DRUG COSTS PRESCRIPTIONS, DRUG INSURANCE, HEALTH HEALTH CARE COSTS