Hi girls,
For anyone interested.
'The United Kingdom comprises four territories – England, Scotland, Wales and Northern Ireland – and each has its own system of publicly funded health care. In Scotland, UHC (Universal Health Coverage) is predominantly financed out of general taxation; thus, health services are generally free at the point of care for all inhabitants. Since 2011, co-payments for prescription medicines have been abolished to ensure access to medicines for all, and in particular for deprived populations.
In many European countries a major issue in pharmaceutical policy is the split of competencies. In several countries different reimbursement agencies are responsible for the outpatient and inpatient sectors, resulting in different policies. The case study on Scotland looks at mechanisms to ensure more aligned coordination in pharmaceutical policies across sectors.
Joint lists of recommended medicines for primary and hospital care were implemented in Scotland over 20 years ago, with both primary and hospital physicians on the drug and therapeutics committee developing joint guidance and guidelines. The initial driver to establish this joined-up working approach was to ensure safe, appropriate and high-quality prescribing. Prior to this, primary care prescribing had increasingly been influenced by hospital recommendations. In addition, health professionals recognized the clinical risk in the use of too many medicines and switching between medicines. Cost-containment soon became another factor, equally in primary and hospital care, which led to the adoption of a single budget for inpatient and outpatient care.
Almost all guidelines in Scotland are now jointly written, reflecting inputs from primary and hospital care, with full declarations of interest required from all contributors. Guidelines are evidence-based and specifically address interface issues, such as guidance on referral to hospital care. Formulary content is informed by guideline advice and vice versa; if the guideline recommends a class of medicines, the formulary may define individual medicines. Guidelines follow the advice of the Scottish Medicines Consortium, which is the HTA (Health Technology Assessment) body in the country. The Consortium was a pioneer in work with horizon scanning to facilitate safe and rational introduction of new medicines into the health care system. Apart from doctors, pharmacists and industry, patients are also represented in the Consortium's decision- making bodies.
All formularies are equally applied in primary and hospital care. Prescribing of medicines is monitored and formulary adherence assessed. Prescribing medicines not included in the formulary (on the grounds of cost–effectiveness, for example) have to be justified. In case of non-coverage of medicines, patients may appeal to the health board and request individual patient treatment, stating specific reasons. If the health board rejects these reasons, the expenses of the medicine has to be borne entirely by the patient. The number of such cases is very small. The formulary is published in paper and electronic versions. There are regular formulary updates, including advice on good prescribing, “medicine of choice†initiatives and prescribing newsletters.
Key findings from the case study in Scotland
∙ Scotland has been working for more than 20 years on ensuring a more coordinated approach in pharmaceutical policies across sectors.
∙ A major point of reference is the joint lists of recommended medicines for outpatient and hospital sectors. These have been developed based on the advice and involvement of both primary and hospital care physicians on the drug and therapeutics committee, who have contributed to developing joint guidance and guidelines.
∙ Decision-makers of the national HTA body include all relevant stakeholders, such as doctors, pharmacists, industry and patients.'
http://www.euro.who.int/__data/assets/pdf_file/0011/376625/pharmaceutical-reimbursement-eng.pdf?ua=1BeaR.
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Topic: NHS Scotland healthcare policy (Read 1276 times)