Chapter 10: Economic considerations regarding pharmaceutical expenditure in Spain and its financing
G. López-Casasnovas INTRODUCTION This chapter seeks to provide some reflections on the behaviour of health expenditure and the evolution of public health financing, with particular attention to spending on pharmaceuticals. The first part attempts to lay the foundations for a series of considerations on the effects of policies aimed at restraining public health expenditure, in particular drug expenditure. In the second part we offer the reader some reflections on what could constitute an alternative framework which would help to rationalize decision-making processes on pharmaceutical financing and spending. THE PROBLEMS INVOLVED IN FINANCING HEALTH CARE For some years now, the sustainability of the social protection systems that have shaped what we call the welfare state has been a recurring theme in the European political and economic debate. In this debate, the future of the financing of public health care has been one of the most controversial issues, for at least two reasons: because health spending is one of the items that receives most attention from citizens, and because this spending has risen significantly (the proportion of Spain’s income spent on public health care has risen nearly 25 per cent in the last decade). Furthermore, the factors that contribute to this growth do not appear to be abating, thus raising doubts as to the financial sustainability of the system. Spain undoubtedly constitutes an atypical case in the context of the European Union (EU) as regards the growth of public health expenditure within health expenditure as a whole. A cursory look at...
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