Exploring the effectiveness of demand-side retail pharmaceutical expenditure reforms : Cross-country evidence from weighted-average least squares estimation.

Increasing expenditures on retail pharmaceuticals bring a critical challenge to the financial stability of healthcare systems worldwide. Policy makers have reacted by introducing a range of measures to control the growth of public pharmaceutical expenditure (PPE). Using panel data on European and non-European OECD member countries from 1990 to 2015, we evaluate the effectiveness of six types of demand-side expenditure control measures including physician-level behaviour measures, system-level price-control measures and substitution measures, alongside a proxy for cost-sharing and add a new dimension to the existing empirical evidence hitherto based on national-level and meta-studies. We use the weighted-average least squares regression framework adapted for estimation with panel-corrected standard errors. Our empirical analysis suggests that direct patient cost-sharing and some-but not all-demand-side measures successfully dampened PPE growth in the past. Cost-sharing schemes stand out as a powerful mechanism to curb PPE growth, but bear a high risk of adverse effects. Other demand-side measures are more limited in effect, though may be more equitable. Due to limitations inherent in the study approach and the data, the results are only explorative.

[Government earnings from cigarette smoking of adolescents in Austria]. / Einnahmen des Staates aus dem Zigarettenkonsum Minderjähriger in Osterreich.

UNLABELLED: Smoking prevalence in minors has increased considerably since 1986. In comparison to other European countries, smoking rates in 15-year-old students are the highest in Austria. Goal of our study was the estimation of government earnings from tobacco consumption of minors in Austria. METHODS: Tobacco tax paid by adolescents aged 11 to 17 years was estimated from smoking prevalences and taxation of cigarettes. RESULTS: In 2006 state revenues from cigarette consumption of minors in Austria amounted to 60.5 million Euro. DISCUSSION: Up to now the fight against business interest of the tobacco industry in Austria has been mainly left to volunteers. Therefore we suggest the funding a professional agency, independent from state budget and interest groups, by a tobacco prevention fund which is financed by the revenues from cigarettes smoked by youth. The mission of this fund should be to lower smoking incidence and smoking prevalence among minors. The WHO framework convention on tobacco control, ratified by Austria in 2005, should be considered in the next amendments of the tobacco law. The efforts of the European Union to reduce tobacco consumption should be supported also by Austria. For this purpose the tobacco prevention fund - similar to the regulation in Switzerland - would give the financial background.