A decade of growth in public and private pharmaceutical expenditures: the case of Belgium 1990-1999.

OBJECTIVE: To make a systematic, transparent, internationally comparable description of trends (1990-1999) in total, public and private (co-payment + out-of-pocket) spending on pharmaceuticals in Belgium. SETTING: Belgium, a western European country, with a Bismarck-type universal coverage healthcare system. NATURE OF THE STUDY: Descriptive analysis of time-series. METHODS: Collaborative data gathering effort between academic and private research institutes and IMS health. RESULTS: Mean annual growth rate was 3.9% for total, 5.3% for public, and 2.0% for private drug expenditures (expressed in constant 1999 EUR). The ratio of public to private spending shifted from 53.4% to 60.3%. Of the private spending, one third was co-payment for reimbursed medication and two thirds was out-of-pocket payment for non-reimbursed medication. CONCLUSION: Co-operation between several data gathering constituencies within one country was necessary to achieve completeness and detail in data collection on out-of-pocket payments for non-reimbursed medicines, and hence in total drug expenditures. Discrepancies were found between the estimate of the public/private mix and OECD health data 2000 for public drug spending.

The demographic impact on ambulatory pharmaceutical expenditure in Belgium.

It has become customary in our society to attribute the rise in health care expenditure to a large extent to the aging of the population. The Belgian Institute of Health Economics (BIGE-IBES) finalised a study to measure the impact of the demographic trend on public spending for ambulatory pharmaceuticals. The results show that the changes in age structure as such have a relatively small impact on health care expenditure. Over the period 1986-1996 an annual growth of +0.73% was observed, while total public spending showed an annual average increase of +6.2% (in constant francs 1996). This first static demographic impact will become +0.75% per year for the next decade 1996-2006. It is, however, possible to calculate the extent to which per capita expenditure envolved differently according to age group: over 1986-1996 expenditure for the elderly was rising more sharply than for the younger age groups. This leads to a second dynamic demographic impact which will cause an annual growth rate of +1.91% for the next decade, according to the working hypothesis put forward. This growth rate is to be compared with the authorized budgetary increase of +1.5% per year (inflation excluded), according to the EU-Maastricht quotes..., and it does even not take into account the other increasing factors as technological innovation and epidemiological needs.