http://bmj.com/cgi/content/full/325/7355/64/b
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Tony Sheldon Utrecht
Doctors and health insurance bodies in the Netherlands are worried that the new Dutch government plans to include cholesterol lowering statins and antacid drugs in a list of so called "lifestyle medicines" to be removed from basic health insurance cover.
The programme of the new, centre-right government aims to "halt the steep growth" in the pharmaceutical budget through "considering critically" which medicines are reimbursed.
It has decided that it should not reimburse patients for drugs that they need as a result of pursuing an unhealthy lifestyle— for example, in terms of diet and smoking. A spokesman for the right wing Liberal party, one of the partners in the new coalition government, has confirmed this position.
The new government has budgeted for little more than a 2.5% growth in the total healthcare budget. Yet the cost of pharmaceuticals is increasing at about 10% a year even though the Dutch remain among Europe’s lowest spenders on prescription medicines per head of population.
The cost of cholesterol reducing medicines alone has increased annually by 20% in the past five years. Along with antacids, they accounted in 2000 for nearly a quarter of the total growth.
Now the Healthcare Insurance Board, which advises the government, has issued a report on cholesterol reducing drugs arguing that current strict criteria for their use should be relaxed. A spokesman said they must remain in the basic insurance because the healthcare benefits in preventing heart and vascular disease in the longer term are extremely good.
Dr Ron Herings, who is the director of the research body the Pharmo Institute and who sits on the advisory committee to the insurance board, said: "We do not believe you should exclude people from reimbursement on the basis of no medical evidence, just economics.
"Some patients may not need these drugs, but there is a substantial group of people for whom these drugs have a real medical benefit. If you do not reimburse them, there are patients, such as those over 65, who don’t have the money to pay."
Limburg GP Eric Cremers has argued that these drugs are not prescribed gratuitously but are prescribed according to specific criteria. Although a medical indication is extremely subtle, "large numbers of prescriptions are medically necessary."
The medical director of the Dutch College of General Practitioners, Dr Arno Timmermans, said that although decisions on reimbursement were for politicians and society at large, there are "clear medical indications" for the use of these drugs.
The new government programme also includes changes in the financing and
organisation of health care to allow greater competition between hospitals and
insurance companies. A single compulsory private insurance package will be
introduced to replace the current split between public-private insurance cover,
with premiums no longer related to income. Financial deregulation and
competition will lead to greater efficiency, it argues.
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Collections under
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