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Germany's medicine spending falls short: doctors

2003-03-27 12:40:14 -0400
By Ned Stafford
Reuters Health
Hamburg, Germany

Germany's public health-insurance system will need to boost drug spending by 5 billion euros a year in order to provide sufficient health care for the 90 percent of Germans the system covers, a national doctors' group said Wednesday.

There are more than a dozen conditions, including Alzheimer's disease and chronic pain, for which some of the public is not getting the most up-to-date drugs, Dr. Manfred Richter-Reichhelm, chairman of the National Association of Statutory Health Insurance Physicians (KBV), said in a statement.

The statement accompanied the release of a major study on prescriptions in Germany from 1993 through 2001.

The study, done by the KBV-affiliated Central Institute for Statutory Health Insurance Care, showed that in 2001 the number of prescriptions covered by public health insurance totaled 742 million, down 21 percent from 944 million in 1993.

But despite the drop in the number of prescriptions covered, health insurance spending rose 41 percent, from 15.1 billion euros in 1993 to 21.3 billion in 2001.

Doctors in the past have been accused by some health care experts and government officials of writing too many prescriptions for drugs of questionable value, which in Germany can also include over-the-counter drugs that are paid for by the public system.

Richter-Reichhelm said the study proves that doctors have succeeded in cutting the number of unnecessary prescriptions. But he said that because of the system's drug-spending caps, doctors were not able to prescribe the newest drugs to all patients.

For example, he said that under the current budget, only about half of all patients needing pain treatment receive sufficient drug therapy. He added that an additional 5 billion euros would be needed to provide German patients with the newest drugs for the 14 medical conditions he believes are inadequately treated now.

Roland Ilzhoefer, a KBV spokesman, told Reuters Health that in addition to pain, the 14 indications referred to by Richter-Reichhelm included Alzheimer's, high blood pressure, psychiatric disorders such as depression, multiple sclerosis, migraine and arthritis, among others.

Ilzhoefer said that spending more money on effective new drugs would end up actually saving the health system money -- for example, in the cost of long-term nursing care.

"If we spend 1 euro for medicine, we might save 7 euros in other areas," he said.

The public system has suffered huge deficits the past two years, and the German Health and Social Ministry has made cost-cutting and health care reform a priority.

Ilzhoefer argued that the ministry was telling members of the public system they would be guaranteed top-quality health care, but were not giving doctors a big enough drug budget to treat patients with the best drugs.

But Michael Schmitz, a spokesman for the Health and Social Ministry, told Reuters Health that drug companies have an interest in promoting new expensive medicines.

"New medicines are not necessarily better medicines," he said. "Doctors should not accept the propaganda of the pharmaceutical industry that new is always better."

He noted that the drug study was done by a KBV-affiliated institute, putting into question the conclusion that doctors no longer prescribe useless drugs and that they need an additional 5 billion euros for "innovative medicines."

Referring to the study, he said: "We are skeptical."

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