Out-of-pocket pharmaceutical expenditure and potential misuse of public resources - analysis in the Italian context

Abstract

The increase in longevity determines a greater need to receive medical care and pharmacological treatments. The introduction of patient cost-sharing in pharmaceutical expenditures aims to finance the National/Regional Health System while simultaneously reducing excessive consumption of health services. However, in the context of national health insurance, decreasing drug expenditures can lead to increased hospitalization costs. This phenomenon highlights the complexity of healthcare financing, where measures intended to control spending in one area may inadvertently escalate costs in another, necessitating a careful evaluation of health policies and their broader implications on patient care and system sustainability. The main focus of the analysis is to examine drug expenditures and the private purchase of drugs. Specifically, the analysis investigates the spending on drug therapies across different regional macro-areas (the Italian regional macro-areas are geographical subdivisions used to organize activities and services, particularly in the context of healthcare and scientific research.). Moreover, it analized the variability in the use of AIFA (Italian Medicines Agency) notes, a regulatory tool used in Italy to define the reimbursement criteria and therapeutic indications for which a drug can be prescribed at the expense of the National Health Service (SSN), and the extent to which individuals resort to private purchasing for drugs that are in total Health Service reimbursement. Additionally, the analysis delves into the top 30 active substances that significantly impact pharmaceutical spending, as reported in the Osmed 2022 report. This research found heterogeneous use of AIFA notes for many drugs across Italy. Inappropriate use of restrictive notes at prescription indicates high patient out-of-pocket spending, constituting financial damage. Comparing regional ratios to national benchmarks reveals deviations in prescribing behavior and AIFA note use by GPs. Regions with highest inappropriate AIFA note use also have highest out-of-pocket spending and lowest incomes, suggesting cultural factors drive branded over generic drug choices when public reimbursement is available.There can be many causes, including a cultural nature, which push patients to purchase the originator drug by paying the excess amount.

Keywords: Prescribing appropriateness; Private health care expenditure; Territorial pharmaceuticals.

Fig. 1

Correlation between per capita income and cost-sharing in pharmaceutical expenditure - Osmed Report “The Use of Drugs in Italy. National Report 2020”. AIFA, re-elaborated by G.L. Colombo et al. in “La relazione tra compartecipazione del paziente alla spesa farmaceutica, aderenza terapeutica e reddito: una revisione di letteratura”