1.03 The principle of "No benefit, no payment"
The principle of money being refunded if a pharmaceutical product fails to have the expected effect on an individual patient is new to the Danish Health Service.
The principle cannot be extended to all types of treatment, as it presupposes that precise treatment objectives can be set.
The introduction of the principle in relation to pharmaceuticals raises a number of medical, pharmacological and technical problems that need to be clarified before a view can be taken as to its future possibilities.
The principle also presupposes support for such a system from the medical profession and the authorities, as it both requires more follow-up and monitoring of patients and their treatment, to establish whether the objectives set have been met, and places added demands on the administrative systems on which the present public reimbursement system rests.
Generally, the principle that patients can have their expenditure refunded if a given medicine does not produce the expected effect recognises the fact that the same product cannot be expected to produce the same effect in all patients.
The legal requirements as to documented clinical efficacy, quality and safety are the same for all medicinal products, and are independent of the form and strength in which a given product is introduced.
Lif believes:
- that the doctor, in consultation with the patient, should at all times choose the medicinal product that has the clinically best-documented effect in the given treatment situation,
- that generally there is a need for consistent treatment guidelines,
- that treatment ought to be planned to a greater extent on the basis of specific treatment objectives, and
- that the treatment chosen should be ongoing evaluated in relation to the objectives set, and this evaluation should include a separate assessment of whether the patient has adhered to the treatment plan.
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