6.01 Reimbursement must support and improve the optimal patient treatment
Reimbursement is granted to the patients, not to medicinal products. At the same time it is important to be aware that reimbursement is important for the use of medicines and the quality of treatment. Therefore the public reimbursements are important health and allocation policy instruments.
The medical treatment at public hospitals is free of charge for patients in Denmark, but as a main rule, this is not the case when the treatment takes place outside the hospitals in the primary healthcare sector. Actually, the most healthcare services are free for the patients – also outside the hospitals. But as a patient you must contribute financially when the health service’s treatment offerings include the use of medicinal products.
The public reimbursement system implies that the patient when buying some medicinal products is granted a public reimbursement. The size of the reimbursement depends on the individual person’s consumption of medicinal products entitled to reimbursement, and is granted only when the consumption is above a certain level (in 2009 DKK 820 for persons older than 18 years of age).
Not all medicinal products are eligible for reimbursement. Approximately 40 per cent of the new medicinal products are not reimbursed automatically (“General reimbursement”). The Danish Medicines Agency decides if a medicinal product is entitled to reimbursement. The Danish Medicines Agency also has the opportunity to favour special patient groups that the agency for some reason finds especially relevant to grant a reimbursement (“general conditional reimbursement”). The Danish Medicines Agency makes use of this possibility very rarely. Instead the Danish Medicines Agency to a wide extent chooses to base the reimbursement system on individual reimbursement (“single reimbursement”), this necessitate that the doctor on behalf of the patient submit an application for reimbursement for the individual patient to the Danish Medicines Agency.
Lif believes:
- that the reimbursement system should support an optimal patient treatment, including a optimal use of medicinal products in the Danish health service,
- that general conditional reimbursement for specific diseases is a reasonable way to support an optimal use of medicinal products in cases where the authorities find no basis for granting reimbursement to all persons who take the individual medicinal product,
- that it must be possible for companies to apply for general reimbursement as well as general conditional reimbursement,
- that the single reimbursement scheme should be used as a safety net for the very special patients. To be used in exceptional cases, as intended, the single reimbursement scheme may be a useful tool,
- that the Reimbursement Committee must be enlarged with representatives with special financial expertise seen in the light of the crucial importance that the financial considerations have in reimbursement cases,
- that reimbursement decisions must be taken on the basis of objective and controllable criteria. The authorities’ decision-making process and procedures have to be transparent, and both companies and patients must have the opportunity to trial all parts of the Danish Medicines Agency’s decisions at another complaints board,
- that the public reimbursements for Danish patients due to safety and market reasons have to be reserved for purchase of medicinal products in Denmark.
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