In 2010, a survey of Austrian sickness funds was undertaken to evaluate how Austrian doctors, patients and pharmacists are encouraged to enhance the rational use of medicines, and increase use of generics [1].
The survey found that a core set of activities took place across all sickness funds but with wide variance in the implementation and design of measures between them.
Most activities across all funds were directed at doctors followed by patients, however, pharmacists were not considered a target group as Austria does not have a reference price system, and legislation on generics substitution and International Nonproprietary Name (INN) prescribing is lacking.
The types of activities targeted at doctors included written letters, personal meetings and telephone conversations. Prescribing behaviour was regularly and systematically monitored using bespoke software tools, so letters may have included, for example, feedback on individual prescribing patterns compared with regional patterns, and possible savings that could be made.
Other activities included educational events, training events, benchmarking, and financial incentives; a searchable database for prescribers to find cost-effective generic alternatives to originator drugs; provision of evidence-based information and cost-effectiveness data in accessible formats to support the uptake of generics; and a monthly journal aimed at prescribers produced collaboratively by sickness funds and tailored and disseminated to their respective constituencies.
Multi-media health journals were used to increase awareness of generics prescribing among patients, in addition to posters and media campaigns.
In Austrian hospitals, it is mandatory to have sickness-fund representation on the Drug and Therapeutics Committees, and this has led to a greater mutual understanding of policies and initiatives. Some sickness funds are working more integrally with junior doctors and nurses by providing in-hospital training designed to raise awareness of generics prescribing. Research has shown that improved cooperation between primary and secondary care can enhance prescribing of generics. Some funds have voluntarily positioned themselves at the interface of primary and secondary care with a view to working with hospital doctors on generics prescribing. Any real impact, however, would require fundamental changes in the organization and funding or Austrian healthcare and pharmaceutical sector.
The findings suggest that pharmacoeconomic units provide activities over and above their specified remits. Without further policies at national level, however, progress in forging links between outpatient and hospital sectors, which are already disincentivized by Austria’s dual financing system, will be limited. Further research is required to analyze the effectiveness of the measures implemented.
Editor’s comment
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Dr Sabine Vogler, Member of International Editorial Advisory Board of GaBI Journal published the full manuscript in GaBI Journal, 2013, Issue 2:
How do regional sickness funds encourage more rational use of medicines, including the increase of generic uptake? A case study from Austria
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Reference
1. Vogler S, Zimmermann N. How do regional sickness funds encourage more rational use of medicines, including the increase of generic uptake? A case study from Austria. Generics and Biosimilars Initiative Journal (GaBI Journal). 2013;2(2):65-75. doi:10.5639/gabij.2013.0202.027
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