To cope with the exponential growth of healthcare spending in our country, is the egg today or the chicken tomorrow better? In other words, would public administrators do better to adopt measures that implement immediate deficit containment or should they instead envisage short-term investments aimed at obtaining significant long-term savings? The issue is complex and widely debated. One of the last cases that has revived its relevance is represented by gastroesophageal reflux disease. In Italy alone there are at least 529,000 patients who suffer from it and who are not treated with the right drugs in the name of saving money. The complaint comes from the international report Europe's Lost Patients, drawn up by clinical experts and economists from the London School of Economics, together with Marcello Tonini from the Department of Legal Medicine, Forensic and Pharmacotoxicological Sciences of the University of Pavia and Josep Darba from the Department of Economics of the University of Barcelona. The Europe's Lost Patients study claims that the average annual cost per patient with GERD is equal to 242.00 euros and this figure doubles with the worsening of the disease in case of inadequate pharmacological control of the same. In Italy, currently, in eight regions, the "reference price" is that of generic lansoprazole, to which omeprazole and pantoprazole have also recently become standardized: the difference in cost with any other proton pump inhibitor possibly prescribed by the doctor is borne by the patient. The doctor can obtain, for his patient, the reimbursement of the prescription of a proton pump inhibitor other than the three described above only by indicating the specific need. Therefore, the prescriptive limitation measures particularly affect the more powerful proton pump inhibitors, the second generation ones still covered by patent, thus hindering the identification of the most appropriate therapy for the needs of each individual patient. In theory, the problem would be easily solved by guaranteeing reimbursement of the most advanced drugs to all patients. But how would the administrators of those regions heavily burdened by health deficits manage to restore their budgets by the end of the legislature? How would a political majority go about proposing itself to the electorate with regional accounts in disarray and a probable increase in taxes to be paid by citizens, on the pretext that this strategy will lead to savings in the future? Certainly citizens would not understand and would only evaluate the higher tax burden with a consequent negative judgment on whoever administered them for five years. For this reason, the problem of containing health expenditure with effective long-term health economic policies is difficult to tackle by those who have to submit to the judgment of the voters. And everything will inevitably fall on the shoulders of future generations…
Source: http://www.sanitanews.it/editoriale.php?id=56
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