The Impact of Cost-Shifting Policies on the Pharmaceutical Sector in Greece During the Financial Crisis

OBJECTIVES: Upon the onset of the economic crisis in 2008, the pharmaceutical sector was identified as one of the priority areas of the Greek reforms, with a plethora of measures being taken, in order to achieve fiscal balance under the provision of the European “rescue packages”. The main objective of this study was to describe the regulatory framework and government policies through a disaggregation on the nature of reforms in terms of cost containment and reallocation among households and the pharmaceutical industry.

METHODS: This study identified 377 unique statutes and regulations (FEK), which were classified with respect to cost reallocation. The extent of this shift on pharmaceutical care funding is examined through descriptive analysis using the Household Budget Survey and evidence on the clawback and rebates.

RESULTS: The proportion of measures shifting healthcare costs to patients was 31%, while a staggering 48% directed expenditure towards the industry. Mean equivalized total consumption decreased by 31%, while mean equivalized total health expenditure decreased by 20%. During the same period mean equivalized pharmaceutical expenditure increased by 26% and the proportion of households with positive expenditure increased by 31%. Meanwhile, the pharmaceutical industry’s direct contribution to the total pharmaceutical expenditure increased from 1.5% in 2010 to 30.1% in 2020.

CONCLUSIONS: Pharmaceutical expenditure reforms during the decade 2010-2020 present a clear tendency of cost reallocation towards consumers and the pharmaceutical industry. This trend implies an attempt to privatize the cost of pharmaceutical care. Public pharmaceutical spending was not reduced through rationalization of consumption but was transferred instead to the pharmaceutical industry as clawback and to households in the form of out-of-pocket payments, leading to the impoverishment of households in Greece and increased inequality. This cost-shifting mechanism could threaten the sustainability of the pharmaceutical sector.