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Sascha G. Wolf, Results in:

Sascha G. Wolf

Pharmaceutical Expenditure in Germany, page 34 - 37

Future Development, Political Influence and Economic Impact

1. Edition 2009, ISBN print: 978-3-8329-4164-2, ISBN online: 978-3-8452-2005-5 https://doi.org/10.5771/9783845220055

Series: Neue Studien zur Politischen Ökonomie, vol. 6

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34 2.4.4. Results We identi? ed 6 groups of indication areas for men and 5 for women. Considering the underlying two dimensions, each group of indication areas possesses different properties concerning “age dependency” (component 1) and “acuteness” (component 2). Groups 1 to 3 for men and groups 1 and 2 for women exhibit comparably high values on component 2 but vary in regards to component 1. Thus they all represent drugs against non-chronic disturbances of health, but age-dependency increases continuously from groups 1 to 3 for men and from 1 to 2 for women. In contrast, from groups 4 to 6 the affected diseases become more chronic. In the next step we assembled group-speci? c consumption pro? les. Analysing the development of these pro? les over time revealed whether drug usage in each group is characterised by the medicalisation or the compression thesis. For this purpose, the pro? les must be standardised. Without standardisation, the alterations of the pro? les’ shape have no explanatory power. For example, the steepness of the pro? les would be augmented even when consumption increases in all age groups with the same growth rate. This is because of the level effect. This could give false indication for the medicalisation thesis (Hof 2001). Standardisation by dividing the values of the single age groups by the average consumption avoids those misleading distortions. Consequently, the standardised pro? les re? ect the development in drug consumption in ratio to the development of average consumption in the same group. Figure 2.7 compares the male pro? les of 1988 with those of 2003.17 17 We use 2003 instead of 2004 as the reference year because of the introduction of the “Health Care Modernisation Act” (GMG). This reform act resulted in signi? cant but only temporary lower drug expenditure in 2004 e.g. by excluding non-prescription pharmaceuticals from reimbursement. 35 Figure 2.7: Standardised Per Capita Age-Related Drug Consumption Pro? les (Men) for 1988 and 2003.18 0 1 2 3 4 0 - 4 30 - 34 60 - 64 ? 90 Group 1 0 1 2 3 4 0 - 4 30 - 34 60 - 64 ? 90 Group 2 0 1 2 3 4 0 - 4 30 - 34 60 - 64 ? 90 Group 3 0 1 2 3 4 0 - 4 30 - 34 60 - 64 ? 90 Group 4 0 1 2 3 4 0 - 4 30 - 34 60 - 64 ? 90 Age Group 5 0 1 2 3 4 0 - 4 30 - 34 60 - 64 ? 90 Age Group 6S ta nd ar di se d Co ns um pt io n pe r C ap ita ----- 1988 2003 Apart from relatively high increases in younger ages, drug consumption against acute, age-independent diseases (group 1) has almost constantly decreased.19 Indication for the medicalisation or the compression thesis cannot be found. The development in group 2 is not clear cut: decreased consumption for people of ages 65 - 79 and 85 - 89 could slightly speak in favour of the compression thesis, but this supposition is uncertain. Group 3 reveals more distinct results. Concerning older people, the pro? le has shifted to the right and stays below the level of 1988 except for the highest age group. In group 4 this effect becomes even more obvious. Consumption has signi? cantly decreased for people between 60 and 79 years and concurrently increased for the very 18 See ? gure A.2.5 in the appendix for the un-standardised pro? les. 19 In parts this effect is due to the “Health Care Reform Act” (GRG) and the exclusion of drugs against bagatelle disturbances of health from the SHI bene? t catalogue. 36 oldest. The combination of decreasing DDD usage for middle-aged and older people and increasing consumption for the very oldest coincide with the rectangularization of the life curve and thus with the compression thesis. Hence, the more drug demand is age-dependent, the more consumption seems to follow the predictions of the compression thesis. Group 5 and 6 also represent age-dependent drugs consumed, but in contrast to the other groups this time they concern chronic diseases. Now, instead of steeping, from the age of 60 the pro? les seem to be protracted. The expansion of the consumption pro? les and higher pro? les’ maxima indicate increasing multimorbidity and speak in favour of the medicalisation thesis. Especially for group 6 a dominating medicalisation effect can be identi? ed. We can also ? nd indication for the compression thesis in these groups because middle aged (60 - 69 years) people’s consumption has slightly declined. Of particular interest is the strong decrease of drug consumption against chronic diseases for younger people (15 - 59 years), which indicates that the appearance of chronic illnesses is more and more delayed into higher ages. The results for women are presented in ? gure 2.8. As expected, they show almost identical developments and con? rm our previous conclusions. The female groups approve the above mentioned indications for compression and medicalisation theses. To recapitulate, we have reached three observations: ? rstly, consumption against acute, age-independent disturbances of health has increased for adolescents, but constantly decreased for adults. Secondly, the more diseases are age-dependent, the stronger indication for the compression thesis can be found. And ? nally, the medicalisation thesis is supported by the development of drug demand against highly chronic diseases, although younger people have become less affected by chronic af? ictions. 37 Figure 2.8: Standardised Per Capita Age-Related Drug Consumption Pro? les (Women) for 1988 and 2003.20 0 1 2 3 4 0 - 4 30 - 34 60 - 64 ? 90 Group 1 0 1 2 3 4 0 - 4 30 - 34 60 - 64 ? 90 Group 2 0 1 2 3 4 0 - 4 30 - 34 60 - 64 ? 90 Group 4 0 1 2 3 4 0 - 4 30 - 34 60 - 64 ? 90 Age Group 5 0 1 2 3 4 0 - 4 30 - 34 60 - 64 ? 90 Age Group 6 (Group 3) Standardis ed Consumption per Capit a ----- 1988 2003 2.5. Forecasting Pharmaceutical Expenditure 2.5.1. Data The expenditure outlook has been developed by using the extracted indication groups instead of aggregated total pharmaceutical expenditure. This approach has the advantage that different developments of drug expenditure can be considered. Thus the prognosis rests upon the assumption that the members of the indication groups underlie comparable growth trends whereas the development between the indication groups varies due to their unequal characteristics concerning age-dependency and acuteness. 20 See ? gure A.2.6 in the appendix for the un-standardised pro? les.

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Zusammenfassung

Der Arzneimittelsektor der Gesetzlichen Krankenversicherung stand wiederholt im Fokus zahlreicher Gesundheitsreformen. Dennoch ist es bislang nicht gelungen, den Trend steigender Ausgaben nachhaltig zu bremsen. Die vorliegende Untersuchung leistet einen Beitrag dazu, die Ursachen dieser Entwicklung zu erklären und Lösungsansätze aufzuzeigen. Mittels Hauptkomponenten- und Cluster-Analyse wurden Gruppen von Arzneimitteln mit vergleichbaren Konsumeigenschaften gebildet. Jede Gruppe wurde auf den Einfluss der Altersabhängigkeit und des technologischen Fortschritts hin analysiert. Aufbauend auf diesen Ergebnissen wurde eine Prognose der zukünftigen Ausgabenentwicklung bis zum Jahr 2050 erstellt. Obwohl die Hauptkostenfaktoren exogen sind, steht der Gesetzgeber dem vorhergesagten ansteigenden Kostenpfad nicht hilflos gegenüber. Im Gegenteil: Anhand ökonometrischer Tests wird gezeigt, dass die Gesundheitspolitik in der Vergangenheit durch wahl- und klientelorientierte Interessendurchsetzung geprägt war. Mehr Effizienz in der Arzneimittelversorgung könnte durch die Einführung individueller Gesundheitssparkonten erzielt werden. Dies bestätigen die Resultate eines vertikal differenzierten Wettbewerbsmodells.