The savings required are important: 550 Million euro. The proposed measures do aim more than just short-run expenditure savings. There is a concern of building mechanisms for future control of expenditures in the public sector. These mechanisms involve performance assessment and benchmark, use of competition forces in public procurement, and introduction of best-practices in transparency and information on the evolution of the National Health Service.
Several of the measures are important and deserve to be implemented, even outside the current crisis setting. They must be seen as stepping stones for the future. They are not disruptive of the National Health Service, only of its culture of opacity.
Curiously, some - but not all - of the measures were already present in the recommendations of 2006 report commissioned by the Government.
A good deal of the effort lies in time horizon for implementation, forcing both technical excellence and political determination to be present.
In a quick appraisal of the main areas:
- moderating fees - values are to be revised, should be updated according to inflation, the structure of fees should guide patients to primary care and away from emergency departments.
- pharmaceuticals - margin reduction in distribution, change in margin structure making it regressive (here I believe we should go for dispensing fee approach instead of margin as percentage of retail price), redefine the international referencing price system to the minimum of the prices in reference countries, instead of current average.
- electronic prescription and quality in prescription - this area has been little explored as a source for savings, and the steps announced are good news for improvement. It will be essential the cooperation from the medical profession, and the IT system will have to work properly (finally, I would add!!)
- Efficiency gains - without mentioning specific areas, but looks for the incentive role that transparency and clear benchmark analysis may have. Continue redefinition of supply network of the National Health Service (including closure of unnecessary or unsafe units). The major warning is about the political process of closure, to avoid unwarranted population unrest.
- planing of health expenditures and projections over 3 or 5 years ahead. This is definitely a good idea. It was used in one specific programme (continued care network). Should be expanded to the whole system.
- reduction in fiscal benefits / tax allowances - it will mean an increase in effective copayments paid by the population, as the implicit health insurance provided is reduced. The tax allowance should not be totally removed on the account of tax evasion of providers if patients lose all interest in asking for receipts for tax purposes.
- explicit planning and follow-up of medical profession dynamics (training, exit, retirement decisions). I would take the chance to do it with all health professions.
Overall, the effect of this set of measures is crucially dependent on Government commitment . There are adjustments to be made in several points, which cumulatively have to produce the aimed savings. But the proposal plan attempts to reach these savings without compromising basic values of the National Health Service. A closer scrutiny needs to be in place, to ensure progress is achieved.