The role of different actors in optimising pharmaceutical expenditures in Belgium

Datum: 17 november 2014

Locatie: University of Antwerp - Campus Drie Eiken - Building Q - Promotiezaal - Universiteitsplein 1 - 2610 Wilrijk

Tijdstip: 16.30 uur

Organisatie / co-organisatie: Faculty of Medicine and Health Sciences

Promovendus: Jessica Fraeyman

Promotor: Prof G. Van Hal & Prof P. Beutels

Korte beschrijving: PhD defense Jessica Fraeyman - Faculty of Medicine and Health Sciences



The role of different actors in optimising pharmaceutical expenditures in Belgium

The aim of this thesis was to seek explanations for the observed phenomena in pharmaceutical consumption behaviour and the organisation of pharmaceutical reimbursement from the perspectives of the patient, the health care providers (general physician and pharmacist) and the health insurance.

In chapter one, we investigated the potential impact of policy regulations and generic competition on sales of three common medicine groups in Belgium.

In chapter two, we found that multiple and successive demand-side measures introduced in Belgium in recent years appear to have appreciably enhanced rational prescribing for both the PPIs and statins. However, there are opportunities to further enhance rational prescribing such as tougher prescribing targets, financial incentives for meeting prescribing targets and prescribing restrictions for patented pharmaceuticals.

In chapter three, we zoomed in on the case of INN-prescribing which plays a crucial role in promoting the use of generic medicines and stimulate competition in the pharmaceutical market. We asked GP’s and pharmacists to express their personal opinions about this policy based on their daily experiences.

In chapter four, we could distinguish several influential events that coincided with shifts in utilization and spending by means of an observational and change point analysis. As the maximum co-payment level decreased over time, it has overruled the reference pricing system in Belgium.

In chapter five, we explored the price awareness of chronic disease patients in times of scarce budgets.

In chapter six, we gained some insights in the lay knowledge on generic medicines in the Flemish population.

In these six chapters, we give a comprehensive overview of the policies that have been implemented in the past 15 years in Belgium, aimed to contain growing pharmaceutical expenditures. Moreover, it gives an idea of how these policies work in daily practice, uncovering some of the adverse effects they have caused.

This doctoral thesis has explored the evolution of some important policies for the reimbursement of medicines within the reference pricing system in Belgium. However, it has also brought up some critical questions that deserve serious consideration in order to ensure sustainability of the social security system in Belgium.