BackgroundAs the health services in Ireland have become more resource-constrained, pressure has increased to reduce public spending on community drug schemes such as General Medical Services (GMS) drug prescribing and to understand current and future trends in prescribing. The GMS scheme covers approximately 37% of the Irish population in 2011 and entitles them, inter alia, to free prescription drugs and appliances. This paper projects the effects of future changes in population, coverage, claims rates and average claims cost on GMS costs in Ireland.MethodsData on GMS coverage, claims rates and average cost per claim are drawn from the Primary Care Reimbursement Service (PCRS) and combined with Central Statistics Office (CSO) (Regional and National Population Projections through to 2026). A Monte Carlo Model is used to simulate the effects of demographic change (by region, age, gender, coverage, claims rates and average claims cost) will have on GMS prescribing costs in 2016, 2021 and 2026 under different scenarios.ResultsThe Population of Ireland is projected to grow by 32% between 2007 and 2026 and by 96% for the over 70s. The Eastern region is estimated to grow by 3% over the lifetime of the projections at the expense of most other regions. The Monte Carlo simulations project that females will be a bigger driver of GMS costs than males. Midlands region will be the most expensive of the eight old health board regions. Those aged 70 and over and children under 11 will be significant drivers of GMS costs with the impending demographic changes. Overall GMS medicines costs are projected to rise to €1.9bn by 2026.ConclusionsIreland’s population will experience rapid growth over the next decade. Population growth coupled with an aging population will result in an increase in coverage rates, thus the projected increase in overall prescribing costs. Our projections and simulations map the likely evolution of GMS cost, given existing policies and demographic trends. These costs can be contained by government policy initiatives.
This article constructs tourism satellite accounts (TSAs) for Ireland and provides a simple matrix representation of how TSAs estimate value added, domestic product and employment. The authors calculate how much tourism has contributed, directly and in total, to Irish value added, domestic product and employment. They find that TSA-measured domestic tourism consumption in Ireland is over five times the traditional official estimate and that tourism indirectly contributes around a further 50% of its direct contribution to Irish GDP. As such, tourism is found to be Ireland's second largest 'industry' in terms of gross value added and that it is Ireland's largest employer. The analysis shows why tourism policies based on traditional estimates of the tourism industry are likely to be misguided.
Our findings highlight the need for policymakers, even when absorbed with reducing cost, to design cost-containment policies that are both fiscally and economically sustainable.
systematically collected through visiting social health insurance bureau websites, literature review and key informant interview. Case study and comparison analysis were conducted among these schemes. Results: Two kinds of risk sharing schemes, performance based scheme and financial based scheme, were employed in sampling provinces and cities, with the latter model more often implemented. Performance based scheme has only been developed in one city (Guangzhou) for a non-small-cell lung cancer drug. Patients eligible for inclusion criteria and treated in one of three designated hospitals could be qualified to reimburse for more than one year treatment if they were responsive to the drug. Other provinces and cities has adopted the financial based scheme, mainly focusing on increasing patients access to expensive drugs, usually for breast cancer, leukemia and non-small-cell lung cancer and not covered by health insurance schemes. For instance, local health insurance fund of Zhejiang and Jiangsu province would only reimburse patients' five to six months treatment and pharmaceutical company should sponsor patients' treatment for the next six months. Besides, cities like Qingdao and Chengdu implemented the price volume scheme for special drugs and medical materials in order to control fund expenditure. ConClusions: By risk sharing scheme, some innovative drugs, previously not covered by social health insurance, can be reimbursed, which will increase patients' access, reduce patients economic burden, and help expending pharmaceutical companies' market share. However, as risk sharing scheme in China has only been adopted for only one or two years, long-term impact still needs to be observed and evaluated.
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