Pub Date : 2010-03-22DOI: 10.2174/1874924001003020034
E. Bassuk, K. Volk, J. Olivet
The purpose of this paper is to discuss the need for supports and services for families who are experiencing homelessness and to propose a framework for developing them based on families' needs over time. The authors propose a three-tier framework for understanding the needs of homeless families. Tier 1 includes short-term basic needs such as affordable housing, child care, transportation, health care; Tier 2 includes ongoing supports such as education and job opportunities, trauma and mental health services, and family supports; and Tier 3 includes lifelong supports related to chronic medical, mental health, or substance use issues. The authors also review recent service trends and emerging evidence for service needs for homeless families.
{"title":"A Framework for Developing Supports and Services for Families Experiencing Homelessness~!2009-08-20~!2009-09-28~!2010-03-22~!","authors":"E. Bassuk, K. Volk, J. Olivet","doi":"10.2174/1874924001003020034","DOIUrl":"https://doi.org/10.2174/1874924001003020034","url":null,"abstract":"The purpose of this paper is to discuss the need for supports and services for families who are experiencing homelessness and to propose a framework for developing them based on families' needs over time. The authors propose a three-tier framework for understanding the needs of homeless families. Tier 1 includes short-term basic needs such as affordable housing, child care, transportation, health care; Tier 2 includes ongoing supports such as education and job opportunities, trauma and mental health services, and family supports; and Tier 3 includes lifelong supports related to chronic medical, mental health, or substance use issues. The authors also review recent service trends and emerging evidence for service needs for homeless families.","PeriodicalId":88329,"journal":{"name":"The open health services and policy journal","volume":"3 1","pages":"34-40"},"PeriodicalIF":0.0,"publicationDate":"2010-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68094920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-03-22DOI: 10.2174/1874924001003020080
E. Hopper, E. Bassuk, J. Olivet
It is reasonable to assume that individuals and families who are homeless have been exposed to trauma. Research has shown that individuals who are homeless are likely to have experienced some form of previous trauma; homelessness itself can be viewed as a traumatic experience; and being homeless increases the risk of further victimization and retraumatization. Historically, homeless service settings have provided care to traumatized people without directly acknowledging or addressing the impact of trauma. As the field advances, providers in homeless service settings are beginning to realize the opportunity that they have to not only respond to the immediate crisis of homelessness, but to also contribute to the longer-term healing of these individuals. Trauma-Informed Care (TIC) offers a framework for providing services to traumatized individuals within a variety of service settings, including homelessness service settings. Although many providers have an emerging awareness of the potential importance of TIC in homeless services, the meaning of TIC remains murky, and the mechanisms for systems change using this framework are poorly defined. This paper explores the evidence base for TIC within homelessness service settings, including a review of quantitative and qualitative studies and other supporting literature. The authors clarify the definition of Trauma-Informed Care, discuss what is known about TIC based on an extensive literature review, review case examples of programs implementing TIC, and discuss implications for practice, programming, policy, and research.
{"title":"Shelter from the Storm: Trauma-Informed Care in Homelessness Services Settings","authors":"E. Hopper, E. Bassuk, J. Olivet","doi":"10.2174/1874924001003020080","DOIUrl":"https://doi.org/10.2174/1874924001003020080","url":null,"abstract":"It is reasonable to assume that individuals and families who are homeless have been exposed to trauma. Research has shown that individuals who are homeless are likely to have experienced some form of previous trauma; homelessness itself can be viewed as a traumatic experience; and being homeless increases the risk of further victimization and retraumatization. Historically, homeless service settings have provided care to traumatized people without directly acknowledging or addressing the impact of trauma. As the field advances, providers in homeless service settings are beginning to realize the opportunity that they have to not only respond to the immediate crisis of homelessness, but to also contribute to the longer-term healing of these individuals. Trauma-Informed Care (TIC) offers a framework for providing services to traumatized individuals within a variety of service settings, including homelessness service settings. Although many providers have an emerging awareness of the potential importance of TIC in homeless services, the meaning of TIC remains murky, and the mechanisms for systems change using this framework are poorly defined. This paper explores the evidence base for TIC within homelessness service settings, including a review of quantitative and qualitative studies and other supporting literature. The authors clarify the definition of Trauma-Informed Care, discuss what is known about TIC based on an extensive literature review, review case examples of programs implementing TIC, and discuss implications for practice, programming, policy, and research.","PeriodicalId":88329,"journal":{"name":"The open health services and policy journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2010-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68095027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-03-22DOI: 10.2174/1874924001003020071
Laura Gillis, Gloria E. Dickerson, J. Hanson
The recovery movement is reshaping approaches to treatment of mental illness, substance abuse, and traumatic stress disorders. Yet recovery principles have not been well integrated into the homeless assistance network, despite high prevalence of mental illness, substance abuse, and trauma histories among people who are chronically homeless in the United States. We review approaches to recovery and recovery-oriented care and propose recommendations for adopting recovery oriented care within the homeless assistance network. zing a recovery-oriented approach to homeless services and systems, drawing from lessons from mental health and addiction services. We identify the need for a shift in the service delivery model and the need for an increased role for consumers as "recovery ambassadors" (5) and for consumer integration at all levels. Lastly, we discuss lessons learned from implementation of recovery-oriented mental health and addiction treatment programs in the state of Connecticut, and the challenge of translating recovery principles into standards and objective practices that can be observed and measured. The paper concludes with a discussion of the adoption of recovery principles across the homelessness assistance network, and the implications for research, practice, and policy. DEFINING RECOVERY
{"title":"Recovery and Homeless Services: New Directions for the Field~!2009-08-14~!2009-09-28~!2010-03-22~!","authors":"Laura Gillis, Gloria E. Dickerson, J. Hanson","doi":"10.2174/1874924001003020071","DOIUrl":"https://doi.org/10.2174/1874924001003020071","url":null,"abstract":"The recovery movement is reshaping approaches to treatment of mental illness, substance abuse, and traumatic stress disorders. Yet recovery principles have not been well integrated into the homeless assistance network, despite high prevalence of mental illness, substance abuse, and trauma histories among people who are chronically homeless in the United States. We review approaches to recovery and recovery-oriented care and propose recommendations for adopting recovery oriented care within the homeless assistance network. zing a recovery-oriented approach to homeless services and systems, drawing from lessons from mental health and addiction services. We identify the need for a shift in the service delivery model and the need for an increased role for consumers as \"recovery ambassadors\" (5) and for consumer integration at all levels. Lastly, we discuss lessons learned from implementation of recovery-oriented mental health and addiction treatment programs in the state of Connecticut, and the challenge of translating recovery principles into standards and objective practices that can be observed and measured. The paper concludes with a discussion of the adoption of recovery principles across the homelessness assistance network, and the implications for research, practice, and policy. DEFINING RECOVERY","PeriodicalId":88329,"journal":{"name":"The open health services and policy journal","volume":"3 1","pages":"71-79"},"PeriodicalIF":0.0,"publicationDate":"2010-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68095015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-03-22DOI: 10.2174/1874924001003020101
J. Mullen, W. Leginski
The available data are imperfect but suggest that between 202,300 and 327,000 workers provide homeless services. However, little is known about the composition of this workforce and little attention has been paid to developing its capacity to address the multiple problems of those living without homes. Workforce development covers a range of activities from recruitment through training and credentialing—all of which support the goal of strengthening the professional identity, skills, and resilience of the workforce. Success in ending homelessness is likely to be out-of-reach without serious investments in the professional development of homeless service providers. The Interagency Council on Homelessness is ideally positioned to establish a national agenda for workforce development in homeless services and to leverage action across federal agencies to build workforce capacity.
{"title":"Building the Capacity of the Homeless Service Workforce~!2009-08-20~!2009-09-28~!2010-03-22~!","authors":"J. Mullen, W. Leginski","doi":"10.2174/1874924001003020101","DOIUrl":"https://doi.org/10.2174/1874924001003020101","url":null,"abstract":"The available data are imperfect but suggest that between 202,300 and 327,000 workers provide homeless services. However, little is known about the composition of this workforce and little attention has been paid to developing its capacity to address the multiple problems of those living without homes. Workforce development covers a range of activities from recruitment through training and credentialing—all of which support the goal of strengthening the professional identity, skills, and resilience of the workforce. Success in ending homelessness is likely to be out-of-reach without serious investments in the professional development of homeless service providers. The Interagency Council on Homelessness is ideally positioned to establish a national agenda for workforce development in homeless services and to leverage action across federal agencies to build workforce capacity.","PeriodicalId":88329,"journal":{"name":"The open health services and policy journal","volume":"3 1","pages":"101-110"},"PeriodicalIF":0.0,"publicationDate":"2010-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68095039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-03-22DOI: 10.2174/1874924001003020027
M. Fleetwood
Homeless services as we know them today-including housing, health care, and social service systems-emerged th at the end of the 20 century. These services developed separately from mainstream systems of care, further marginalizing people who were displaced by homelessness and poverty. In this editorial, the author proposes strategies for developing comprehensive, inclusive, and targeted responses to end homelessness.
{"title":"Homeless Services in the U.S.: Looking Back, Looking Forward: An Open Letter to Policymakers, Advocates, and Providers","authors":"M. Fleetwood","doi":"10.2174/1874924001003020027","DOIUrl":"https://doi.org/10.2174/1874924001003020027","url":null,"abstract":"Homeless services as we know them today-including housing, health care, and social service systems-emerged th at the end of the 20 century. These services developed separately from mainstream systems of care, further marginalizing people who were displaced by homelessness and poverty. In this editorial, the author proposes strategies for developing comprehensive, inclusive, and targeted responses to end homelessness.","PeriodicalId":88329,"journal":{"name":"The open health services and policy journal","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2010-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68094829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-03-22DOI: 10.2174/1874924001003020053
J. Olivet, E. Bassuk, Emily A. Elstad, Rachael Kenney, Lauren Jassil
Outreach and engagement are regarded by many who work in homeless programs as essential services. Outreach on the streets and in shelters is often the first point of contact for people who are not served by traditional site- based services and is often the first step in engaging homeless people in services. While outreach and engagement are critical components of the response to homelessness, consensus is lacking about the nature and effectiveness of these services. The purpose of this paper is to examine what is known about outreach and engagement for people experiencing homelessness. The authors review quantitative studies that examine outcomes and augment this understanding with information from qualitative studies and non-research literature. The latter provides information about the goals of outreach, assumptions and values, staffing issues, and consumer involvement. The paper concludes with implications for practice, policy, and research.
{"title":"Outreach and Engagement in Homeless Services: A Review of the Literature~!2009-08-18~!2009-09-28~!2010-03-22~!","authors":"J. Olivet, E. Bassuk, Emily A. Elstad, Rachael Kenney, Lauren Jassil","doi":"10.2174/1874924001003020053","DOIUrl":"https://doi.org/10.2174/1874924001003020053","url":null,"abstract":"Outreach and engagement are regarded by many who work in homeless programs as essential services. Outreach on the streets and in shelters is often the first point of contact for people who are not served by traditional site- based services and is often the first step in engaging homeless people in services. While outreach and engagement are critical components of the response to homelessness, consensus is lacking about the nature and effectiveness of these services. The purpose of this paper is to examine what is known about outreach and engagement for people experiencing homelessness. The authors review quantitative studies that examine outcomes and augment this understanding with information from qualitative studies and non-research literature. The latter provides information about the goals of outreach, assumptions and values, staffing issues, and consumer involvement. The paper concludes with implications for practice, policy, and research.","PeriodicalId":88329,"journal":{"name":"The open health services and policy journal","volume":"3 1","pages":"53-70"},"PeriodicalIF":0.0,"publicationDate":"2010-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68094975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-03-22DOI: 10.2174/1874924001003020041
J. Apicello
Prevention is critical in any effort to end homelessness. Unfortunately, the practice of homelessness prevention is still in its infancy and there is little science base for its implementation. Risk factors for homelessness have been identified at multiple levels: the individual, institutional, and societal levels. Addressing all three in prevention practice is necessary. The population/high-risk framework is the most appropriate framework for conceptualizing how to design programs and policies to prevent homelessness because it draws attention to the need for direct intervention among those at most risk, and also for modifying the overall context. This review of the literature and technical reports points to a number of strategies that demonstrate preliminary effectiveness or are in need of rigorous evaluations. Reductions in homelessness as a result of targeted, high-risk approaches alone are achievable, but will be short-lived unless low-cost and affordable housing and income are addressed at the population level. Simultaneous implementation and evaluation of both population and high-risk prevention strategies will bring us closer to reaching our goal of ending homelessness.
{"title":"A Paradigm Shift in Housing and Homeless Services: Applying the Population and High-Risk Framework to Preventing Homelessness~!2009-08-20~!2009-09-28~!2010-03-22~!","authors":"J. Apicello","doi":"10.2174/1874924001003020041","DOIUrl":"https://doi.org/10.2174/1874924001003020041","url":null,"abstract":"Prevention is critical in any effort to end homelessness. Unfortunately, the practice of homelessness prevention is still in its infancy and there is little science base for its implementation. Risk factors for homelessness have been identified at multiple levels: the individual, institutional, and societal levels. Addressing all three in prevention practice is necessary. The population/high-risk framework is the most appropriate framework for conceptualizing how to design programs and policies to prevent homelessness because it draws attention to the need for direct intervention among those at most risk, and also for modifying the overall context. This review of the literature and technical reports points to a number of strategies that demonstrate preliminary effectiveness or are in need of rigorous evaluations. Reductions in homelessness as a result of targeted, high-risk approaches alone are achievable, but will be short-lived unless low-cost and affordable housing and income are addressed at the population level. Simultaneous implementation and evaluation of both population and high-risk prevention strategies will bring us closer to reaching our goal of ending homelessness.","PeriodicalId":88329,"journal":{"name":"The open health services and policy journal","volume":"3 1","pages":"41-52"},"PeriodicalIF":0.0,"publicationDate":"2010-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68094956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-11-24DOI: 10.2174/1874924000902010084
J. Holst
Globalisation induces nation states to build marketplaces that span various countries with the objective of facilitating trade and improving economic competitiveness. International experiences gained from three common markets, the European Union (EU), North American Free Trade Agreement (NAFTA) and Common Southern Market (MERCOSUR) allow for drawing some general conclusions that might be helpful for guiding similar processes in other regions and preparing them better for the challenges of human and social rights in open economies. Analysis of existing trade agreements shows that even relevant differences in design, structure, financing, coverage and regulation of health systems in member states do not necessarily prevent them from implementing common block-wide social protection and health service arrangements. Public health activities, epidemiologic surveillance and disease prevention have the potential of being starting points for shared activities of member states in the health field. Bi- or multi-national enterprises are eligible to become focal points of cross-border arrangements and regulations, especially if they are public or publicly administered. In general, coordination and cooperation between countries can be tried out or applied first in border regions where there is a high flow of goods, services and persons. When it comes to implementing the social dimension in the policy and priority setting of trade agreements, motivating spirit, driving forces and the concordance of value-sets in member states are crucial conditions. National governments planning to set up or join regional trade agreements have a broad decision margin regarding the extent to which they include social and human rights in regional trade arrangements. International organisations that are promoting regional economic blocks such as the World Bank, the World Trade Organisation and others should inspire political and economic decision-makers to consider health and social protection as crucial points for international trade. There is a broad array of political options between either strengthening the social dimension of common markets or dissolving the existing regional cohesion in favour of entering strictly market-driven blocks.
{"title":"The Potential of Regional Trade Agreements for Extending Social Protection in Health: Lessons Learned and Emerging Challenges","authors":"J. Holst","doi":"10.2174/1874924000902010084","DOIUrl":"https://doi.org/10.2174/1874924000902010084","url":null,"abstract":"Globalisation induces nation states to build marketplaces that span various countries with the objective of facilitating trade and improving economic competitiveness. International experiences gained from three common markets, the European Union (EU), North American Free Trade Agreement (NAFTA) and Common Southern Market (MERCOSUR) allow for drawing some general conclusions that might be helpful for guiding similar processes in other regions and preparing them better for the challenges of human and social rights in open economies. Analysis of existing trade agreements shows that even relevant differences in design, structure, financing, coverage and regulation of health systems in member states do not necessarily prevent them from implementing common block-wide social protection and health service arrangements. Public health activities, epidemiologic surveillance and disease prevention have the potential of being starting points for shared activities of member states in the health field. Bi- or multi-national enterprises are eligible to become focal points of cross-border arrangements and regulations, especially if they are public or publicly administered. In general, coordination and cooperation between countries can be tried out or applied first in border regions where there is a high flow of goods, services and persons. When it comes to implementing the social dimension in the policy and priority setting of trade agreements, motivating spirit, driving forces and the concordance of value-sets in member states are crucial conditions. National governments planning to set up or join regional trade agreements have a broad decision margin regarding the extent to which they include social and human rights in regional trade arrangements. International organisations that are promoting regional economic blocks such as the World Bank, the World Trade Organisation and others should inspire political and economic decision-makers to consider health and social protection as crucial points for international trade. There is a broad array of political options between either strengthening the social dimension of common markets or dissolving the existing regional cohesion in favour of entering strictly market-driven blocks.","PeriodicalId":88329,"journal":{"name":"The open health services and policy journal","volume":"2 1","pages":"84-93"},"PeriodicalIF":0.0,"publicationDate":"2009-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68095001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-11-17DOI: 10.2174/1874924001003010010
Susan M. Gates, P. Karaca-Mandic, J. Burgdorf, K. Kapur
A combination of high deductible health plans (HDHPs) and health savings accounts (HSAs) holds promise for expanding health insurance for small firms. We provide information on HSA take-up and shopping behavior from a 2008 survey of female small business owners, revealing that the HSA marketplace can be confusing for small firms. HSAs may have expanded access to health insurance for the smallest firms (under three employees), but not for small firms more generally. A sizable number of firms offering HSA-eligible insurance did not offer attached HSAs. Firms offering HSAs were satisfied with their experiences, but faced challenges in implementing them.
{"title":"Health Savings Accounts for Small Businesses and Entrepreneurs: Shopping, Take-Up and Implementation Challenges~!2009-11-12~!2010-01-28~!2010-03-19~!","authors":"Susan M. Gates, P. Karaca-Mandic, J. Burgdorf, K. Kapur","doi":"10.2174/1874924001003010010","DOIUrl":"https://doi.org/10.2174/1874924001003010010","url":null,"abstract":"A combination of high deductible health plans (HDHPs) and health savings accounts (HSAs) holds promise for expanding health insurance for small firms. We provide information on HSA take-up and shopping behavior from a 2008 survey of female small business owners, revealing that the HSA marketplace can be confusing for small firms. HSAs may have expanded access to health insurance for the smallest firms (under three employees), but not for small firms more generally. A sizable number of firms offering HSA-eligible insurance did not offer attached HSAs. Firms offering HSAs were satisfied with their experiences, but faced challenges in implementing them.","PeriodicalId":88329,"journal":{"name":"The open health services and policy journal","volume":"3 1","pages":"10-20"},"PeriodicalIF":0.0,"publicationDate":"2009-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68095047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-09-16DOI: 10.2174/1874924000902010071
Paula Tele, W. Groot
A vast majority of the EU countries are witnessing a rise in the share of public pharmaceutical spending in the total drugs expenditure. This urges governments to adopt cost containment measures through more stringent norms in their pharmaceutical policies. The aim of this paper is to review the existing pharmaceuticals cost-containment policies in the EU in order to illustrate the complexity of the drug policy decision making and to assess the effectiveness of the cost containment measures introduced so far in the 27 selected countries. The paper is focused on measures aimed at reducing the public expenditures on pharmaceutical products. It is shown that cost containment policies for pharmaceutical expenditure are mostly targeted towards supply side measures, as they are proved to be more effective than demand side measures. However, price control policies do not guarantee expenditure control as long as they are not accompanied by control over volume. Rationalizing consumption volume should be targeted as well by giving more importance to demand side measures. We argue that, given the structurally imperfect pharmaceutical market and the dominant position of the supply side, it is maybe unrealistic to expect cost containment measures to be very successful. With an aging European population demanding more health care and an enlarging EU, it is likely that the debate concerning pharmaceutical expenditure will become a never ending story. At the same time, substantial evidence shows that the effect of innovative drugs is worth the increased cost. Therefore, a change of perspective from the cost of medicines per se to the cost-benefit ratio of the pharmaceuticals might be the solution, almost ignored so far.
{"title":"Cost Containment Measures for Pharmaceuticals Expenditure in the EU Countries: A Comparative Analysis","authors":"Paula Tele, W. Groot","doi":"10.2174/1874924000902010071","DOIUrl":"https://doi.org/10.2174/1874924000902010071","url":null,"abstract":"A vast majority of the EU countries are witnessing a rise in the share of public pharmaceutical spending in the total drugs expenditure. This urges governments to adopt cost containment measures through more stringent norms in their pharmaceutical policies. The aim of this paper is to review the existing pharmaceuticals cost-containment policies in the EU in order to illustrate the complexity of the drug policy decision making and to assess the effectiveness of the cost containment measures introduced so far in the 27 selected countries. The paper is focused on measures aimed at reducing the public expenditures on pharmaceutical products. It is shown that cost containment policies for pharmaceutical expenditure are mostly targeted towards supply side measures, as they are proved to be more effective than demand side measures. However, price control policies do not guarantee expenditure control as long as they are not accompanied by control over volume. Rationalizing consumption volume should be targeted as well by giving more importance to demand side measures. We argue that, given the structurally imperfect pharmaceutical market and the dominant position of the supply side, it is maybe unrealistic to expect cost containment measures to be very successful. With an aging European population demanding more health care and an enlarging EU, it is likely that the debate concerning pharmaceutical expenditure will become a never ending story. At the same time, substantial evidence shows that the effect of innovative drugs is worth the increased cost. Therefore, a change of perspective from the cost of medicines per se to the cost-benefit ratio of the pharmaceuticals might be the solution, almost ignored so far.","PeriodicalId":88329,"journal":{"name":"The open health services and policy journal","volume":"2 1","pages":"71-83"},"PeriodicalIF":0.0,"publicationDate":"2009-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68094986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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