The AIReF proposes to end the treatment of favor to the pensioners and to fix the pharmaceutical copayment according to the income

The Independent Authority for Fiscal Responsibility (AIReF) considers that the management of the pharmaceutical benefits of the National Health System (SNS) has important margins


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The Independent Authority of Fiscal Responsibility (AIReF) considers that the management of the pharmaceutical benefits of the National Health System (NHS) has important margins of improvement in terms of expenditure and proposes that a change of the drug co-payment system is undertaken to make it more «Efficient and equitable» .

Specifically, the body chaired by José Luis Escrivá proposes to eliminate the distinction between active workers and the almost 10 million pensioners when it comes to benefiting from the co-payment system, and to establish a system in which the subsidies are deserved according to the rent maintaining current exemptions such as those that exist for people with very low incomes or unemployed who have exhausted the benefit. The new system that it raises, and that has been translated into a document to which EL MUNDO has had access, would implement more income categories and would eliminate the monthly limit of spending for pensioners who, on the other hand, are the group that by age more uses medical prescriptions

Until 2012, the pensioners did not pay for the medicines prescribed by the SNS and since then (the same year that they tried to implant the euro by prescription as a way of financing) they pay 10% of the price if their income is less than 100,000 euros. The benefits are completed with spending limits of 8.23 ​​or 18.52 euros per month, from which they do not pay the difference.

The 2012 reform reduced consumption and spending on drugs by 12%. But from the deepest moment of the recession until now, there have been significant changes in the labor market and Social Security. The study argues that the distinction in favor of pensioners in spending on medicines is " inequitable and harmful for groups of population with less capacity such as young people or people receiving unemployment benefits ."

It is based on the fact that, according to the Wage Structure Survey, in 2016 the average salary of a young person between 20 and 24 years old was 11,316 euros per year when the average contributory pension in that same year amounted to 12,757 euros per year. The difference would be aggravated if that same young person had become unemployed, receiving 70% of the regulatory base in the first 180 days of unemployment and 50% afterwards.

The AIReF also points out that a worker with a salary of 23,156 euros who would be unemployed would also be at a disadvantage compared to a pensioner 180 days after receiving the unemployment benefit. When going to a prescription pharmacy, active workers would pay a 40% copayment against 10 % with a monthly limit of 8.23 ​​euros from the pensioner, who is guaranteed his income.

Without positive discrimination in favor of pensioners, the co-payment system proposed by the agency would set discounts based on income. Equity would consist of equalizing access to medicines by eliminating the largest subsidies to pensioners with higher incomes and extending them to workers in more precarious situations. Depending on how the proposals are applied, the SNS can raise spending by more than 1 billion or reduce it by 127 million . The savings, as recognized by the agency, would be scarce and the risk of social rejection high. For this reason, it considers that if you want to use the copayment as a saving element, "your political viability is low".

The co-payment is one of the chapters of the SNS in which the body proposes changes. There are proposals for improvement for the system of buying medicines , setting their prices or improving the governance of a very decentralized system in which the responsibility of the autonomous communities is very high. The study focuses on prescription drugs, which represented a cost of 10,171 million in 2017, and offers alternatives to improve management in what qualifies as one of the pillars of the welfare state and whose annual public expenditure amounts to 72,813 million .

'Spending review'

The evaluation of the disbursement in medicines is one of the seven projects that, as a whole, make up the Action Plan for the review of spending on subsidies from the Public Administration. Or in words: of the review of 20,000 million of public spending that the Fiscal Authority is carrying out and whose results will be known during the next weeks.

This action, known as spending review , was agreed at the Council of Ministers in June 2017. The measure, therefore, was taken by the Executive of Mariano Rajoy, but Spain committed itself to the European Commission to carry out this transparency exercise, and Brussels has closely followed the work . Therefore, the Government of Pedro Sánchez has not only been obliged to provide continuity but also must comply with the recommendations included in the different documents.

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