|Implemented in this survey?|
A new governmental agency, the Development Centre for Drug Therapy, has been established under the Ministry of Social Affairs and Health. The purpose of the agency is to promote rational drug therapy by influencing physicians' prescribing behaviour. The agency will use methods like information dissemination and education of physicians and will be in close collaboration with hospitals and health care centres. The agency is Government funded and independent from pharmaceutical companies.
Purpose of this policy is to promote rational drug therapy in Finland.
Physicians, Health Care Units, Payers
|Medienpräsenz||sehr gering||sehr hoch|
There is a great need to provide independent information on drugs to physicians and to have limited resources of health care used in the most efficient way. Founding the new governmental agency is an important step towards these goals.
Since 1998 the Ministry of Social Affairs and Health has partly funded the ROHTO programme which has same goals as the new agency. The project has now ended and its work will be continued by
the new agency.
The importance of the continuation of the ROHTO programme was notified in "the Decision in Principle by the Council of State on Securing the Future of Health Care" published by the Government in April 2002. This decision also secured governmental funding for this work.
There was no pressure to comply with EU or other international regulations.
The Decision in Principle by the Council of State on securing the future of health care
|Implemented in this survey?|
The idea of this policy process is not completely new. Since the economic depression in the early 1990's the need of independent drug information for doctors have been stated in different reports
and by various governmental working groups. In 1997 an ad hoc working group published a report on controlling drug costs. The report suggested a project promoting rational prescribing, for instance,
by providing information and training for doctors. Soon after that the ROHTO programme was started. Most active stakeholders in this process were the Ministry of Social Affairs and Health, Social
Insurance Institution, Finnish Medical Society Duodecim and Finnish Medical Association.
The aim of the ROHTO programme was to steer physicians' prescription practices to a more rational direction. The principle of the action programme was to encourage physicians to review critically their own prescription practices. Methods for achieving this were education in small groups and workshops, extensive information activities and national support measures. The ROHTO programme was managed by the Finnish Medical Society Duodecim. The programme was evaluated in 2002 and it was rated to have been important.
In 2001 the Government initiated "the National Project to Ensure the Future of Health Care". One outcome of this was "the Decision in Principle by the Council of State on Securing the Future of Health Care" issued by the Government in 2002. In the decision the need of securing the continuation of the ROHTO programme was highlighted. At the same time, the Council of State promised to allocate EUR 1.3 million to the ROHTO programme annually.
Soon after this The Ministry of Social Affairs and Health made plans to enact the Development Centre for Drug Therapy, and thus to establish a government agency to continue the activities of the ROHTO programme. The bill on the agency was passed in the Parliament in the same year.
The main background motivation for this policy process was rising drug costs and the lack of independent information on drugs.
The approach of the idea is described as:
Pilot project - the ROHTO programme can be considered as a pilot for the new
The leadership role in founding the new agency lies with the Ministry of Social Affairs and Health. In addition to the ministry, the Social Insurance Institution managing the national health
insurance reimbursing patients' outpatient medicinal expenses had a significant interest in methods to promote rational prescribing and to lower the rate of increase of drug costs. In addition to
authorities, the Finnish Medical Society Duodecim had interest to secure the continuation of the ROHTO programme to which the society had invested a significant amount of its resources. One of the
key objectives of the Finnish Medical Society Duodecim is to support the physicians' knowledge base needed in medical practise, for example, by promoting continuous education of physicians.
There have been no major opponents for the establishment of the new agency and the public debate on the initiative has been low. However, the National Agency of Medicines would have favoured that the activities of the ROHTO programme had been sited in its organisation. This was rejected because the high level of independence from existing stakeholders is tried to be achieved. Pharmaceutical industry has not openly voiced their opinion but some representatives of the industry have expressed their concern that the new agency may focus too much on curbing the cost and to decrease the pharmaceutical sales.
The main group to be affected by this policy initiative are physicians, which are rather positive towards the new agency.
The legislative process for the initiative was very quick. From the decision in principle made by the government it took only eight months to pass the bill on the Development Centre for Drug Therapy. The original idea did not significantly change in the legislative process and there was no significant involvement of other stakeholders than the Government and the Parliament in the process.
The Ministry of Social Affairs and Health has the responsibility for starting the new agency and for providing funding and other prerequisites of the activities of the agency. The Ministry will
also supervise and set targets for the operation of the agency. In addition, an advisory board representing relevant stakeholders will be formed to guide the work of the agency.
The main collaboration partners of the agency are hospital districts, hospitals and health care centres. The agency will also collaborate with the Social Insurance Institution and National Agency of Medicines in gathering statistical and other information on the use and prescribing of pharmaceuticals.
The previous ROHTO programme has been evaluated (see http://www.stm.fi/suomi/eho/julkaisut/rohto/summary.htm )
The Development Centre for Drug Therapy is guided and supervised by its own advisory board and the Ministry of Social Affairs and Health.
The Development Centre for Drug Therapy has a challenging task to promote rational drug therapy as the dissemination of information by the agency is unevenly competing in terms of resources with the marketing efforts of pharmaceutical companies. However, the agency still have a good opportunity to steer drug therapies to more rational direction, especially by concentrating some specific problematic issues. For the success of the agency, an important issue will be that key stakeholders have positive attitude towards the agency.
|Qualität||kaum Einfluss||starker Einfluss|
|Gerechtigkeit||System weniger gerecht||System gerechter|
|Kosteneffizienz||sehr gering||sehr hoch|
The impact of the agency can not be evaluated yet, but partly based on experiences from the ROHTO programme the agency will probably have positive impact on quality and cost-efficiency of drug therapy.
Helin-Salmivaara A, Huupponen R, Klaukka T & Hoppu K (2003) Focusing on changing clinical practice to enhance rational prescribing - collaboration and network enable comprehensive approaches.
Health Policy 66:1-10.
Nikkarinen ?, Huvinen ?, Brommels M (2002) National consensus and local consideration. Changing the prescription practices by means of training. Evaluation Report of the ROHTO Project. Helsinki, 2002. (Reports of the Ministry of Social Affairs and Health)
Decision in Principle by the Council of State on securing the future of health care. Brochures of the Ministry of Social Affairs and Health 2002:6eng
Lauri Vuorenkoski & Ilmo Keskimäki