Public policy trends in drug pricing and reimbursement in the European Community

In the European Community, the key issue of cost containment in healthcare (including pharmaceuticals) is dominated by three main background influences: The principle of 'solidarity' (society's responsibility for those who cannot afford to pay the full cost of healthcare); 'subsidiarity' (doing nationally what is best done nationally rather than at the Community level); and the 'pharmapolitics' of balancing the drug budget with the demands of patients in their capacity as voters. Pharmaceutical expenditure generally exceeded the rate of inflation during the 1980s despite legislation to contain costs. In the 1990s, more intensive efforts are being applied to oblige doctors to prescribe rationally and economically whilst putting even greater pressure on the pharmaceutical industry. Again with an eye on electoral repercussions, only limited attempts to make patients pay a higher proportion of total costs have so far been made.