LA SPESA FARMACEUTICA TERRITORIALE NELLE AZIENDE SANITARIE LOCALI: INDICATORI PER IL CONTROLLO E PER L'ALLOCAZIONE DELLE RISORSE

Despite the territorial pharmaceutical expenditure represents only about the 15% of the health expenditure, some features, as the high increase, the supply containment policies (even in the short period), the variability as to the volume of the services supplied, make it the cost item where the health managers focus there attention on. Such importance has gone growing during the last years due to two main groups of factors: the ones, demographic, scientific and epidemiological, which made its volume growing, the others, administrative and financial, which tried to restrain its growing due to the slowdown of the public resources. The Local Health Units (LHU) of the National Health Service, whose financial balances are under their responsibility according to the legislative decree 502/92, developed and begun to use some control indicators to guarantee a correct management of the pharmaceutical expenditure, a correct allocation of the resources available and a support for the managers decisions. Mostly, such indicators have been used for the drugs use assessment (in pieces and value), on the short period (one financial year) and threshold survey fields (pharmaceutical department). Nevertheless, do not assess the therapeutic practice (drugs use) and outcomes connected to the different therapeutic solutions (population health) caused some criticality, as the absence of a control system between applied and indicated processes (analysis of the variance as regards the therapeutic indications of efficacy and cost-efficacy of the drugs therapy) and the inducement to a change towards a control of the consumers rather than towards an increase of therapeutic appropriateness. The absence of a complete indicators system caused a situation of allocative inefficiency, as the same amount of resources available should have been used alternatively producing a better clinical and economic result, and this reduced the control of the LHU towards the several actors who wheel around the territorial pharmaceutical expenditure with different objectives. The project of this thesis was the investigation of the Ferrara LHU case which can give to this research results the generalization to an enough wide sample of health structures, as regards its demographic, social and consumer structure, as well as its business management and its control system. The project was carried out by the ratification of a “second level” control indicators package, in addition to those present, by the arrangement of information technologies and data processing methods, by the cooperation with the stakeholders charged by the LHU of the outcomes assessment. The project of this thesis, called ALARM project (Adherence to Long-term therapies: Assessment and Real practice Management), started on 2004, was renewed till 2010 with the cooperation of Centro di Ricerca in Economia e Management della Salute (CRISAL) of the Univerity of Ferrara, LHU of Ferrara, Ferrara Hospital, Azienda delle Farmacie Municipalizzate (AFM) of Ferrara, AstraZeneca Italia S.p.A. and Pfizer Italia S.p.A. The results of the study were object of presentations at several national and international congresses.