Mentally ill to suffer in Czech cutbacks

By Anna McLauchlin

Date: 13/01/05

PATIENT groups and mental health organisations have criticised a decision by the Czech government to cut healthcare spending, claiming it will limit patients' access to cutting-edge drugs.

On 1 January, new levels of reimbursement for prescription drugs began in the Czech Republic that limit the use of four popular medications, used in the treatment of schizophrenia, depression and senility. Doctors must now give primacy to generic drugs which are produced by the Czech firm Zentiva at a reduced price.

The health ministry has said that this will save the government €6.6 million a year without raising drug prices for patients. But critics have denounced the decision, highlighting the risk that in a poorer state such as the Czech Republic, thousands of patients will not be able to pay the higher prices of more modern treatment.

"If the choice for psychiatrists is limited it's inevitable that some will simply prescribe the approved drugs, rather than face the difficulty of trying to convince a patient that he should pay more for more effective treatment," says Susan Kirkwood of EUFAMI, the European Information Desk on Mental Illness.

Access to a broad range of anti-psychotic drugs is vital for mentally ill patients because each patient reacts differently. Psychiatrists may need to try several before choosing the drug that is most suitable for an individual patient.

"People are different and they require different treatments," Professor Norman Sartorius from the World Psychiatric Association told European Voice. "When rules like this come in, drugs that could be useful to patients are denied to them and it means that treatment is not optimal."

Older drugs also have what Kirkwood describes as "unacceptable" side effects that often make the patient look mentally ill. These have been reduced in newer medicines. Favouring generic medicines is a common cost-cutting mechanism for governments, especially in the new member states where affordability is an acute problem. And mental healthcare is a particularly low government priority, Kirkwood says.

"It's easy to find money for cancer treatment, but mental health seems to be the area where ministers are most likely to chop spending," she says.

A spokeswoman for the Czech health ministry denied that the decision would lead to a deterioration in patient care. "The [new legislation] will not cause any negative changes from the point of view of treatment standard," she said. "The range of reimbursed drugs has been enlarged and the state insurance budget is estimated to grow by 6-10% in 2005 compared with last year."

The European Federation of Pharmaceutical Industries and Associations (EFPIA) will shortly publish a study into state reimbursement of new drugs. This will reveal Poland as the slowest EU member state to authorise products for reimbursement. No innovative medicines have been approved in the last six years in Poland. Other laggards are Greece, Slovakia, Belgium, France and the Czech Republic.

Also lurking behind the Zentiva deal are accusations of corruption, as the Czech Health Minister Milada Emmerova's son is on Zentiva's board of directors.

The International Association of Pharmaceutical Companies (MAFS) in the Czech Republic is currently drafting a complaint that will be submitted to the European Commission. MAFS says that the deal was done behind closed doors and breaches EU law requiring national governments to publish their pricing policy for medicines.

The health ministry spokesman also denied this charge.

Article reports that patient groups and mental health organisations have criticised a decision by the Czech government to cut healthcare spending, claiming it would limit patients' access to cutting-edge drugs. On 1 January 2005, new levels of reimbursement for prescription drugs began in the Czech Republic that limit the use of four popular medications, used in the treatment of schizophrenia, depression and senility. Doctors are now obliged to give primacy to generic drugs which are produced by the Czech firm Zentiva at a reduced price.