M. Jakovljevic

When cure becomes an illness-abuse of addictive prescription medicines.

Citation: Jakovljevic M, Lazarevic M, Jurisevic M and Jovanovic MR (2015) When cure becomes an illness—abuse of addictive prescription medicines. Substance Addiction as Societal Phenomenon—the Case of Serbia Psychoactive substance addiction presents a challenging public health issue worldwide particularly targeting vulnerable adolescent population (Babor et al., 2007). The illegal market turnover of the controlled substances is very difficult to trace and intervene timely among the young in the early stage of illness (Inciardi et al., 2007). Contrary to this one, legally regulated pharmaceuticals pose another dangerous threat that is more accessible to the authorities. In order to combat substance dependence the national strategies should specially emphasize prescription medicines with proven potential of abuse and addiction (Compton and Volkow, 2006). Serbia as the largest Western Balkans market and a typical Eastern European transitional health system might serve as an appropriate example of medicines abuse in the EU borderlands (Jakovljevic, 2013). The results of local research in 2008, showed that 15.1% of first grade high school students, at least once had used, some psychoactive substance (excluding nicotine and alcohol), while 7.6% of them used sedatives, which was the most common [European School Survey Project on Alcohol and Other Drugs (ESSPAD), 2008]. The national survey on life styles of citizens in Serbia in 2014 about substance use and gambling addiction reported that in the past 12 months 22.4% of the respondents used sedatives, anxiolytics or hypnotics drugs (13.9% of males and 30.9% of females) and in the last 30 days 14.6% of respondents (8% of males and 21.2% of females) used these drugs with higher preponderance among older population. In the last 12 months 5.1% of the respondents used opioids for pain treatment (4.1% of males and 6.1% of females) and in the last 30 days 2.2% of respondents (1.6% of males and 2.8% of females) used these drugs. A large number of respondents said that they had purchased these drugs in the pharmacies prescribed by their physicians –85.3% of the population 18–64 years of age used hypnotics and sedatives, and 70.3% of the population used opioid drugs (Kilibarda et al., 2014). Various studies have shown that drug addiction disorders are related to personality disorders, anxiety disorders and a considerably higher suicide rate (Regier et al., 1990). Further consequences of drug addiction are: education (Yamada et al., 1993) and employment underachievement, reduced work productivity, poor health, higher rates of human immunodeficiency virus (HIV) …

High Out-of-Pocket Health Spending in Countries With a Mediterranean Connection

In this study, we analyzed healthcare provision and health expenditure across six Mediterranean countries that adopt the National Health System (Beveridge model) and that form part of the European Union (EU) with the main aim being that of analyzing and comparing out-of-pocket health spending in countries with a European Mediterranean connection. To this end, we considered various economic indicators and statistics to derive commonalities and differences across these countries and also compared trends in these indicators to those observed across the rest of the EU. We then analyzed these findings in light of other data related to the quality of healthcare delivery and the infrastructure of the health system and discussed recent developments in healthcare within each country and the main challenges faced by the respective health systems. The results show that on average, Mediterranean countries spend less on total healthcare expenditure (THE) than the EU average, both as a proportion of GDP, as well as in per capita terms. This is primarily driven by lower-than-EU-average public funding of healthcare. The 2008/2009 macro-economic and financial crisis had a significant impact on the countries under review, and explains the persistent reductions in public health spending as part of the austerity measures put in force across sectors. On the flipside, Mediterranean countries have a higher presence of private health providers in total funding, thereby explaining the higher Out-of-Pocket (OOPs) health expenditures in these countries relative to the EU-average. With regard to the overall health infrastructure in these countries, we observed that although the supply of physicians is largely in line with the rest of the EU, there is under-supply when it comes to hospital beds. This may be symptomatic of lower government funding. Nonetheless, all countries score highly in the evaluation of the quality of health services, as recorded by international rankings like the WHOs 2000 metric, whereas health system performance indicators, namely mortality rates and life expectancy reveal favorable health outcomes in the Mediterranean EU countries. The findings in this paper may be seen in light of the Mediterranean regions lifestyle in terms of diet, health behavior, health beliefs and shared culture. In particular, the higher out-of-pocket expenditure may reflect the tendency for one-to-one relationships with private clinicians and the pursuit of person-centered care (1). Additionally, the Mediterranean people may not be as disciplined as their European counterparts in accessing and using the public health sector. The lower THE also reflects the fact that the Mediterranean countries are less wealthy than the more economically-advanced European countries.

Cold War Legacy in Public and Private Health Spending in Europe

Cold War Era (1946–1991) was marked by the presence of two distinctively different economic systems, namely the free-market (The Western ones) and central-planned (The Eastern ones) economies. The main goal of this study refers to the exploration of development pathways of Public and Private Health Expenditure in all of the countries of the European WHO Region. Based on the availability of fully comparable data from the National Health Accounts system, we adopted the 1995–2014 time horizon. All countries were divided into two groups: those defined in 1989 as free market economies and those defined as centrally-planned economies. We observed six major health expenditures: Total Health Expenditure (% of GDP), Total Health Expenditure (PPP unit), General government expenditure on health (PPP), Private expenditure on health (PPP), Social security funds (PPP) and Out-of-pocket expenditure (PPP). All of the numerical values used refer exclusively to per capita health spending. In a time-window from the middle of the 1990s towards recent years, total health expenditure was rising fast in both groups of countries. Expenditure on health % of GDP in both group of countries increased over time with the increase in the Free-market economies seen to be more rapid. The steeper level of total expenditure on health for the Free-market as of 1989 market economies, is due mainly to a steep increase in both the government and private expenditure on health relative to spending by centrally-planned economies as of the same date, with the out-of-pocket expenditure and the social security funds in the same market economies category following the same steepness. Variety of governments were leading Eastern European countries into their transitional health care reforms. We may confirm clear presence of obvious divergent upward trends in total governmental and private health expenditures between these two groups of countries over the past two decades. The degree of challenge to the fiscal sustainability of these health systems will have to be judged for each single nation, in line with its own local circumstances and perspectives.