Drug Reimbursement in Four Nordic Countries

Abstract

The purpose of the present study was to describe the reimbursement systems in use for the reimbursement of medicaments purchased within the state compulsory health (sickness) insurance systems in four Nordic countries, and to study whether and how reimbursement for drug costs has been used to check the quality and quantity of drug consumption. During the study period drug reimbursement has been selective in Denmark and Norway, but in Finland and Sweden it has been a mixture of selective (free drugs) and unselective (partially reimbursed drugs). The use of drug reimbursement as a control measure to regulate the quality and quantity of drug consumption has not been explicit. With the exception of monetary costs, the objectives of the control have not been explicitly stated, and administrative practices have sometimes been arbitrary. Even though at first sight the Finnish, Norwegian, and Swedish systems of free medication may appear alike, a more detailed analysis of diseases and drugs showed that the comprehensiveness and contents of the schemes differed. The differences seemed largely of an administrative nature. The financial costs of drug reimbursement had risen rapidly and varied from one country to another, being highest in Sweden.