Abstract

background

This analysis was considered within the framework of the German healthcare system and the associated background of resource scarcity in order to develop and present practicable policy recommendations. Germany is number one worldwide in terms of the number of physician consultations per year. On average, 242 patients are treated by a German GP per week. This has to be considered as an unsafe workload regarding patients’ health. The objective of this study was to provide a socio- and health economics focused analysis and assessment of pharmacy-based self-care and self-medication with non-prescription medicines (over the counter – OTC) as an alternative to GP consultations in cases of minor ailments.

Methods

An evaluation of data sets generated prior to this study, covering market research, epidemiology and demographics, was conducted to map the existing therapeutic pathways within the current supply system. Expert interviews lent additional support to this study as well as a decision tree diagram as an analysing tool for the behaviour of patients in the context of minor ailments. Based on these tools a qualitative and quantitative health economics analysis of the specific effects associated with pharmacy-based self-care was conducted. Based on this analysis several different scenarios were derived. Using a multi-step process with defined benchmarks, a number of healthcare policy recommendations were formulated.

findings

In Germany a net saving of ca. 21 bn Euro p.a. in expenses for medical services and products provided through the statutory health insurance sector (GKV) can be already produced by current practices of consumer self-care and self-medication. A future scenario forecasts additional savings of 2.2 bn Euro in medical expenses and 426 mio Euro in costs of medicines for the statutory health insurance. Due to fewer sick leave-associated losses of work productivity and man hours a projected further 6 bn Euro of expenditure can be avoided already and additional 750 mio Euro are expected to be saved in a future scenario. Statistically speaking, each Euro spent by consumers on self-medication translates to a net saving equivalent of about 14 Euro of otherwise required economic resources for the GKV and about 4 Euro for the national economy. Healthcare professionals and consumers alike reap substantial benefits in terms of time spent and appointments allocated to the examination and treatment of minor ailments, with self-care freeing up these finite resources for more pressing medical cases. Especially in the scope of a very high workload of GPs the saving of predicted two working hours per day in a future scenario outlines a major relief for the healthcare system.

discussion

As this project distinctly improves the data situation on saving effects and future economic potentials through self-care, the resulting ‘real-world evidence’ can replace previous assumptions. The scenario used in this study considers self-care as a substitute for medical therapy (including physician consultations and prescribed medicines). The chosen cost-minimisation analysis could be complemented by information regarding the benefits resulting from physician treatment and self-care as treatment pathways. In addition, product and indication specific results could complement the ‘average’ case of self-care which was calculated in this study.

The approach described in this paper could be used for analyses of single indications for example to investigate potential benefits of specific Rx-to-OTC-Switches.