OBJECTIVES: The objective of this study was to study cost containment and cost reallocation and to discern how they burden households and the pharmaceutical industry. METHODS: For the period 2010-2020, we implemented content analysis on 377 statutes that concerned pharmaceutical expenditure. These measures were classified firstly with reference to their character as cost containing or rationing and, secondly, with respect to cost reallocation. RESULTS: The proportion of measures shifting healthcare costs to consumers was 31% and 48.5% to industry. Mean equivalized total consumption between 2008 and 2018 decreased by 31.5% while mean equivalized total health expenditure decreased by 20.5%. During the same period mean equivalized pharmaceutical expenditure increased by 25.56% and the proportion of households with positive expenditure increased by 31 %. Meanwhile pharmaceutical industry’s direct contribution to the total pharmaceutical expenditure increased from 1.5% in 2010 to 30.1% in 2020. CONCLUSIONS: Recent reforms (2010-2020) regarding pharmaceutical expenditure present a clear tendency to reallocate pharmaceutical cost to consumers and the pharmaceutical industry. This shifting of the cost from the public health sector to the private sector endanger the sustainability of the pharmaceutical sector, and the access of patients to quality pharmaceutical treatment.
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