PARIS (Reuters) - The French, among Europe's most avid consumers of prescription drugs, are popping fewer pills and powders -- not because they have become healthier, but because the government is on a mission to cut the country's healthcare bill.
In a major break with previous years, growth in medicine sales has slowed this year, to just 1 percent in the year to August compared with 5 to 7 percent between 1990 and 2005.
Drugmaker Sanofi-Aventis has announced job cuts in France and Germany and French sector body LEEM has warned of more to come, urging the government to see drugs not just as a cost but as products that help the economy and jobs.
Facing an ageing population and subsequent rise in healthcare needs, France is under pressure to reform its former lavish spending on a healthcare system rated as among the best.
In a country where doctors prescribe on average 4.5 drugs per patient against 0.8 in Europe's northern nations, this might not be such a big deal -- but the French are averse to change and the pharmaceutical industry is up in arms.
"The industry's major fear is that the government might next year decide to price drugs along the lines of what's happening in Germany, though not as radical," Emmanuel Seve, head of healthcare research at French consultant PRECEPTA, said.
When a generic drug hits the German market, prices of brand drugs in the same therapeutic area will have to come down to the generic's level.
But France's gradual reforms contrast with the sweeping plans Germany has for its system.
The government aims to cut its healthcare deficit to 3.9 billion euros ($4.98 billion) in 2007 from a targeted 6 billion this year by pushing for the sale of cheaper generics, by asking doctors to prescribe fewer medicines, by cutting or ending drug reimbursement, by taxing drugs or by combating fraud.
Without these measures, the deficit last year would have hit 16 billion euros instead of 8 billion, the Health Ministry says.
Change of Habbits
It took about 10 years of to-ing and fro-ing to get to the reform that began in 2004. That year, health spending took up 10.5 percent of France's gross domestic product, OECD data show, ranking it fourth after the U.S., Switzerland and Germany.
"The French need to change their habits -- that is at the heart of (the government's) ideas," Claude Le Pen, health economics professor at the Paris Dauphine university said. "We don't touch the ideology -- for everyone there will be a wide reimbursement basket, but the system will be better managed."
A poll in September showed that 85 percent of those surveyed believe French healthcare spending is too high due to inefficient management. Three quarters said savings could be made if doctors prescribed fewer drugs or health check-ups.
The government has involved the entire sector -- drugmakers, physicians, pharmacies and patients -- in its savings effort and this approach has been paying off in the past year and a half.
The most symbolic change, Le Pen says, is that general practitioners now have a gate-keeping role. Until 2005 the French had straight access to specialists and could see any GP.
"It's a revolution -- public authorities are discovering very late the technique and benefits of managed care," he said.
Medical services are gradually computerizing the wide use in France of paper files, which has been hampering quick and easy access for doctors to a patient's history. The government's main challenge will be to reform hospital spending.
"The system needs to become more efficient," Geoffroy Sainte-Claire Deville, account director at IMS Health France. "The question is up to what point -- do we want France to remain attractive for the industry?"
France ranks No. 4 in the global pharmaceutical market with a 5.4 percent share and is Europe's main producer of drugs.
Deville said he expected the industry to adapt and bounce back as the reforms push them to target expensive niche products on which authorities cannot refuse reimbursement.
And the government has raised its awards for innovative drugs.
"Some drugmakers say they are not opposed as such to generics when their drugs go off patent or when reimbursement on their old products stops -- as long as in return they get a high price for their innovation," PRECEPTA's Seve said.