The Drug Budget Silo Mentality: The Dutch Case

This article provides a broad outline of developments in the Dutch health-care policy related to the costs, budget-ing, and reimbursement of pharmaceuticals. In-hospital drugs costs are part of hospital budgets, whereas for the main part of costs, nonhospital drugs, no strict budget exists. The government sets a goal for the annual cost increase of nonhospital drugs, but has only limited means to enforce that goal. Two measures were implemented to reduce drug prices: a reference price system and a price law. Both measures had a modest and temporary impact on drug prices during the 1990s. In limiting the utilization of drugs, the package of reim-bursed drugs has been restricted. This led to a shift from public to private costs and possible substitution of cheape