Pharmacoeconomics: science, practice and challenges

In most European countries the first wave of reform in hospital finance was the introduction of some form of hospital budgeting. This changed the environment of the hospital pharmacist, who assumed more responsibility for the efficient delivery of pharmaceuticals. As a consequence of the current trend towards more demand driven healthcare systems with further reliance on market mechanisms, a second wave of reform in hospital finance is taking place. This is the introduction of case payment systems, generally based on some adaptation of the diagnosis-related groups system (DRGs), established in 1983 as the basis for reimbursing providers in the US Medicare system.