The argument over who will determine which drugs and technologies are provided through the basic national health insurance is really secondary. The important argument about the public drug basket has always been - and still is - over the budget.
In particular, the argument is whether the drug basket budget should be updated automatically, or whether the process should remain dependent on the treasury. This is really what will determine the level of service. The question of how the drugs are chosen is really not as important.
According to the treasury's proposal, which is still being formulated, the vast majority of the basket will be determined by the Health Ministry, with only "marginal" amounts subject to the HMOs' control.
The plan is to allow the HMOs to choose, for example, how to allocate a quarter of the budget increase, but only from a pre-approved list of drugs and technologies.
The treasury says the new freedom of choice would allow those who know best to pick what patients need. Also, this would differentiate between the HMOs and provide a certain level of competition between them.
Finally, it seems that the treasury wants to rid itself of the burden of making such decisions, and the criticism it brings.
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