This release is categorised as a CSO Frontier Series output. Particular care must be taken when interpreting the statistics in this release as it may use new methods which are under development and/or data sources which may be incomplete, for example new administrative data sources.
The data in this release is provided to the Central Statistics Office by the Health Service Executive’s PCRS. The PCRS is responsible for reimbursing GPs, Dentists, Pharmacists, Optometrists/Ophthalmologists, and other contractors who provide free or reduced-cost services to the public across a range of primary care schemes. PCRS supports the delivery of primary healthcare by providing reimbursement services to primary care contractors for the provision of health services to members of the public in their own community. Almost all payments for publicly funded healthcare services provided in the community by GPs, community pharmacies, dentists, and optometrists/ophthalmologists are made by the PCRS.
The General Medical Services (GMS) scheme provides access to medical and surgical services for people for whom acquiring such services would present undue hardship, such as the elderly and those with low incomes. They may be granted a medical card or GP visit card and receive free general medical services for themselves and their dependants. All GMS claims to pharmacies are processed and paid by the PCRS and are the focus of analysis here. PCRS claims are also submitted under the schemes “Drug Payment Scheme” and “Long-Term Illness Scheme”. The data in this release includes people who received an item on the GMS only. Claims made under other schemes managed by the PCRS are not included in this release. The data used in this release is from 2016 - 2023. Persons receiving medication(s) on the GMS for whom Age and Gender were not available due to linking issues were excluded from the analysis. A small number of medications did not have an ATC code available and were also excluded from the analysis.
ATC codes refer to the Anatomical Therapeutic Chemical (ATC) Classification System, which is used to classify drugs and other medical products. The system is maintained by the World Health Organization (WHO) and is widely used in pharmacology, research, and health statistics.
ATC codes follow a hierarchical structure with five levels, each providing more detail:
For example, “A10BA02” corresponds to:
It should be noted that this analysis uses a file linking HSE Drug Code to ATC code from 2022. Therefore, drugs that were classified with different ATC codes before or after this point may not be reflected in the data with their alternate codes. They are classified according to their corresponding code in 2022 alone. Details of reclassified ATC codes are included on the Norwegian Institute of Public Health website. Pregabalin and Gabapentin which were reclassified from N03 to N02 from 2023, for example.
In this release, “dispensed items” refer to instances where a prescription was filled for a given person and a claim was submitted under the GMS for reimbursement. In small numbers of cases, ATC codes were not available for dispensed items – these claims have been excluded from the analysis.
Being "active" on the GMS Scheme refers to a person holding a medical card that was reimbursed for at least one prescribed item over the course of the year.
HSE Health Regions were created in 2024 for the management of HSE activities, however, these have been linked to data going back to 2016 in the release. There are six in total and some additional information on them is contained in the HSE Health Regions 2022 release. There are health profiles of each of the Health Regions located on the ED Profiles site. Health Regions in this publication were identified by linking Local Health Office boundaries to Health Region boundaries, which is not an exact process.
The term “Medications” in this release is used to refer to items corresponding to Fifth-Level ATC codes; however, it should be noted that sometimes items such as stoma care, urinary products and diabetes ancillaries, which are not chemical substances are included. In addition, sometimes a Fifth-Level ATC can refer to the combination of multiple chemicals in a single medication.
In the interests of Statistical Disclosure Control (SDC), all figures have been rounded to the nearest ten. Furthermore, ATC codes are only reported down to the third level and SDC measures were applied to these statistics. Counts with a “..” in the PxStat files are cases where data was excluded from the outputs due to SDC concerns. In the case of percentages, a “..” is in places where a calculation of a percentage was not possible, either due to missing/suppressed data or dividing by zero.
There are misclassified ATC codes present in the data, where the same active drug is contained in multiple products used for different diseases or conditions, each with a different ATC code. For example, Diclofenac has a number of ATC codes, one of which is "D11AX18" (Diclofenac formulated as a 3% hyaluronic acid gel used in treatment of actinic keratosis). This code is present in the data beyond what would be expected based on the prevalence of this condition. It was beyond the scope of this project to reclassify misclassified ATC codes in the source data.
There was a HSE cyber-attack in May of 2021 which affected 2021 figures. Very few claims were recorded in this month and the figures for the subsequent two months were also affected. Caution should be exercised when analysing 2021 figures.
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