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Kenter K, Bovid K, Baker EB, Carson E, Mercer D. AOA Critical Issues Symposium: Promoting Health Equity. J Bone Joint Surg Am 2024; 106:1529-1534. [PMID: 38574165 DOI: 10.2106/jbjs.23.01056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
ABSTRACT Promoting equitable health care is to ensure that everyone has access to high-quality medical services and appropriate treatment options. The definition of health equity often can be misinterpreted, and there are challenges in fully understanding the disparities and costs of health care and when measuring the outcomes of treatment. However, these topics play an important role in promoting health equity. The COVID-19 pandemic has made us more aware of profound health-care disparities and systemic racism, which, in turn, has prompted many academic medical centers and health-care systems to increase their efforts surrounding diversity, equity, and inclusion. Therefore, it is important to understand the problems that some patients have in accessing care, promote health care that is culturally competent, create policies and standard operating procedures (at the federal, state, regional, or institutional level), and be innovative to provide cost-effective care for the underserved population. All of these efforts can assist in promoting equitable care and thus result in a more just and healthier society.
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Affiliation(s)
- Keith Kenter
- Department of Orthopaedic Surgery, Western Michigan University Homer Styker M.D. School of Medicine, Kalamazoo, Michigan
| | - Karen Bovid
- Department of Orthopaedic Surgery, Western Michigan University Homer Styker M.D. School of Medicine, Kalamazoo, Michigan
| | - E Brooke Baker
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Eric Carson
- Harlem Hospital Center, New York, NY
- Hospital for Special Surgery, Weill Cornell Medical College, New York, NY
| | - Deana Mercer
- Department of Orthopaedics and Rehabilitation, University of New Mexico, Albuquerque, New Mexico
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Sheehy O, Eltonsy S, Hawken S, Walker M, Kaul P, Winquist B, Barrett O, Savu A, Dragan R, Pugliese M, Bernatsky S, Gorgui J, Bérard A. Health Canada advisory impacts on the prevalence of oral codeine use in the Pediatric Canadian population: comparative study across provinces. Sci Rep 2024; 14:5370. [PMID: 38438444 PMCID: PMC10912710 DOI: 10.1038/s41598-024-55758-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 02/27/2024] [Indexed: 03/06/2024] Open
Abstract
Health Canada (HC) has, since 2013, issued safety alerts restricting the use of codeine-containing drugs among breastfeeding women and children/adolescents under 18 years of age. These products are linked to breathing problems among ultra-rapid CYP2D6 metabolizers and early use of opioid can lead to future opioid misuse. Using a multi-province population-based cohort study, we estimate the impact of federal safety alerts on annual rates of codeine use in the Canadian pediatric population. We analyzed data from 8,156,948 children/adolescents in five Canadian provinces between 1996 and 2021, using a common protocol. Children/adolescents were categorized as: ≤ 12 years (children) or > 12 years (adolescents). We defined codeine exposure by ≥ 1 prescription filled for codeine alone or combined with other medications. For both age categories, we obtained province-specific codeine prescription filling rates per calendar year by dividing the number of children/adolescents with ≥ 1 codeine prescription filled by the number of person-time. Annual rates of codeine use per 1000 persons vary by province from 3.0 (Quebec) to 10.1 (Manitoba) in children, and from 5.5 to 51.3 in adolescents. After the 2013 HC advisory, exposure decreased in all provinces (adjusted level change from - 0.6 to - 18.4%) in children and from - 2.1 to - 17.9% in adolescents after the 2016 advisory. Annual rates declined over time in all provinces, following HC safety alerts specific to each of the two age categories.
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Affiliation(s)
- O Sheehy
- CHU Sainte-Justine, Research Center, 3175, Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - S Eltonsy
- Rady Faculty, College of Pharmacy, University of Manitoba, Winnipeg, MB, Canada
| | - S Hawken
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Scholl of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- ICES, Ottawa, ON, Canada
| | - M Walker
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Scholl of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Better Outcomes Registry and Network (BORN) Ontario, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Departement of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
- Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, ON, Canada
- International and Global Health Office, University of Ottawa, Ottawa, ON, Canada
| | - P Kaul
- Department of Medicine Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - B Winquist
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - O Barrett
- Data and Analytics, Alberta Health Services, Calgary, AB, Canada
| | - A Savu
- Department of Medicine Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - R Dragan
- Manitoba Centre for Health Policy, Winnipeg, MB, Canada
| | - M Pugliese
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, ICES uOttawa, Ottawa, ON, Canada
| | - S Bernatsky
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - J Gorgui
- CHU Sainte-Justine, Research Center, 3175, Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - A Bérard
- CHU Sainte-Justine, Research Center, 3175, Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada.
- Faculty of Pharmacy, University of Montreal, Montreal, QC, Canada.
- Faculty of Medicine, Université Claude Bernard Lyon 1, Lyon, France.
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Berger M, Six E, Czypionka T. Policy implications of heterogeneous demand reactions to changes in cost-sharing: Patient-level evidence from Austria. Soc Sci Med 2024; 340:116488. [PMID: 38101171 DOI: 10.1016/j.socscimed.2023.116488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/11/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023]
Abstract
Cost-sharing is a prominent tool in many healthcare systems, both for raising revenue and steering patient behaviour. Although the effect of cost-sharing on demand for healthcare services has been heavily studied in the literature, researchers often apply a macro-perspective to these issues, opening the door for policy makers to the fallacy of assuming uniform demand reactions across a spectrum of different forms of treatments and diagnostic procedures. We use a simple classification system to categorize 11 such healthcare services along the dimensions of urgency and price to estimate patients' (anticipatory) demand reactions to a reduction in the co-insurance rate by a sickness fund in the Austrian social health insurance system. We use a two-stage study design combining matching and two-way fixed effects difference-in-differences estimation. Our results highlight how an overall joint estimate of an average increase in healthcare service utilization (0.8%) across all healthcare services can be driven by healthcare services that are deferrable (+1%), comparatively costly (+1.4%) or both (+1.6%) and for which patients also postponed their consumption until after the cost-sharing reduction. In contrast, we do not find a clear demand reaction for inexpensive or urgent services. The detailed analysis of the demand reaction for each individual healthcare service further illustrates their heterogeneity. We show that even comparatively minor changes to the costs borne by patients may already evoke tangible (anticipatory) demand reactions. Our findings help policy makers better understand the implications of heterogeneous demand reactions across healthcare services for using cost-sharing as a policy tool.
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Affiliation(s)
- Michael Berger
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria; Institute for Advanced Studies, Josefstädterstraße 39, 1080, Vienna, Austria.
| | - Eva Six
- Research Institute Economics of Inequality, Vienna University of Economics and Business, Welthandelsplatz 1, 1020, Wien, Austria
| | - Thomas Czypionka
- Institute for Advanced Studies, Josefstädterstraße 39, 1080, Vienna, Austria; London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
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Peacocke EF, Fusheini A, Norris P. Community pharmacists' views about prescription medicine co-payments and potential implications for equitable access to medicines: a critical realist interpretation. J Pharm Policy Pract 2023; 16:156. [PMID: 38012721 PMCID: PMC10680315 DOI: 10.1186/s40545-023-00673-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND In many countries the community pharmacist's role includes collecting prescription medicine co-payments at the point of dispensing. This is a context which can provide unique insights into individuals' access to prescription medicines, as interactions with service users about out-of-pocket (OOP) expenses that may negatively affect a pharmacist's patient counselling role. Prior research has identified that OOP expenses for prescription medicines led to decreased treatment adherence. This study aims to understand the role of community pharmacists in the collection of co-payments for prescription medicines in one region of Aotearoa New Zealand, and the possible implications for equitable access to medicines. METHODS This is a qualitative study using a case study research design. Data were collected through focus groups, individual interviews, and an electronic survey. Using a critical realist approach in thematic analysis, findings were categorised as Causal tendencies (the things that cause the events); Events (the things that community pharmacists experience); and Experiences (the perceptions and feelings of individual participants). RESULTS Our analysis finds that the current profession of community pharmacy in Aotearoa New Zealand, is under strain. The results suggest that broader government policies, such as the pharmacist's role in delivering essential health services, the fairness of standard prescription co-payments, and the role of community pharmacists as gatekeepers, have a significant influence on the profession. In addition, the study found that individual community pharmacists have a unique position in the co-payment process, face power imbalances within their role, and the study indicates evidence of value judgements towards service users. CONCLUSIONS This study is exploratory; however, its examination of the policy of prescription medicine co-payments from the perspective of community pharmacists, who play a vital role in both dispensing medicines and collecting prescription medicine co-payments, is novel. Despite prescription medicine co-payments being a routine part of pharmacists' role in many countries, it is a topic where there is limited published peer-reviewed literature. The study adds to existing evidence that funding models influence community pharmacists' role. In addition, this study identified value judgements about service users in relation to prescription medicine co-payments which may influence service users' health-seeking behaviour. In this setting, limited representation of at-risk populations in the community pharmacy profession may be a factor that negatively influence interactions between pharmacists and service users.
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Affiliation(s)
- Elizabeth F Peacocke
- Norwegian Institute of Public Health, Skøyen, P.O. Box 222, 0213, Oslo, Norway.
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
| | - Adam Fusheini
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Pauline Norris
- Va'a o Tautai, Centre for Pacific Health, University of Otago, Dunedin, New Zealand
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Berger M, Pock M, Reiss M, Röhrling G, Czypionka T. Exploring the effectiveness of demand-side retail pharmaceutical expenditure reforms : Cross-country evidence from weighted-average least squares estimation. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2023; 23:149-172. [PMID: 36131191 PMCID: PMC9968684 DOI: 10.1007/s10754-022-09337-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
Increasing expenditures on retail pharmaceuticals bring a critical challenge to the financial stability of healthcare systems worldwide. Policy makers have reacted by introducing a range of measures to control the growth of public pharmaceutical expenditure (PPE). Using panel data on European and non-European OECD member countries from 1990 to 2015, we evaluate the effectiveness of six types of demand-side expenditure control measures including physician-level behaviour measures, system-level price-control measures and substitution measures, alongside a proxy for cost-sharing and add a new dimension to the existing empirical evidence hitherto based on national-level and meta-studies. We use the weighted-average least squares regression framework adapted for estimation with panel-corrected standard errors. Our empirical analysis suggests that direct patient cost-sharing and some-but not all-demand-side measures successfully dampened PPE growth in the past. Cost-sharing schemes stand out as a powerful mechanism to curb PPE growth, but bear a high risk of adverse effects. Other demand-side measures are more limited in effect, though may be more equitable. Due to limitations inherent in the study approach and the data, the results are only explorative.
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Affiliation(s)
- Michael Berger
- Department of Health Economics Center for Public Health, Medical University of Vienna, Vienna, Austria
- Institute for Advanced Studies, Josefstädterstraße 39, Vienna, Austria
| | - Markus Pock
- Institute for Advanced Studies, Josefstädterstraße 39, Vienna, Austria
| | - Miriam Reiss
- Institute for Advanced Studies, Josefstädterstraße 39, Vienna, Austria
| | - Gerald Röhrling
- Institute for Advanced Studies, Josefstädterstraße 39, Vienna, Austria
| | - Thomas Czypionka
- Institute for Advanced Studies, Josefstädterstraße 39, Vienna, Austria.
- London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
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Sajjad A, Versteegh MM, Santi I, Busschbach J, Simon J, Roijen LHV. In search of a 'pan-European value set'; application for EQ-5D-3L. BMC Med Res Methodol 2023; 23:13. [PMID: 36635625 PMCID: PMC9835298 DOI: 10.1186/s12874-022-01830-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 12/23/2022] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES Country-specific value sets for the EQ-5D are available which reflect preferences for health states elicited from the general population. This allows the transformation of responses on EQ-5D to health state utility values. Only twelve European countries possess country-specific value sets and no value set reflecting the preferences of Europe exists. We aim to estimate a 'pan-European' value set for the EQ-5D-3L, reflecting the preferences for health states of the European population that could help to evaluate health care from the perspective of the European decision-maker. METHODS We systematically assessed and compared the methodologies of available EQ-5D-3L time trade-off (TTO) value sets from twelve European countries: Denmark, France, Germany, Hungary, Italy, Netherlands, Poland, Portugal, Romania, Slovenia, Spain and UK. Using their published coefficients, a dataset with utility values for all 243 health states was simulated. Different modelling techniques and model specifications including interaction terms were tested. Model selection was based on goodness-of-fit criteria. We also explored results with application of population size weights. RESULTS Methodological, procedural and analytical characteristics of the included EQ-5D-3L valuation studies were quite comparable. An OLS based model was the preferred model to represent European preferences. Weighting with population size made little difference. CONCLUSIONS EQ-5D-3L valuation studies were considered of sufficient comparability to form the basis for a new 'pan-European' value set. The method used allows for an easy update when new national value sets become available.
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Affiliation(s)
- Ayesha Sajjad
- grid.6906.90000000092621349Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Matthijs M. Versteegh
- grid.6906.90000000092621349Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Irene Santi
- grid.6906.90000000092621349Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jan Busschbach
- grid.5645.2000000040459992XSection of Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, The Netherlands
| | - Judit Simon
- grid.22937.3d0000 0000 9259 8492Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria ,grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK
| | - Leona Hakkaart-van Roijen
- grid.6906.90000000092621349Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands ,grid.6906.90000000092621349Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
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Nugraheni DA, Satibi S, Kristina SA, Puspandari DA. Factors Associated with Willingness to Pay for Cost-Sharing under Universal Health Coverage Scheme in Yogyakarta, Indonesia: A Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15017. [PMID: 36429734 PMCID: PMC9690347 DOI: 10.3390/ijerph192215017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND National Health Insurance (NHI) in Indonesia requires an appropriate cost-sharing policy, particularly for diseases that require the largest financing. This study examined factors that influence willingness to pay (WTP) for cost-sharing under the universal health coverage scheme among patients with catastrophic illnesses in Yogyakarta, Indonesia. METHODS This was a cross-sectional study using structured questionnaires through direct interviews. The factors related to the WTP for cost-sharing under the NHI scheme in Indonesia were identified by a bivariable logistic regression analysis. RESULTS Two out of every five (41.2%) participants had willingness to pay for cost-sharing. Sex [AOR = 0.69 (0.51, 0.92)], education [AOR = 1.54 (0.67, 3.55)], family size [AOR = 1.71 (1.07, 2.73)], occupation [AOR = 1.35 (0.88, 2.07)], individual income [AOR = 1.50 (0.87, 2.61)], household income [AOR = 1.47 (0.90, 2.39)], place of treatment [AOR = 2.54 (1.44, 4.45)], a health insurance plan [AOR = 1.22 (0.87, 1.71)], and whether someone receives an inpatient or outpatient service [AOR = 0.23 (0.10, 0.51)] were found to affect the WTP for a cost-sharing scheme with p < 0.05. CONCLUSION Healthcare (place of treatment, health insurance plan, and whether someone receives an inpatient or outpatient service) and individual socioeconomic (sex, educational, family size, occupational, income) factors were significantly related to the WTP for cost-sharing.
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Affiliation(s)
- Diesty Anita Nugraheni
- Doctoral Graduate Program, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, Universitas Islam Indonesia, Yogyakarta 55584, Indonesia
| | - Satibi Satibi
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Susi Ari Kristina
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Diah Ayu Puspandari
- Department of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
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Kim J, Je NK, Choo E, Jang EJ, Lee IH. Association between cost-sharing and drug prescribing in Korean elderly veterans with chronic diseases: A real-world claims data study. Medicine (Baltimore) 2022; 101:e30649. [PMID: 36123850 PMCID: PMC9478235 DOI: 10.1097/md.0000000000030649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
This study aimed to investigate the relationship between cost-sharing and drug prescribing and its appropriateness in Korean elderly veterans with chronic conditions. This is a cross-sectional study using real-world claims data. Veterans with primary hypertension or dyslipidemia were compared with two controls with higher levels of cost-sharing. Study subjects (age ≥65 years) were selected through stratified random sampling and matching the individual attributes. The primary outcome was the annual amount of drugs prescribed per patient, and the secondary outcomes included several other measures investigating multifaceted aspects of drug prescribing, medical institution utilization behavior, and prescribing appropriateness. Gamma regression models or logistic regression models were employed. Veterans were prescribed 59%~74% more drugs (exp (β) = 1.59 [95% confidence interval [CI] = 1.55-1.64] ~ 1.74 [1.70-1.79]) compared to the National Health Insurance (NHI) patients. This was attributed mainly to longer prescribing days (44%) and slightly more prescriptions (6%~7%) than NHI patients. Veterans spent 14%~15% higher medication costs. Veterans were less likely to visit multiple medical institutions by estimates of 0.77 (0.76-0.79) ~ 0.80 (0.79-0.82). Similar but smaller differences were observed between veterans and medical aid (MedAid) patients. The veteran patients showed a more than 50% increased risk of therapeutic duplication than the other two controls (adjusted odds ratio [ORs] = 1.47 [1.37-1.57] ~ 1.61 [1.50-1.72]). Inappropriate drug prescribing was also more common in veterans than the two controls (adjusted ORs = 1.20 [1.11-1.31] ~ 1.32 [1.22-1.43]). In Korean elderly veterans with chronic illnesses, a level of cost-sharing was associated with having more prescribed medicines, and increased inappropriate prescribing.
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Affiliation(s)
- Jin Kim
- College of Pharmacy, Yeungnam University, Gyeongsan, Republic of Korea
| | - Nam Kyung Je
- College of Pharmacy, Pusan National University, Busan, Republic of Korea
| | - Eunjung Choo
- College of Pharmacy, Ajou University, Suwon, Republic of Korea
| | - Eun Jin Jang
- Department of Information Statistics, Andong National University, Andong, Republic of Korea
| | - Iyn-Hyang Lee
- College of Pharmacy, Yeungnam University, Gyeongsan, Republic of Korea
- *Correspondence: Iyn-Hyang Lee, College of Pharmacy, Yeungnam University, Gyeongsan 38541, Republic of Korea (e-mail: )
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de Moraes RM, dos Santos MAB, Vieira FS, de Almeida RT. Public policy coverage and access to medicines in Brazil. Rev Saude Publica 2022; 56:58. [PMID: 35766787 PMCID: PMC9239427 DOI: 10.11606/s1518-8787.2022056003898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/03/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Describe consumption patterns for monetary and non-monetary acquisition of medicines according to age and income groups, highlighting pharmaceuticals associated with health programs with specific access guarantees. METHODS Descriptive observational study using microdata from the 2017-2018 Pesquisa de Orçamentos Familiares (Household Budget Survey, POF/IBGE). We initially reviewed programs/policies with specific guarantees of access to medicines in the SUS. Using the pharmaceutical product list of POF-4 (chart 29 of the questionnaire on individual expenditures), we selected the medicines related to these programs. We then described frequencies and percentages for not reporting medicine consumption and for reporting consumption (either through monetary or non-monetary acquisition) according to age and income groups. For medicines with distinctive access guarantees, we compared average monthly values of acquisitions and consumption patterns by age and income. RESULTS 63% of those in the ≤ 2 minimum wage (MW) household income group did not report consuming medicines in the last month. Among those earning > 25 MW, 44.3% did not report consumption. Non-monetary acquisitions of medicines were mainly reported for the < 10 MW group and for the elderly and accounted for 20.5% of the total consumption of medicines (in value). For policies with specific access guarantees, non-monetary acquisitions reached 33.6% of total consumption. This percentage varied for the various selected medicines: vaccines, 83.3%; cancer drugs, 70.3%; diabetes, 47.9%; hypertension, 35.9%; asthma and bronchitis, 29.2%; eye problems, 14%; prostate and urinary tract, 10.7%; gynecological, 11.6%; and contraceptives, 9.7%. CONCLUSION Shares for non-monetary acquisitions of medicines are still low but benefit mainly lower-income and older age groups. Policies and programs with specific access guarantees to medicines have increased access. Results suggest the need to strengthen and expand pharmaceutical care policies.
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Affiliation(s)
- Ricardo Montes de Moraes
- Instituto Brasileiro de Geografia e EstatísticaRio de JaneiroRJBrasil Instituto Brasileiro de Geografia e Estatística. Rio de Janeiro, RJ, Brasil
- Universidade Federal do Rio de JaneiroInstituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa em EngenhariaPrograma de Engenharia BiomédicaRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro.Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa em Engenharia. Programa de Engenharia Biomédica. Rio de Janeiro, RJ, Brasil
| | - Maria Angelica Borges dos Santos
- Fundação Oswaldo CruzEscola Nacional de Saúde PúblicaRio de JaneiroRJBrasilFundação Oswaldo Cruz.Escola Nacional de Saúde Pública. Rio de Janeiro, RJ, Brasil
| | - Fabiola Sulpino Vieira
- Instituto de Pesquisa Econômica AplicadaBrasíliaDFBrasil Instituto de Pesquisa Econômica Aplicada. Brasília, DF, Brasil
| | - Rosimary Terezinha de Almeida
- Universidade Federal do Rio de JaneiroInstituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa em EngenhariaPrograma de Engenharia BiomédicaRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro.Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa em Engenharia. Programa de Engenharia Biomédica. Rio de Janeiro, RJ, Brasil
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The impact of a co-payment increase on the consumption of type 2 antidiabetics - A nationwide interrupted time series analysis. Health Policy 2021; 125:1166-1172. [PMID: 34078544 DOI: 10.1016/j.healthpol.2021.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 11/21/2020] [Accepted: 05/15/2021] [Indexed: 11/21/2022]
Abstract
International literature suggests that co-payment increases are associated with decreased medicine use, although the effects depend on context. We examined the impact of a co-payment increase on the consumption of type 2 antidiabetics in Finland, a country with a comprehensive health and social security system including ceiling mechanisms aiming to protect patients from high co-payment expenditures. We used administrative register data on all reimbursed purchases of antidiabetics during 2014-2018. An interrupted time series design with segmented regression was used to examine the mean monthly purchase per person, measured as Defined Daily Doses (DDDs), before and after the co-payment increase. At baseline, the mean monthly purchase per person of type 2 antidiabetics was 105 DDDs (95% CI 103.8; 106.0;p<0.001) and there was a decreasing trend of 0.2 DDDs per month (95% CI -0.23;-0.13;p<0.001). A statistically significant decrease of 5.6 DDDs (95% CI -7.3;-3.8;p<0.001) was detected after the reform; however, no significant change in the trend was observed. No significant increase was detected in the mean monthly per person purchase of insulins. The results suggest that a co-payment increase decreases consumption of necessary medicines despite the presence of a medicine co-payment ceiling mechanism. Whether the decrease was associated with negative health effects remains to be further investigated.
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Martínez-Jiménez M, García-Gómez P, Puig-Junoy J. The Effect of Changes in Cost Sharing on the Consumption of Prescription and Over-the-Counter Medicines in Catalonia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052562. [PMID: 33806543 PMCID: PMC7967646 DOI: 10.3390/ijerph18052562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 02/25/2021] [Indexed: 11/16/2022]
Abstract
Many universal health care systems have increased the share of the price of medicines paid by the patient to reduce the cost pressure faced after the Great Recession. This paper assesses the impact of cost-sharing changes on the propensity to consume prescription and over-the-counter medicines in Catalonia, a Spanish autonomous community, affected by three new cost-sharing policies implemented in 2012. We applied a quasi-experimental difference-in-difference method using data from 2010 to 2014. These reforms were heterogeneous across different groups of individuals, so we define three intervention groups: (i) middle-income working population—co-insurance rate changed from 40% to 50%; (ii) low/middle-income pensioners—from free full coverage to 10% co-insurance rate; (iii) unemployed individuals without benefits—from 40% co-insurance rate to free full coverage. Our control group was the low-income working population whose co-insurance rate remained unchanged. We estimated the effects on the overall population as well as on the group with long-term care needs. We evaluated the effect of these changes on the propensity to consume prescription or over-the-counter medicines, and explored the heterogeneity effects across seven therapeutic groups of prescription medicines. Our findings showed that, on average, these changes did not significantly change the propensity to consume prescription or over-the-counter medicines. Nonetheless, we observed that the propensity to consume prescription medicines for mental disorders significantly increased among unemployed without benefits, while the consumption of prescribed mental disorders medicines for low/middle-income pensioners with long-term care needs decreased after becoming no longer free. We conclude that the propensity to consume medicines was not affected by the new cost-sharing policies, except for mental disorders. However, our results do not preclude potential changes in the quantity of medicines individuals consume.
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Affiliation(s)
- Mario Martínez-Jiménez
- Division of Health Research, Faculty of Health & Medicine, Lancaster University, Lancaster LA1 4AT, UK
- Correspondence:
| | - Pilar García-Gómez
- Erasmus School of Economics, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands;
- Tinbergen Institute, Burgemeester Oudlaan 50, 3062 PA Rotterdam, The Netherlands
| | - Jaume Puig-Junoy
- School of Management (UPF-BSM), Universitat Pompeu Fabra-Barcelona, Balmes 134, 08008 Barcelona, Spain;
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What happens to drug use and expenditure when cost sharing is completely removed? Evidence from a Canadian provincial public drug plan. Health Policy 2020; 124:977-983. [PMID: 32553741 DOI: 10.1016/j.healthpol.2020.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 03/06/2020] [Accepted: 05/05/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The role of cost-sharing for medicines is under active policy discussion, including in proposals for value-based insurance design. To inform this debate, we estimated the impact of completely removing cost-sharing on medication use and expenditure using a quasi-experimental approach. METHODS Fair PharmaCare, British Columbia's income-based public drug plan, includes a household out-of-pocket limit. Therefore, when one household member starts a long-term high-cost drug surpassing this maximum, cost-sharing is completely removed for other family members. We used an interrupted time series design to estimate monthly prescriptions and expenditures of other household members, 24 months before and after cost-sharing removal. RESULTS We studied 2191 household members newly free of cost-sharing requirements, most of whom had lower incomes. R emoving cost-sharing increased the level of drug expenditure and prescription numbers by 16 and 19%, respectively (i.e. $2659.43 (95%$1507.27-$3811.59, p < 0.001); 50.0 (95%CI 25.1-74.9, p < 0.001)) relative to prior expenditures and utilization without changing pre-existing trends. Much of this change was driven by 533 individuals initiating medication for the first time after cost-sharing removal. This initiation substantially increased average expenditure, especially for antiviral agents. CONCLUSIONS Completely removing cost-sharing, independent of health status, significantly increased medication use and expenditure particularly due to medicine initiation by new users. While costs may be preventing use, the appropriateness of additional use, especially among new users, is unclear.
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Portable Normothermic Cardiac Perfusion System in Donation After Cardiocirculatory Death: A Health Technology Assessment. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2020; 20:1-90. [PMID: 32190164 PMCID: PMC7077939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Heart transplantation is the most effective treatment for people experiencing end-stage heart failure whose quality of life and life expectancy are unacceptable. However, there is a chronic shortage of donor hearts to meet the demand, so it is essential to expand the donor pool and increase supply. Heart donation mainly occurs after brain death (neurological determination of death [NDD]), but it may also be feasible after cardiocirculatory death (when the heart has stopped beating and there is no longer blood flow or a pulse), provided specialized preservation techniques are used. An investigational device, a portable normothermic cardiac perfusion system, could make it possible to procure, preserve, and transport hearts donated after cardiocirculatory death (DCD). We conducted a health technology assessment of a portable normothermic cardiac perfusion system for the preservation and transportation of DCD hearts for adult transplantation. This included an evaluation of the effectiveness, safety, value for money, and budget impact of publicly funding this system, as well as an evaluation of patient preferences and values. METHODS We performed a systematic review of the clinical literature published since 1998 that examined the clinical safety and effectiveness of a portable normothermic cardiac perfusion system for DCD heart transplantation. We assessed the risk of bias of each included study and the quality of the body of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. We also reviewed the economic evidence published during the same time period for the cost-effectiveness of a portable normothermic cardiac perfusion system for DCD hearts compared with cold storage for NDD hearts. We further estimated the 5-year net budget impact of publicly funding a normothermic cardiac perfusion system for DCD heart transplantation for adults on Ontario's waitlist. To contextualize the potential value of a portable normothermic cardiac perfusion system, we spoke with people waiting for a heart transplant, people who had received a heart transplant, and family members of organ donors. RESULTS We screened 2,386 clinical citations. One study and two case reports met the inclusion criteria. The survival of recipients of DCD hearts procured with a portable normothermic cardiac perfusion system did not differ significantly from the survival of recipients of hearts donated after NDD at 30 days or 90 days, nor was there a significant difference in cumulative survival at 1 year post-transplant (GRADE: Very Low). The occurrence of rejection and graft failure also did not significantly differ between the groups (GRADE: Very Low). Cardiac function in the early post-operative period was better in DCD hearts than NDD hearts (GRADE: Very Low). There were no differences in outcomes between DCD procurement techniques.The economic literature search yielded 62 citations. One report met the inclusion criteria but was not directly applicable to the Ontario context. Given the lack of clinical and economic evidence on long-term outcomes, we did not conduct a primary economic evaluation. In the budget impact analysis, based on the number of DCD donors under 40 years of age in the last 5 years, we estimated that the increased availability of donor hearts made possible by the technology would result in an additional seven transplants in year 1, increasing to 12 in year 5. The annual net budget impact of publicly funding a normothermic cardiac perfusion system for the transplantation of DCD hearts in Ontario over the next 5 years is about $2.0 million in the first year and about $0.9 million in each of years 2 through 5, yielding a total net budget impact of about $5.6 million. This number increases to about $10.3 million if the transplant volume increases to 18 hearts in year 1 (meaning a subsequent increase of up to 21 hearts in year 5). If transplantation were limited to people who do not qualify for a ventricular assistive device or who qualify but do not wish to receive one, the total 5-year net budget impact would be about $7.9 million.People waiting for a heart transplant or who had received a heart transplant and family members of organ donors expressed no substantial concerns about the potential use of a portable normothermic cardiac perfusion system. They hope that it may increase the number of donor hearts available for transplant. For family members of organ donors, a perfusion system may provide comfort and value if it can increase the successful procurement of donor hearts. CONCLUSIONS Based on very low quality of evidence, the outcomes for recipients of DCD hearts preserved using a portable normothermic cardiac perfusion system appear to be similar to outcomes for recipients of NDD hearts. Owing to a lack of evidence relevant to the Ontario context, we were unable to determine whether a portable normothermic perfusion system may be cost-effective. We estimate that publicly funding a portable normothermic cardiac perfusion system for DCD heart transplantation over the next 5 years will cost about $5.6 million. The people we spoke with believe that the system may increase the number of hearts available for transplant and therefore increase the number of heart transplants that can be done.
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Mann BS, Manns BJ, Barnieh L, Oliver MJ, Devoe D, Lorenzetti D, Pauly R, Quinn RR. Peritoneal Dialysis: A Scoping Review of Strategies to Maximize pd Utilization. Perit Dial Int 2020; 37:159-164. [DOI: 10.3747/pdi.2016.00057] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/02/2016] [Indexed: 12/15/2022] Open
Abstract
The percentage of end-stage renal disease (ESRD) patients treated with peritoneal dialysis (PD) has declined in many countries since the mid-1990s. Barriers to PD have been reviewed extensively in the literature, but evidence about strategies to address these barriers and maximize the safe and effective use of PD is lacking. We therefore decided to conduct a scoping review identifying strategies to maximize PD use in adults with ESRD. Our search strategy included the following online databases: MEDLINE (OVID), EMBASE, PubMed, Cochrane Controlled Trials Register, Current Controlled Trials, and Cochrane Database of Systematic Reviews for articles published from 1974 to November 2013. Experts in the field were contacted for information about other ongoing or unpublished studies. A complementary search was conducted in the gray literature. Websites of national, provincial or regional agencies were searched for documents regarding policies surrounding the use of PD. Individual dialysis centers need to identify barriers to increasing PD in their program and direct targeted strategies to maximize PD utilization. Our review highlights some effective strategies that may be used. Our review also highlights the need for further research into strategies to maximize PD utilization.
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Affiliation(s)
| | - Braden J. Manns
- Cumming School of Medicine, Calgary, AB, Canada
- University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Calgary, AB, Canada
- University of Calgary, Calgary, AB, Canada; Alberta Kidney Disease Network, Calgary, AB, Canada
| | - Lianne Barnieh
- University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Calgary, AB, Canada
| | - Matthew J. Oliver
- Calgary, AB, Canada; Sunnybrook Health Sciences Centre, Calgary, AB, Canada
| | - Daniel Devoe
- University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Calgary, AB, Canada
| | - Dianne Lorenzetti
- University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Calgary, AB, Canada
| | - Robert Pauly
- University of Toronto, Toronto, ON, Canada; Department of Medicine, and University of Alberta, Calgary, AB, Canada
| | - Robert R. Quinn
- Cumming School of Medicine, Calgary, AB, Canada
- University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Calgary, AB, Canada
- University of Calgary, Calgary, AB, Canada; Alberta Kidney Disease Network, Calgary, AB, Canada
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Rodríguez-Feijoó S, Rodríguez-Caro A. [Pharmaceutical copayment in Spain after the 2012 reform from the user's perspective. Evidence of inequity?]. GACETA SANITARIA 2019; 35:138-144. [PMID: 31879054 DOI: 10.1016/j.gaceta.2019.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/07/2019] [Accepted: 09/17/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Identify what are the characteristics of the part of the population that says they cannot buy all the medicines prescribed by a public health doctor, relating them to the criteria that define the pharmaceutical co-payment system established by Royal Decree 16/2012, with the purpose of guiding changes that eliminate possible inequities. METHOD Association study and causal relationship between the difficulty to buy prescription drugs that users expressed through the survey called Health Barometer and a set of variables that reflect the degree of need for health services and the economic capacity, that is also part of the co-payment criteria, using multiple correspondence and regression analysis techniques. RESULTS After the analysis of the data corresponding to the years 2013-2017, evidence has been found in favour of the hypothesis that the poorest users, as well as the working ones and those with worst health show greater difficulties in accessing the medicines which have been prescribed by a public health doctor and, consequently, changes are proposed in the copayment system aimed at eliminating or, at least, reducing such differences. CONCLUSIONS The results obtained are compatible with the hypothesis that the current copayment is perceived as a barrier to access necessary medicines by some sectors of the population. Although certain actions aimed at reducing this barrier can be derived from the work, more research that considers the opinion of the users is needed.
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Affiliation(s)
- Santiago Rodríguez-Feijoó
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Alejandro Rodríguez-Caro
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España.
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Färdow J, Broström L, Johansson M. Co-payment for Unfunded Additional Care in Publicly Funded Healthcare Systems: Ethical Issues. JOURNAL OF BIOETHICAL INQUIRY 2019; 16:515-524. [PMID: 31236758 PMCID: PMC6937223 DOI: 10.1007/s11673-019-09924-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 06/14/2019] [Indexed: 06/09/2023]
Abstract
The burdens of resource constraints in publicly funded healthcare systems urge decision makers in countries like Sweden, Norway and the UK to find new financial solutions. One proposal that has been put forward is co-payment-a financial model where some treatment or care is made available to patients who are willing and able to pay the costs that exceed the available alternatives fully covered by public means. Co-payment of this sort has been associated with various ethical concerns. These range from worries that it has a negative impact on patients' wellbeing and on health care institutions, to fears that co-payment is in conflict with core values of publicly funded health care systems. This article provides an overview of the main ethical issues associated with co-payment, and ethical arguments both in support of and against it will be presented and analyzed.
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Affiliation(s)
- Joakim Färdow
- Medical ethics, Department of Clinical Sciences Lund, Lund university, 221 84 Lund, Sweden
| | - Linus Broström
- Medical ethics, Department of Clinical Sciences Lund, Lund university, 221 84 Lund, Sweden
| | - Mats Johansson
- Medical ethics, Department of Clinical Sciences Lund, Lund university, 221 84 Lund, Sweden
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You CH, Kang S, Kwon YD. The Economic Burden of Breast Cancer Survivors in Korea: A Descriptive Study Using a 26-Month Micro-Costing Cohort Approach. Asian Pac J Cancer Prev 2019; 20:2131-2137. [PMID: 31350976 PMCID: PMC6745209 DOI: 10.31557/apjcp.2019.20.7.2131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Indexed: 11/25/2022] Open
Abstract
Background: This study analyzed the burden of cancer treatment costs on patients by calculating the monthly amount of medical expenses paid by breast cancer patients for two years after mastectomy. Methods: Among those who were diagnosed with breast cancer and had received treatment at one of two academic medical centers in Seoul between 2003 and 2011, 1,087 patients who underwent mastectomy and received follow-up for at least two years were recruited. A micro-costing approach from the provider’s perspective, based on a retrospective review of patient medical claim records, was used to analyze cancer treatment cost of care. The cohort’s number of hospitalizations, total hospitalization duration, and number of outpatient visits were noted, and the total amount of medical expenses, out-of-pocket (OOP) expenditures, uninsured costs, and OOP ratio were calculated. Results: The total amount of medical expenses tended to increase by year, whereas the OOP expenditure ratio decreased. The OOP expenditure ratio was highest in the first month post-operation. Around one quarter of the total OOP payments incurred over the course of three months: one month before the operation, the month of the operation, and one month post-operation. Conclusion: OOP payment burden on patients was concentrated in the initial phase of treatment, and items not covered by the National Health Insurance caused an additional increase in patients’ burden in the initial phase. The economic burden of cancer treatment varies considerably. In order to alleviate patients’ medical expenses burden, the timing of expenditures and the possible financial burden on cancer survivors, they should be understood more fully and possibly addressed in interventions aimed at reducing the cancer burden.
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Affiliation(s)
- Chang Hoon You
- Graduate School of Public Health, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Korea
| | - Sungwook Kang
- Department of Public Health, Daegu Haany University, 1 Haanydaero, Gyeongsan, Korea
| | - Young Dae Kwon
- Department of Humanities and Social Medicine, College of Medicine and Catholic Institute for Healthcare Management, The Catholic University of Korea, 222 Banpodaero, Seocho-gu, Seoul, Korea.
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Regulating pharmaceutical companies’ financial largesse. Isr J Health Policy Res 2018; 7:25. [PMID: 29759077 PMCID: PMC5952623 DOI: 10.1186/s13584-018-0220-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 04/25/2018] [Indexed: 11/16/2022] Open
Abstract
Nissanholtz-Gannot and Yenkellevich (NGY) explore the impact of a 2010 amendment to the Israeli National Health Insurance Law that requires annual reporting of payments from pharmaceutical companies (PCs) to doctors and healthcare organizations. The amendment was adopted to ensure transparency and to facilitate appropriate regulation of interest conflicts. To learn whether the amendment was having the desired effects, NGY interviewed multiple representatives of an assortment of stakeholders. They found broad agreement among the respondents that financial relationships between PCs and physicians should be transparent. But they also discovered that ignorance of the 2010 amendment was widespread, especially among physicians, and that knowledgeable respondents thought loopholes rendered the law ineffective. Lastly, NGY found that the improvement in the transparency culture has more to do with pressure put by international and non-Israeli national actors on the multi-national PCs operating in Israel than with the Israeli new law. In this short paper we critically review NGY’s study. We are much less optimistic than they are about the situation in Israel. For example, we show that the new law has not increased transparency vis-à-vis the patients as virtually all reports to the government specify only the institutions receiving them and not individual physicians’ names. We are skeptical of the effectiveness of self-regulation or government regulation. Instead, we propose some ways to increase patients’ oversight, such as facilitation of class actions to enforce fiduciary duties and disclosures, as well as structuring co-payments for drugs in ways which will signal to the patients their relative efficacy.
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Einav L, Finkelstein A, Polyakova M. Private provision of social insurance: drug-specific price elasticities and cost sharing in Medicare Part D. AMERICAN ECONOMIC JOURNAL. ECONOMIC POLICY 2018; 10:122-153. [PMID: 30233766 PMCID: PMC6141206 DOI: 10.1257/pol.20160355] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
We explore how private drug plans set cost-sharing in the context of Medicare Part D. While publicly-provided drug coverage typically involves uniform cost-sharing across drugs, we document substantial heterogeneity in the cost-sharing for different drugs within privately-provided plans. We also document that private plans systematically set higher consumer cost sharing for drugs or classes associated with more elastic demand; to do so we estimate price elasticities of demand across more than 150 drugs and across more than 100 therapeutic classes. We conclude by discussing the various channels that likely affect private plans' cost-sharing decisions.
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Affiliation(s)
- Liran Einav
- Department of Economics, Stanford University, and NBER, 579 Serra Mall, Stanford, CA 94305- 6072
| | - Amy Finkelstein
- Department of Economics, Massachusetts Institute of Technology, and NBER, 77 Massachusetts Avenue, Building E52, Room 442, Cambridge MA 02139
| | - Maria Polyakova
- Department of Health Research and Policy, Stanford University, and NBER, Redwood Building T111, 150 Governor's Lane, Stanford, CA 94305
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Affiliation(s)
- Fiona Clement
- From the Department of Community Health Sciences, O'Brien Institute of Public Health, University of Calgary, Calgary, Alta., Canada
| | - Katherine A Memedovich
- From the Department of Community Health Sciences, O'Brien Institute of Public Health, University of Calgary, Calgary, Alta., Canada
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Alam MF, Cohen D, Dunstan F, Hughes D, Routledge P. Impact of the phased abolition of co-payments on the utilisation of selected prescription medicines in Wales. HEALTH ECONOMICS 2018; 27:236-243. [PMID: 28685890 DOI: 10.1002/hec.3530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 01/13/2017] [Accepted: 04/26/2017] [Indexed: 06/07/2023]
Abstract
We have taken advantage of a natural experiment to measure the impact of the phased abolition of prescription co-payments in Wales. We investigated 3 study periods covering the phased abolition: from £6 to £4, £4 to £3, and £3 to £0. A difference-in-difference modelling was adopted and applied to monthly UK general practice level dispensing data on 14 selected medicines which had the highest percentage of items dispensed subject to a co-payment prior to abolition. Dispensing from a comparator region (North East of England) with similar health and socio-economic characteristics to Wales, and where prescription co-payments continued during the study periods, was used to isolate any non-price effects on dispensing in Wales. Results show a small increase in dispensing of 14 selected medicines versus the comparator. Compared with NE England, monthly average Welsh dispensing was increased by 11.93 items (7.67%; 95% CI [7.2%, 8.1%]), 6.37 items (3.38%; 95% CI [2.9%, 3.7%]) and 9.18 items (4.54%; 95% CI [4.2%, 4.9%]) per practice per 1,000 population during the periods when co-payment was reduced. Price elasticities of the selected medicines utilisation were -0.23, -0.13, and -0.04 in 3 analyses, suggesting the abolition of co-payment had small effect on Welsh dispensing.
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Affiliation(s)
- M Fasihul Alam
- Public Health Department, College of Health Sciences, Qatar University, Qatar
| | - David Cohen
- Faculty of Life Sciences and Education, University of South Wales, UK
| | - Frank Dunstan
- Department of Primary Care and Public Health, Cardiff University, UK
| | - Dyfrig Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, UK
| | - Philip Routledge
- Department of Pharmacology, Therapeutics & Toxicology, Cardiff University, UK
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Campbell DJT, Manns BJ, Soril LJJ, Clement F. Comparison of Canadian public medication insurance plans and the impact on out-of-pocket costs. CMAJ Open 2017; 5:E808-E813. [PMID: 29180377 PMCID: PMC5741433 DOI: 10.9778/cmajo.20170065] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Research from 2006 documented substantial variation in medication coverage for residents across Canada. Since then, some provinces have implemented major medication plan reforms. We aimed to update the information on publicly funded medication insurance plans available across Canada and to compare out-of-pocket costs across the country. METHODS We compared provincial medication insurance plans using data from public websites and other public source documents. Using 2 hypothetical clinical examples, we determined the amount and type of a patient's out-of-pocket costs for 5 different patient subtypes that varied based on medication burden, age and income. RESULTS Each province offers a plan to all residents. Cost-sharing is employed across all provinces. Some residents must pay a premium to receive insurance or must pay 100% of their medication costs until they reach a deductible amount, above which government funding covers a portion of medication costs. With the scenario of low medication burden (medication cost about $500), out-of-pocket costs ranged from $250 to $2100 for higher-income residents and from $0 to $700 for lower-income residents. With the scenario of high medication burden (medication cost about $1800), the corresponding ranges were $250-$2500 and $0-$1100. The variation was due to province of residence, age and income. INTERPRETATION Variations in out-of-pocket payments continue to exist across the provinces, with some groups facing high expenses. Further work is required to understand the impact of different cost-sharing mechanisms, develop policies to limit out-of-pocket expenses and improve provincial drug plans.
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Affiliation(s)
- David J T Campbell
- Affiliations: Departments of Medicine (Campbell, Manns) and Community Health Sciences (Manns, Soril, Clement) and O'Brien Institute for Public Health (Manns, Clement), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Braden J Manns
- Affiliations: Departments of Medicine (Campbell, Manns) and Community Health Sciences (Manns, Soril, Clement) and O'Brien Institute for Public Health (Manns, Clement), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Lesley J J Soril
- Affiliations: Departments of Medicine (Campbell, Manns) and Community Health Sciences (Manns, Soril, Clement) and O'Brien Institute for Public Health (Manns, Clement), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Fiona Clement
- Affiliations: Departments of Medicine (Campbell, Manns) and Community Health Sciences (Manns, Soril, Clement) and O'Brien Institute for Public Health (Manns, Clement), Cumming School of Medicine, University of Calgary, Calgary, Alta
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Association between copayment, medication adherence and outcomes in the management of patients with diabetes and heart failure. Health Policy 2017; 121:363-377. [PMID: 28314467 DOI: 10.1016/j.healthpol.2017.02.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 02/02/2017] [Accepted: 02/06/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To determine the association between copayment, medication adherence and outcomes in patients with Heart failure (HF) and Diabetes Mellitus (DM). METHODS PubMed, Scopus and Cochrane databases were searched using combinations of four sets of key words for: drug cost sharing; resource use, health and economic outcomes; medication adherence; and chronic disease. RESULTS Thirty eight studies were included in the review. Concerning the direct effect of copayment changes on outcomes, the scarcity and diversity of data, does not allow us to reach a clear conclusion, although there is some evidence indicating that higher copayments may result in poorer health and economic outcomes. Seven and one studies evaluating the relationship between copayment and medication adherence in DM and HF population, respectively, demonstrated an inverse statistically significant association. All studies (29) examining the relationship between medication adherence and outcomes, revealed that increased adherence is associated with health benefits in both DM and HF patients. Finally, the majority of studies in both populations, showed that medication adherence was related to lower resource utilization which in turn may lead to lower total healthcare cost. CONCLUSION The results of our systematic review imply that lower copayments may result in higher medication adherence, which in turn may lead to better health outcomes and lower total healthcare expenses. Future studies are recommended to reinforce these findings.
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Morgan SG, Lee A. Cost-related non-adherence to prescribed medicines among older adults: a cross-sectional analysis of a survey in 11 developed countries. BMJ Open 2017; 7:e014287. [PMID: 28143838 PMCID: PMC5293866 DOI: 10.1136/bmjopen-2016-014287] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES To assess the effects of costs on access to medicines in 11 developed countries offering different levels of prescription drug coverage for their populations. DESIGN Cross-sectional study of data from the Commonwealth Fund 2014 International Health Policy Survey of Older Adults. SETTING Telephone survey conducted in 11 high-income countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK and the USA. PARTICIPANTS 22 532 adults aged 55 and older and living in the community in studied countries. PRIMARY OUTCOME MEASURE Self-reported cost-related non-adherence (CRNA) in the form of either not filling a prescription or skipping doses within the last 12 months because of out-of-pocket costs. RESULTS Estimated prevalence of CRNA among all older adults varied from <3% in the France, Norway, Sweden, Switzerland and the UK to 16.8% in the USA. Canada had the second highest national prevalence of CRNA (8.3%), followed by Australia (6.8%). Older adults in the USA were approximately six times more likely to report CRNA than older adults in the UK (adjusted OR=6.09; 95% CI 3.60 to 10.20). Older adults in Australia and Canada were also statistically significantly more likely to report CRNA than older adults in the UK. Across most countries, the prevalence of CRNA was higher among lower income residents and lower among residents over age 65. CONCLUSIONS Observed differences in national prevalence of CRNA appear to follow lines of availability of prescription drug coverage and the extent of direct patient charges for prescriptions under available drug plans.
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Affiliation(s)
- Steven G Morgan
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Augustine Lee
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Morgan SG, Boothe K. Universal prescription drug coverage in Canada: Long-promised yet undelivered. Healthc Manage Forum 2016; 29:247-254. [PMID: 27744279 PMCID: PMC5094297 DOI: 10.1177/0840470416658907] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Canada's universal public healthcare system is unique among developed countries insofar as it does not include universal coverage of prescription drugs. Universal, public coverage of prescription drugs has been recommended by major national commissions in Canada dating back to the 1960s. It has not, however, been implemented. In this article, we extend research on the failure of early proposals for universal drug coverage in Canada to explain failures of calls for reform over the past 20 years. We describe the confluence of barriers to reform stemming from Canadian policy institutions, ideas held by federal policy-makers, and electoral incentives for necessary reforms. Though universal "pharmacare" is once again on the policy agenda in Canada, arguably at higher levels of policy discourse than ever before, the frequently recommended option of universal, public coverage of prescription drugs remains unlikely to be implemented without political leadership necessary to overcome these policy barriers.
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Affiliation(s)
- Steven G Morgan
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Katherine Boothe
- Department of Political Science, McMaster University, Hamilton, Ontario, Canada
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Campbell DJT, Tonelli M, Hemmelgarn B, Mitchell C, Tsuyuki R, Ivers N, Campbell T, Pannu R, Verkerke E, Klarenbach S, King-Shier K, Faris P, Exner D, Chaubey V, Manns B. Assessing outcomes of enhanced chronic disease care through patient education and a value-based formulary study (ACCESS)-study protocol for a 2×2 factorial randomized trial. Implement Sci 2016; 11:131. [PMID: 27671037 PMCID: PMC5037634 DOI: 10.1186/s13012-016-0491-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 09/08/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Chronic diseases result in significant morbidity and costs. Although medications and lifestyle changes are effective for improving outcomes in chronic diseases, many patients do not receive these treatments, in part because of financial barriers, patient and provider-level knowledge gaps, and low patient motivation. The Assessing outcomes of enhanced chronic disease care through patient education and a value-based formulary study (ACCESS) will determine the impact of two interventions: (1) a value-based formulary which eliminates copayment for high-value preventive medications; and (2) a comprehensive self-management support program aimed at promoting health behavior change and medication adherence, combined with relay of information on medication use to healthcare providers, on cardiovascular events and/or mortality in low-income seniors with elevated cardiovascular risk. METHODS The ACCESS study will use a parallel, open label, factorial randomized trial design, with blinded endpoint evaluation in 4714 participants who are over age >65 (and therefore have drug insurance provided by Alberta Blue Cross with 30 % co-payment); are at a high risk for cardiovascular events based on a history of any one of the following: coronary heart disease, prior stroke, chronic kidney disease, heart failure, or any two of the following: current cigarette smoking, diabetes mellitus, hypertension, or hypercholesterolemia; and have a household income DISCUSSION Given identified gaps in care in chronic disease, and the frequency of financial and knowledge-related barriers in low-income Albertans, this study will test the impact of providing free high-value preventive medications (i.e., value-based insurance) and a tailored self-management education and facilitated relay strategy on outcomes and costs. By measuring the impact on both health outcomes and costs, as well as the impact on reducing health inequities in this vulnerable population, our study will facilitate informed policy decisions. TRIAL REGISTRATION Clinicaltrials.gov: NCT02579655 . Registered Oct 15, 2015.
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Affiliation(s)
- David J. T. Campbell
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Marcello Tonelli
- Departments of Medicine and Community Health Sciences, Libin Institute and Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Brenda Hemmelgarn
- Departments of Medicine and Community Health Sciences, Libin Institute and Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Ross Tsuyuki
- Department of Pharmaceutical Sciences, University of Alberta, Edmonton, Canada
| | - Noah Ivers
- Department of Family Medicine, University of Toronto, Toronto, Canada
| | - Tavis Campbell
- Department of Psychology, University of Calgary, Calgary, Canada
| | | | | | | | | | | | - Derek Exner
- Departments of Medicine and Community Health Sciences, Libin Institute and Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Vikas Chaubey
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Braden Manns
- Departments of Medicine and Community Health Sciences, Libin Institute and Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Foothills Medical Centre, 1403 29th St. NW, Calgary, Alberta Canada T2N 2T9
| | - On behalf of the Interdisciplinary Chronic Disease Collaboration
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Departments of Medicine and Community Health Sciences, Libin Institute and Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Alberta Health, Edmonton, Canada
- Department of Pharmaceutical Sciences, University of Alberta, Edmonton, Canada
- Department of Family Medicine, University of Toronto, Toronto, Canada
- Department of Psychology, University of Calgary, Calgary, Canada
- Emergence Creative, New york, USA
- Department of Medicine, University of Alberta, Edmonton, Canada
- Faculty of Nursing, University of Calgary, Calgary, Canada
- Alberta Health Services, Edmonton, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Foothills Medical Centre, 1403 29th St. NW, Calgary, Alberta Canada T2N 2T9
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Arsenijevic J, Pavlova M, Rechel B, Groot W. Catastrophic Health Care Expenditure among Older People with Chronic Diseases in 15 European Countries. PLoS One 2016; 11:e0157765. [PMID: 27379926 PMCID: PMC4933384 DOI: 10.1371/journal.pone.0157765] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 06/03/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION It is well-known that the prevalence of chronic diseases is high among older people, especially those who are poor. Moreover, chronic diseases can result in catastrophic health expenditure. The relationship between chronic diseases and their financial burden on households is thus double-sided, as financial difficulties can give rise to, and result from, chronic diseases. Our aim was to examine the levels of catastrophic health expenditure imposed by private out-of-pocket payments among older people diagnosed with diabetes mellitus, cardiovascular diseases and cancer in 15 European countries. METHODS The SHARE dataset for individuals aged 50+ and their households, collected in 2010-2012 was used. The total number of participants included in this study was N = 51,661. The sample consisted of 43.8% male and 56.2% female participants. The average age was 67 years. We applied an instrumental variable approach for binary instrumented variables known as a treatment-effect model. RESULTS We found that being diagnosed with diabetes mellitus and cardiovascular diseases was associated with catastrophic health expenditure among older people even in comparatively wealthy countries with developed risk-pooling mechanisms. When compared to the Netherlands (the country with the lowest share of out-of-pocket payments as a percentage of total health expenditure in our study), older people diagnosed with diabetes mellitus in Portugal, Poland, Denmark, Italy, Switzerland, Belgium, the Czech Republic and Hungary were more likely to experience catastrophic health expenditure. Similar results were observed for diagnosed cardiovascular diseases. In contrast, cancer was not associated with catastrophic health expenditure. DISCUSSION Our study shows that older people with diagnosed chronic diseases face catastrophic health expenditure even in some of the wealthiest countries in Europe. The effect differs across chronic diseases and countries. This may be due to different socio-economic contexts, but also due to the specific characteristics of the different health systems. In view of the ageing of European populations, it will be crucial to strengthen the mechanisms for financial protection for older people with chronic diseases.
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Affiliation(s)
- Jelena Arsenijevic
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Bernd Rechel
- European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Wim Groot
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Top Institute Evidence-Based Education Research (TIER), Maastricht University, Maastricht, The Netherlands
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Jakovljevic M. Commentary: Patient Cost Sharing and Medical Expenditures for the Elderly. Front Pharmacol 2016; 7:73. [PMID: 27065864 PMCID: PMC4813085 DOI: 10.3389/fphar.2016.00073] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/10/2016] [Indexed: 12/03/2022] Open
Affiliation(s)
- Mihajlo Jakovljevic
- Graduate Health Economics and Pharmacoeconomics Curricula, Faculty of Medical Sciences, University of KragujevacKragujevac, Serbia
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Lessing C, Ashton T, Davis P. New Zealand patients' understanding of brand substitution and opinions on copayment options for choice of medicine brand. AUST HEALTH REV 2015; 40:345-350. [PMID: 26363980 DOI: 10.1071/ah15004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 07/30/2015] [Indexed: 12/30/2022]
Abstract
Objective The aim of the present study was to better understand the views and experiences of New Zealand patients on switching between brands of prescription medicines and on alternative funding options for the provision of medicines, including an increase in copayments. Methods A self-administered questionnaire was offered to selected patients through participating community pharmacies. Pharmacies were stratified according to level of deprivation of the community served before random selection and invitation for involvement in the study. Patient understanding of and rationale for brand substitution was assessed. Preference for different copayment options was elicited, together with demographic and other explanatory information. Results In all, 194 patient-completed questionnaires were returned. Some gaps in patient knowledge and understanding of brand changes were evident. Most respondents indicated a preference for the existing subsidy arrangements with little desire expressed for alternatives. Around half were willing to contribute towards paying for a choice of brand other than the subsidised brand; however, the maximum contribution nominated was disproportionately lower than real cost differences between originator brand and generics. Conclusion The findings of the present study suggest that although most patients have experienced brand changes without any problems occurring, a lack of knowledge about substitution does persist. There may be some additional gain in ensuring New Zealanders are aware of the full cost of their medicines at the point of dispensing to reinforce the benefits of the Pharmaceutical Management Agency (PHARMAC) purchasing model. What is known about the topic? Generic reference pricing is used as a mechanism to make savings to pharmaceutical budgets; however, reticence to the use of generic medicines persists. What does this paper add? Most New Zealand patients experience brand changes without any problems occurring; however, a lack of knowledge about substitution does persist. The dollar value patients indicate they would contribute for brand choice is lower than the true cost difference between brands. What are the implications for practitioners? Opportunities exist for healthcare professionals to reinforce generic policies and there may be some additional gain in ensuring New Zealanders are aware of the full cost of their medicines at the point of dispensing.
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Affiliation(s)
- Charon Lessing
- Health Systems Section, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Toni Ashton
- Health Systems Section, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Peter Davis
- Health Systems Section, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
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Han E, Chae SM, Kim NS, Park S. Effects of pharmaceutical cost containment policies on doctors' prescribing behavior: Focus on antibiotics. Health Policy 2015; 119:1245-54. [PMID: 26119997 DOI: 10.1016/j.healthpol.2015.05.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 05/08/2015] [Accepted: 05/12/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We analyzed the effect of the outpatient prescription incentive program and price cuts of listed medicines in South Korea on prescription drug expenditures and prescription behaviors, focusing on antibiotics for the most common infectious diseases. METHODS We used the National Health Insurance claims data from January 1, 2009 through December 31, 2012. For 1625 primary clinics randomly sampled, we included all claims with principal diagnoses of acute upper respiratory tract infections (URTIs, J00-J06), acute lower respiratory tract infections (LRTIs, J20-J22), or otitis media (H65, H66). An interrupted time-series analysis was conducted. RESULTS Pharmaceutical spending per claim dropped immediately after the outpatient prescription incentive program only for otitis media (adults), but the secular trend shifted downward after the incentive program for all target diseases. The incentive program lowered the trend of antibiotic prescribing rate in otitis media (adults). The program was associated with an increase of the number of antibiotics prescribed in URTI (adults) and LRTI (children) and decrease in otitis media (adults). The broad markdown of drug prices reduced pharmaceutical expenditures immediately for all diseases, but without lasting effect. CONCLUSION The direct financial incentives to physicians to reduce in prescription spending had the intended effect over time and can be an important tool to improve pharmaceutical spending management.
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Affiliation(s)
- Euna Han
- College of Pharmacy, Yonsei Institute for Pharmaceutical Research, Yonsei University, Republic of Korea
| | - Su-Mi Chae
- Korea Institute for Health and Social Affairs, Republic of Korea
| | - Nam-Soon Kim
- Korea Institute for Health and Social Affairs, Republic of Korea
| | - Sylvia Park
- Korea Institute for Health and Social Affairs, Republic of Korea.
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van Deen WK, Esrailian E, Hommes DW. Value-based health care for inflammatory bowel diseases. J Crohns Colitis 2015; 9:421-7. [PMID: 25687204 DOI: 10.1093/ecco-jcc/jjv036] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 02/10/2015] [Indexed: 02/08/2023]
Abstract
Increasing healthcare costs worldwide put the current healthcare systems under pressure. Although many efforts have aimed to contain costs in medicine, only a few have achieved substantial changes. Inflammatory bowel diseases rank among the most costly of chronic diseases, and physicians nowadays are increasingly engaged in health economics discussions. Value-based health care [VBHC] has gained a lot of attention recently, and is thought to be the way forward to contain costs while maintaining quality. The key concept behind VBHC is to improve achieved outcomes per encountered costs, and evaluate performance accordingly. Four main components need to be in place for the system to be effective: [1] accurate measurement of health outcomes and costs; [2] reporting of these outcomes and benchmarking against other providers; [3] identification of areas in need of improvement based on these data and adjusting the care delivery processes accordingly; and [4] rewarding high-performing participants. In this article we will explore the key components of VBHC, we will review available evidence focussing on inflammatory bowel diseases, and we will present our own experience as a guide for other providers.
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Affiliation(s)
- Welmoed K van Deen
- Center for Inflammatory Bowel Diseases, Melvin and Bren Simon Digestive Diseases Center, David Geffen School of Medicine, University of California Los Angeles, USA
| | - Eric Esrailian
- Center for Inflammatory Bowel Diseases, Melvin and Bren Simon Digestive Diseases Center, David Geffen School of Medicine, University of California Los Angeles, USA
| | - Daniel W Hommes
- Center for Inflammatory Bowel Diseases, Melvin and Bren Simon Digestive Diseases Center, David Geffen School of Medicine, University of California Los Angeles, USA
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