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Applied Health Economics and Health Policy
Erschienen in: Applied Health Economics and Health Policy 1/2005

01.03.2005 | Original Research Article

Affordability of medicines and patients’ cost-reducing behaviour

Empirical evidence based on SUR estimates from Italy and the UK

verfasst von: Dr Vincenzo Atella, Ellen Schafheutle, Peter Noyce, Karen Hassell

Erschienen in: Applied Health Economics and Health Policy | Ausgabe 1/2005

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Abstract

Introduction

Studies have demonstrated that co-payments on medication reduce the consumption of both non-essential and essential drugs, and that the latter can lead to worse health outcomes. Far less is known about how patients cope with the cost of medication, particularly if affordability is an issue, and how this compares across two countries with different prescription charge policies. Therefore, the aim of this article is to explore empirically how, and to what extent, costs incurred by patients influence their decision-making behaviour in accessing medicines.

Methods

Based on the findings from focus groups, a questionnaire was designed that addressed medication cost issues relevant to patients in both the UK and Italy. Using an econometric model, several hypotheses are tested regarding patients’ decision-making behaviour and how it is influenced by health status, sociodemographic characteristics and the novel concept of a self-rated affordability measure.

Results

Quite a large percentage of patients (70.3% in the UK and 66.5% in Italy) stated they have to think about the cost of medicines at least sometimes. Respondents adopted numerous cost-reducing strategies, subdivided into (i) those initiated by patients and (ii) those involving self-medication. Their use was strongly influenced by income and drug affordability problems, but the self-rated affordability measure was a stronger predictor. Commonly used strategies were not to get prescribed drugs dispensed at all, prioritising by not getting all prescribed items dispensed or delaying until the respondent got paid. Furthermore, respondents with affordability issues were also cost-conscious when self-medicating with over-the-counter (OTC) products for minor conditions such as dyspepsia. Despite patients in both countries using cost-reducing strategies, their use was more pronounced in the UK, where the prescription charge was significantly higher than in Italy.

Discussion/conclusion

The results from this study provide detail on the kinds of strategies patients use to reduce the cost burden of prescription charges, and support previous research showing they may be foregoing essential medication. Because the same questionnaire was applied in two European countries, where the national health systems aim to provide healthcare services that are accessible to all citizens in need, it offers interesting insights for policy makers in other countries, where patients may have to pay a larger share of their drugs out-of-pocket, such as the US.
Fußnoten
1
11 Main studies on the topic include Leibowitz et al.,[2] Soumerai et al.,[3] O’Brien,[4] Harris et al.,[5] Ryan and Birch,[6] Huttin,[7] Hughes and McGuire,[8] Tamblyn et al.,[9] Atella[10,11] and Atella and Rosati.[12] Lexchin and Grootendorst[13] and Rice and Matsuoka[14] provide reviews of the impact of cost sharing on drug use by vulnerable populations.
 
2
22 All costs and nominal values expressed in this article refer to the period June–November 2000, when the field study was conducted.
 
3
33 In Italy, visits to specialists may incur a relatively high charge (about €35) for the patient. In the UK, these are free of charge if patients are treated under the National Health Service (NHS).
 
4
44 For more detail on the history and current organisation of the health services in Italy and the UK, see Hassell et al.[17]
 
5
55 The cost of PPCs at the time of the study was £31.40 (€52.00) and £86.20 (€144.00) for 4 and 12 months, respectively. They make financial sense for people who receive two or more prescription items per month.
 
6
66 The questionnaire is available from the authors upon request. It is also appears as Appendix 4 in Huttin (2003).[28]
 
7
77 UK pharmacists were provided with a list of drugs indicated in the two conditions, and were then asked to check with patients that they were indeed taking their medication for either dyspepsia or hypertension.
 
8
88 In this respect, it is useful to note that the Italian response rate may be considerably underestimated. In fact, in several circumstances we have not been able to recover from GPs the questionnaires that were not distributed, and in four cases GPs decided to withdraw from the study after receiving the questionnaires (accounting for 100 questionnaires). UK studies where questionnaires were handed out in pharmacies achieved similar response rates, ranging between 34% and 88% (median 50%).
 
9
99 We define an exempted patient as a patient with full exemption from any payment for prescribed medicine.
 
10
1010 The book Equity in the Finance and Delivery of Health Care: an International Perspective by van Doorslaer et al.[39] includes some of the best known articles on this subject; also see Wolfe,[40] the recent Future of Children[41] on child health and managed care, and Blackburn[42] and Blaxter.[43] An extensive review of the causality relationship existing between health and income has been provided by Adams et al.[44]
 
11
1111 In the UK, prices for OTC products for dyspepsia vary between approximately €0.60 and €3.50 for small packs of antacids, alginates and peppermint water, and approximately €3.30 to €4.00 for a small course of H2 antagonists.[50] Italian prices for the cheapest OTC products range from €4.20 for antacids to €5.90 for H2 antagonists.
 
12
1212 See Greene[51] and Stata 8.0 Reference Manual.[52]
 
13
1313 Discussion of the full set of results is available in Atella et al.[53]
 
Literatur
1.
Jacobzone S. Pharmaceutical policies in OECD countries: reconciling social and industrial goals [occasional paper no. 40]. Paris: OECD Labour Market and Social Policy, 2000CrossRef
2.
Leibowitz A, Manning W, Newhouse J. The demand for prescription drugs as a function of cost sharing. Soc Sci Med 1985; 21: 1063–9PubMedCrossRef
3.
Soumerai SB, Avorn J, Ross-Degnan D, et al. Payment restrictions for drugs under Medicaid: effects on therapy, cost and equity. N Engl J Med 1987; 317: 550–6PubMedCrossRef
4.
O’Brien B. The effect of patient charges on the utilisation of prescription medicines. J Health Econ 1989; 8: 109–32PubMedCrossRef
5.
Harris BL, Stergachis A, Ried LD. The effect of drug co-payments on utilization and cost of pharmaceuticals in a health maintenance organization. Med Care 1990; 28: 907–17PubMedCrossRef
6.
Ryan M, Birch S. Charging for health care: evidence on the utilization of NHS prescribed medicines. Soc Sci Med 1991; 33: 681–7PubMedCrossRef
7.
8.
Hughes D, McGuire A. Patient charges and the utilization of NHS prescription medicines: some estimates using a cointegration procedure. Health Econ 1995; 4: 213–20PubMedCrossRef
9.
Tamblyn R, Laprise R, Hanley JA, et al. Adverse events associated with prescription drug cost-sharing among poor and elderly persons. JAMA 2001; 285: 421–9PubMedCrossRef
10.
Atella V. Drug cost containment policies in Italy: are they really effective in the long-run? The case of minimum reference price. Health Policy 1999; 50: 197–218CrossRef
11.
Atella V. Physicians’ prescription behavior and cost to the patients in Italy: first evidence based on focus group techniques and prescription data. In: Huttin C, editor. Patient charges and decision-making behaviors of consumers and physicians. IOS Press: Amsterdam, 2003: 63–91
12.
Atella V, Rosati FC. Spesa, equità e politiche sanitarie in Italia negli anni’ 90: quali insegnamenti per il futuro. Politica Sanitaria 2002; 3(1): 3–17
13.
Lexchin J, Grootendorst P. Effects of prescription drug user fees on drug and health services use and on health status in vulnerable populations: a systematic review of the evidence. Int J Health Serv 2004; 34: 101–22PubMedCrossRef
14.
Rice T, Matsuoka KY. The impact of cost-sharing on appropriate utilization and health status: a review of the literature on seniors. Med Care Res Rev 2004; 61: 415–52PubMedCrossRef
15.
Freemantle N, Bloor K. Lessons from international experience in controlling pharmaceutical expenditure: I. Influencing patients. BMJ 1996; 312: 1469–71PubMedCrossRef
16.
McManus P, Donnelly N, Henry D, et al. Prescription drug utilization following patient co-payment changes in Australia. Pharmacoepidemiol Drug Saf 1996; 5: 385–92PubMedCrossRef
17.
Hassell K, Atella V, Schafheutle EI, et al. Cost to the patient or cost to the healthcare system? Which one matters the most for GP prescribing decisions? A UK-Italy comparison. Eur J Public Health 2003; 13: 18–23PubMedCrossRef
18.
Ham C. Health policy in Britain. Hampshire: McMillan Press Ltd, 1999
19.
Noyce PR, Huttin C, Atella V, et al. The cost of prescription medicines to patients. Health Policy 2000; 52: 129–45PubMedCrossRef
20.
Department of Health. Prescriptions dispensed in the community, statistics for 1993 to 2003: England, statistical bulletin 2004/12. London: Department of Health, 2004
21.
Office for Population Censuses and Surveys. Health Survey for England 1995. London: The Stationery Office, 1997
22.
McInnes GT. Integrated approaches to management of hypertension: promoting treatment acceptance. Am Heart J 1999; 138(3 Pt 2): 252–5PubMedCrossRef
23.
Nathan A. A non-prescription medicines formulary: 5. Products for indigestion. Pharm J 1996; 256: 678–82
24.
Jones R, Lydeard S. Prevalence of symptoms of dyspepsia in the community. BMJ 1989; 298: 30–2PubMedCrossRef
25.
Weiss MC, Hassell K, Schafheutle EI, et al. Strategies used by general practitioners to minimise the impact of the prescription charge. Eur J Gen Pract 2001; 7: 23–6CrossRef
26.
Huttin C, Andral J. How the reimbursement system may influence physicians’ decisions: results from focus groups interviews in France. Health Policy 2000; 54: 67–86PubMedCrossRef
27.
Schafheutle EI, Hassell K, Noyce PR, et al. Access to medicines: cost as an influence on the views and behaviour of patients. Health Soc Care Community 2002; 10: 187–95PubMedCrossRef
28.
Huttin C. Patient charges and decision-making behaviors of consumers and physicians. Amsterdam: IOS Press, 2003
29.
Schafheutle EI, Hassell K, Noyce PR. Developing an instrument for studying the impact of patient charge systems for pharmaceuticals on the uptake of medicines. Proceedings of the European Public Health Association (EUPHA) congress; 2000 Dec 14-16; Paris. Vandoeuvres-lès-Nancy: Société Française de Sante Publique, 2000: 290
30.
ISTAT (Istituto Nazionale di Statistica). Indagine multiscopo sulle famiglie. Rome: Condizioni di salute, 1998
31.
32.
33.
34.
35.
36.
Smith F. Health services research methods in pharmacy. Survey research: (1) design, samples and response. Int J Pharm Pract 1997; 5: 152–66CrossRef
37.
Bank of Italy 1998 Survey on Household Income and Wealth. Supplementi al bollettino statistico: note metodologiche e informazioni statistiche “I bilanci delle famiglie italiane nell’anno 1998”. Rome: Bank of Italy, 2000
38.
Office for National Statistics. Social trends 30. London: The Stationery Office, 2000: 92
39.
Van Doorslaer E, Wagstaff A, Rutten F, editors. Equity in the finance and delivery of health care: an international perspective. Oxford: Oxford Medical Publications, 1993
40.
Wolfe BL. Confronting poverty: prescriptions for change. In: Danziger SH, Sandefur GD, Weinberg DH, editors. Reform of health care for the nonelderly poor. Cambridge and London: Harvard University Press, 1994: 253–88
41.
Future of children: children and managed health care. Vol. 8, no. 2 (summer–fall). Los Altos (CA): The David and Lucille Packard Foundation, 1998
42.
Blackburn C. Poverty and health. Milton Keynes: Open University Press, 1991
43.
Blaxter M. Health and lifestyles. London and New York: Tavistock/Routledge, 1990CrossRef
44.
Adams P, Hurd MD, McFadden D, et al. Healthy, wealthy, and wise? Tests for direct causal paths between health and socioeconomic status. J Econom 2003; 112(1): 3–56CrossRef
45.
Wagstaff A. 1986. The demand for health: some new empirical evidence. J Health Econ 1986; 5(3): 195–233PubMedCrossRef
46.
Cameron AC, Trivedi PK, Milne F, et al. A microeconometric model of the demand for health care and health insurance in Australia. Rev Econ Stud 1988; 55: 85–106CrossRef
47.
Windmeijer FAG, Santos Silva JMC. Endogeneity in count data models: an application to demand for health care. J Appl Econom 1997; 12: 281–94CrossRef
48.
Atella V, Brindisi F, Deb P, et al. The determinants of access to physician services: a latent class Probit approach. Health Econ 2004; 13: 657–68PubMedCrossRef
49.
Schafheutle EI, Hassell K, Noyce PR. Coping with prescription charges in the UK. IJPP 2004; 12: 239–46
50.
Chemist & Druggist Monthly Price List. Tonbridge: United Business Media, 2000 Aug; 41(8)
51.
Greene WH. Econometric analysis. 3rd ed. Upper Saddle River (NJ): Prentice Hall, 1993
52.
Stata 8.0 Reference Manual. College Station (TX): Stata Corporation, 2003
53.
Atella V, Hassell K, Schafheutle E, et al. Do consumers adopt drug cost containment strategies? Empirical evidence from Italy and in UK [CEIS Working Paper no. 160]. Rome, 2004
54.
Schafheutle EI, Hassell K, Seston EM, et al. Non-dispensing of NHS prescriptions in community pharmacies. Int J Pharm Pract 2002; 10: 11–5CrossRef
55.
56.
Lundberg L, Johannesson M, Isacson DGL, et al. Effects of user charges on the use of prescription medicines in different socio-economic groups. Health Policy 1998; 44: 123–34PubMedCrossRef
57.
Kennedy J, Coyne J, Sclar D. Drug affordability and prescription noncompliance in the United States: 1997-2002. Clin Ther 2004; 26: 607–14PubMedCrossRef
58.
59.
Soumerai SB, McLaughlin TJ, Ross-Degnan D, et al. Effect of limiting Medicaid drug-reimbursement benefits on the use of psychotropic agents and acute mental health services by patients with schizophrenia. N Engl J Med 1994; 331: 650–5PubMedCrossRef
60.
Doran E, Robertson J, Rolfe I, et al. Patient co-payments and use of prescription medicines. Aust NZ J Public Health 2004; 28(1): 62–7CrossRef
61.
Cox ER, Henderson RR. Prescription use behaviour among Medicare beneficiaries with capped prescription benefits. J Manag Care Pharm 2002; 8: 360–4PubMed
62.
Cox ER, Jernigan C, Joel Coons SJ, et al. Medicare beneficiaries’ management of capped prescription benefits. Med Care 2001; 39: 296–301PubMedCrossRef
Metadaten
Titel
Affordability of medicines and patients’ cost-reducing behaviour
Empirical evidence based on SUR estimates from Italy and the UK
verfasst von
Dr Vincenzo Atella
Ellen Schafheutle
Peter Noyce
Karen Hassell
Publikationsdatum
01.03.2005
Verlag
Springer International Publishing
Erschienen in
Applied Health Economics and Health Policy / Ausgabe 1/2005
Print ISSN: 1175-5652
Elektronische ISSN: 1179-1896
DOI
https://doi.org/10.2165/00148365-200504010-00005

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