Cost-related non-adherence to prescribed medicines among older adults: a cross-sectional analysis of a survey in 11 developed countries

Abstract

ObjectivesTo assess the effects of costs on access to medicines in 11 developed countries offering different levels of prescription drug coverage for their populations.DesignCross-sectional study of data from the Commonwealth Fund 2014 International Health Policy Survey of Older Adults.SettingTelephone survey conducted in 11 high-income countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK and the USA.Participants22 532 adults aged 55 and older and living in the community in studied countries.Primary outcome measureSelf-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.ResultsEstimated 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.ConclusionsObserved 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.

Healing an ailing pharmaceutical system: prescription for reform for United States and Canada

“…High out-of-pocket costs leave millions unable to fill prescriptions141518 and drive many into bankruptcy 1920. In the US an estimated 28 million people remain uninsured for healthcare,21 while 3.5 million in Canada lack drug coverage 14…”

“…Proportion of adults aged over 55 with cost related non-adherence to medication in 11 high income nations15…”

“…Cost sharing (copayments, deductibles, and co-insurance) also impedes access on both sides of the border 1522. It reduces needed and unnecessary care to similar degrees23; is a factor in reduced adherence2425; and, for some conditions, exacerbates racial disparities in health,26 raises non-drug healthcare spending, and worsens outcomes 2426.…”

“…Canada already has a single payer system but it would still require reforms because the system fully covers hospital and doctors’ services but not drugs out of hospital 1415…”

Is Cost-Related Non-Adherence to Medical Care Unique to the USA?

“…However, there is burgeoning body of research on cross-sectional comparison in CRN behaviors among developed countries. For example, in a study of adults aged 55 and older and living in the community in 11 developed countries, the authors found that following the lead of the USA with 16.8% in CRN to medication, Canada had the second highest national prevalence of CRN (8.3%), followed by Australia (6.8%) [3]. While the prevalence of CRN among all older adults were much lower in France, Norway, Sweden, Switzerland and the UK, the same study showed that CRN rates vary by income, indicating a combination of effects on access to medication by income and additional insurance coverage due to low income (i.e., additional public insurance coverage associated with low income may have offset the effect of low income).…”