Drug compliance, co-payment and health outcomes: evidence from a panel of Italian patients

Atella, Vincenzo; Peracchi, Franco; Depalo, Domenico; Rossetti, Claudio

doi:10.1002/hec.1135

Cited by 48 publications

(44 citation statements)

References 20 publications

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“…Our results suggest that protection of vulnerable social groups should be revised and extended to improve equity of these payments. Nevertheless it has been shown in previous studies that the lack of exemption mechanisms can produce inequalities in access to health care, which can lead to higher morbidity, emergency care admissions and mortality [34,35]. Here, we have to highlight that the health status of the Hungarian population is already lagging behind other European countries [10].…”

Section: Discussion Of the Resultsmentioning

confidence: 92%

Changes in Equity in Out-of-pocket Payments during the Period of Health Care Reforms: Evidence from Hungary

Baji

Pavlova

Gulàcsi

et al. 2012

International Journal for Equity in Health

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BackgroundAt the beginning of 2007, health care reforms were implemented in Hungary in order to decrease public expenditure on health care. Reforms involved the increase of co-payments for pharmaceuticals and the introduction of co-payments for health care services.ObjectiveThe objective of this paper is to examine the progressivity of household expenditure on health care during the reform period, separately for expenditures on pharmaceuticals and medical devices, as well as for formal and informal patient payments for health care services.MethodsWe use data on household expenditure from the Household Budget Survey carried out by the Central Statistical Office of Hungary. We present household expenditure as a percentage of household income across different income quintiles and calculate Kakwani indexes as a measure of progressivity for a four years period (2005–2008): before, during and after the implementation of the health care reforms.ResultsWe find that out-of-pocket payments on health care are highly regressive in Hungary with a Kakwani index of −0.22. In particular, households from the lowest income quintile spend an about three times larger share of their income on out-of-pocket payments (6–7 %) compared to households in the highest income quintile (2 %). Expenditures on pharmaceuticals and medical devices are the most regressive types of expenditure (Kakwani index −0.23/-0.24), and at the same time they represent a major part of the total household expenditure on health care (78–85 %). Informal payments are also regressive while expenditures on formal payments for services are the most proportional to income. We find that expenditures on formal payments became regressive after the introduction of user fees (Kakwani index −0.1). At the same time, we observe that expenditures on informal payments became less regressive during the reform period (Kakwani index increases from −0.20/-0.18 to −0.12.)ConclusionsMore attention should be paid on the protection of low-income social groups when increasing or introducing co-payments especially for pharmaceuticals but also for services. Also, it is important to eliminate the practice of informal payments in order to improve equity in health care financing.

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Section: Discussion Of the Resultsmentioning

confidence: 92%

Changes in Equity in Out-of-pocket Payments during the Period of Health Care Reforms: Evidence from Hungary

Baji

Pavlova

Gulàcsi

et al. 2012

International Journal for Equity in Health

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“…These reviews show that nonadherence to therapies tends to lead to poor outcomes, which then increase health care service utilisation and overall health care costs. In general, these costs are then passed on to patients by payers or governments through higher copayment and/or taxes, which in turn impact negatively on the level of medication adherence and on health outcomes (see Atella, Depalo, Peracchi, & Rossetti, 2006;Atella & Kopinska, 2014). For example, Sokol, McGuigan, Verbrugge, and Epstein (2005) point out that worse health outcome caused by nonadherence may be responsible for an extra 10% of hospitalisations.…”

Section: The Literature Reviewmentioning

confidence: 99%

Drug therapy adherence and health outcomes in the presence of physician and patient unobserved heterogeneity

2017

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Understanding the role that drug adherence has on health outcomes in everyday clinical practice is central for the policy maker. This is particularly true when patients suffer from asymptomatic chronic conditions (e.g., hypertension, hypercholesterolaemia, and diabetes). By exploiting a unique longitudinal dataset at patient and physician level in Italy, we show that patients and physicians unobserved characteristics play an important role in determining health status, at least as important as drug adherence. Most importantly, we find that both adherence and prescribed treatment regimen effects are highly heterogeneous across physicians, highlighting their crucial role in shaping patients' health status.

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“…Reviews in the past have focused on utilization; however, the effect of copayments on adherence is increasingly being researched. It is generally accepted that reduced adherence, which may occur in response to a copayment, leads to poorer health outcomes and increased costs for a health service through hospital admissions and hospital care [23]–[29]. Furthermore, improved adherence can lead to savings in health expenditures [30], [31].…”

Section: Introductionmentioning

confidence: 99%

The Effect of Copayments for Prescriptions on Adherence to Prescription Medicines in Publicly Insured Populations; A Systematic Review and Meta-Analysis

et al. 2013

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IntroductionCopayments are intended to decrease third party expenditure on pharmaceuticals, particularly those regarded as less essential. However, copayments are associated with decreased use of all medicines. Publicly insured populations encompass some vulnerable patient groups such as older individuals and low income groups, who may be especially susceptible to medication non-adherence when required to pay. Non-adherence has potential consequences of increased morbidity and costs elsewhere in the system.ObjectiveTo quantify the risk of non-adherence to prescribed medicines in publicly insured populations exposed to copayments.MethodsThe population of interest consisted of cohorts who received public health insurance. The intervention was the introduction of, or an increase, in copayment. The outcome was non-adherence to medications, evaluated using objective measures. Eight electronic databases and the grey literature were systematically searched for relevant articles, along with hand searches of references in review articles and the included studies. Studies were quality appraised using modified EPOC and EHPPH checklists. A random effects model was used to generate the meta-analysis in RevMan v5.1. Statistical heterogeneity was assessed using the I2 test; p>0.1 indicated a lack of heterogeneity.ResultsSeven out of 41 studies met the inclusion criteria. Five studies contributed more than 1 result to the meta-analysis. The meta-analysis included 199, 996 people overall; 74, 236 people in the copayment group and 125,760 people in the non-copayment group. Average age was 71.75years. In the copayment group, (verses the non-copayment group), the odds ratio for non-adherence was 1.11 (95% CI 1.09–1.14; P = <0.00001). An acceptable level of heterogeneity at I2 = 7%, (p = 0.37) was observed.ConclusionThis meta-analysis showed an 11% increased odds of non-adherence to medicines in publicly insured populations where copayments for medicines are necessary. Policy-makers should be wary of potential negative clinical outcomes resulting from non-adherence, and also possible knock-on economic repercussions.

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Drug compliance, co-payment and health outcomes: evidence from a panel of Italian patients

Cited by 48 publications

References 20 publications

Changes in Equity in Out-of-pocket Payments during the Period of Health Care Reforms: Evidence from Hungary

Changes in Equity in Out-of-pocket Payments during the Period of Health Care Reforms: Evidence from Hungary

Drug therapy adherence and health outcomes in the presence of physician and patient unobserved heterogeneity

The Effect of Copayments for Prescriptions on Adherence to Prescription Medicines in Publicly Insured Populations; A Systematic Review and Meta-Analysis

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