The effect of pharmaceutical co-payment increase on the use of social assistance—A natural experiment study

Abstract

Health care out-of-pocket payments can create barriers to access or lead to financial distress. Out-of-pocket expenditure is often driven by outpatient pharmaceuticals. In this nationwide register study, we study the causal relationship between an increase in patients’ pharmaceutical expenses and financial difficulties by exploiting a natural experiment design arising from a 2017 reform, which introduced higher co-payments for type 2 diabetes medicines in Finland. With difference-in-differences estimation, we analyze whether the reform increased the use of social assistance, a last-resort financial aid. We found that after the reform the share of social assistance recipients increased more among type 2 diabetes patients than among a patient group not affected by the co-payment increase, suggesting the reform increased the use of social assistance among those subject to it. The results indicate that increases in patients’ pharmaceutical expenses can lead to serious financial difficulties even in countries with a comprehensive social security system.

Austerity, economic hardship and access to medications: a repeated cross-sectional population survey study, 2013–2020

“…Previous studies revealed coinciding decrease in medication consumption and increase in economic problems. [15][16][17][18] I complement previous evidence by examining financial access to medicines as part of more general patterns of economic hardship. I ask whether austerity coincided with exacerbation of inequalities, and whether hardship related to medications developed differently than other economic problems.…”

Socioeconomic inequalities in insulin initiation among individuals with type 2 diabetes – A quasi-experimental nationwide register study

“…Previous studies have suggested an increase in economic difficulties ( Aaltonen, Niemelä, & Prix, 2022 ; Rättö & Aaltonen, 2021 ; Lavikainen, Aarnio, Jalkanen, et al, 2020 ), negative developments in satisfaction of care ( Lavikainen, Aarnio, Niskanen, Mäntyselkä, & Martikainen, 2020 ), and impacts related to the consumption of type 2 antidiabetics ( Lavikainen, Aarnio, Jalkanen, et al, 2020 ; Lavikainen, Aarnio, Niskanen, et al, 2020 ) among individuals with type 2 diabetes after the reform. Regarding insulin consumption, a survey study found responders reporting increased insulin use due to cost ( Lavikainen, Aarnio, Niskanen, et al, 2020 ).…”

The impact of national comprehensive medical reform on residents' medical expenses: Evidence from China

“…The benchmark regression results are reported in Table 3. Column (1) shows that the estimated coefficient of Policy is 0.0044 but not significant, indicating that China's NCMR pilot policy had no significant impact on residents' medical expenses of outpatients. Column (2) presents that the estimated coefficient of Policy is−0.0213 and significant at the 1% level, indicating that the pilot policy significantly reduced residents' medical expenses of inpatients.…”

“…The rapid rise of medical expenses will crowd out residents' consumption in other fields, bring about a loss of social welfare, and thus affecting the sustainable development of macro-economy ( 1 , 2 ). Therefore, how to effectively cope with the continuous rising in residents' medical expenses has become a common challenge for the medical systems worldwide, which is also a problem that national medical reform hope to solve ( 3 ).…”