What happens to drug use and expenditure when cost sharing is completely removed? Evidence from a Canadian provincial public drug plan

Bai

Luo

et al. 2021

IJERPH

Full coverage policies for medicines have been implemented worldwide to alleviate medicine cost burden and promote access to medicines. However, few studies have explored the factors associated with free medicine use in patients with chronic diseases. This study aimed to analyze the utilization of free medicines by patients with hypertension and diabetes after the implementation of the full coverage policy for essential medicines (FCPEM) in Taizhou, China, and to explore the factors associated with free medicine use. We conducted a descriptive analysis of characteristics of patients with and without free medicine use and performed a panel logit model to examine factors associated with free medicine use, based on an electronic health record database in Taizhou from the baseline year (12 months in priori) to three years after FCPEM implementation. After FCPEM implementation, the proportion of patients without any free medicine use decreased from 31.1% in the baseline year to 28.9% in the third year, while that of patients taking free medicines rose from 11.0% to 22.8%. Patients with lower income or education level, those with agricultural hukou, patients aged 65 and above, married patients, and patients in the Huangyan district were more likely to take free medicines. In conclusion, FCPEM contributed to improved medicine access, especially in vulnerable populations. Local policy makers should consider expanding the coverage of FCPEM to other types of medicines and cultivate the potential of social supports for patients to enhance the effectiveness of FCPEM policies.

Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Factors Associated with Free Medicine Use in Patients with Hypertension and Diabetes: A 4-Year Longitudinal Study on Full Coverage Policy for Essential Medicines in Taizhou, China

Bai

Luo

et al. 2021

IJERPH

“…Among these countries, 54 had full coverage programs for any essential medicines (Wang et al, 2019). FCPMs is also increasingly studied and implemented in hypertension and diabetes interventions in the United States (Zheng et al, 2017;Ross-Degnan et al, 2020), Canada (Laba et al, 2020), Brazil (Emmerick et al, 2020), Spain (Puig-Junoy et al, 2016;Gonzalez et al, 2017), Madagascar (Garchitorena et al, 2017), India (Bose and Dutta, 2018), and Burkina Faso (Yaogo, 2017).…”

Section: Introductionmentioning

confidence: 99%

Effects of the Full Coverage Policy of Essential Medicines on Inequality in Medication Adherence: A Longitudinal Study in Taizhou, China

Zheng

et al. 2022

Front. Pharmacol.

The full coverage policy for essential medicines (FCPEMs) was proposed and implemented in Taizhou city of Zhejiang Province, China, to promote equal access and adherence to medicines. This study aimed to examine the effects of FCPEMs on the income-related inequality in medication adherence among local patients with hypertension or diabetes. We collected electronic health records of patients with hypertension or diabetes of three districts of Taizhou from 2011 to 2016. As the implementation schedule of the FCPEMs varied across districts, we applied a retrospective longitudinal study design and assigned records from 1 year before to 3 years following the implementation of FCPEMs as baseline and follow-up data. We thus generated a dataset with 4-year longitudinal data. The concentration index (CI) and its decomposition method were employed to measure factors contributing to inequality in medication adherence and the role played by FCPEMs. The sample size rose from 264,836 at the baseline to 315,677, 340,512, and 355,676 by each follow-up year, and the proportion of patients taking free medicines rose from 17.6 to 25.0 and 29.8% after FCPEMs implementation. The proportion of patients with high adherence increased from 39.9% at baseline to 51.6, 57.2, and 60.5%, while CI decreased from 0.073 to −0.011, −0.029, and −0.035. The contribution of FCPEMs ranked at 2nd/13, 7th/13, and 2nd/13 after the implementation of FCPEMs. Changes in CI of medication adherence for every 2 years were −0.084, −0.018, and −0.006, and the contribution of FCPEMs was −0.006, 0.006, and 0.007, ranking at 2nd/13, 2nd/13, and 1st/13, respectively. Most changes in CI of medication adherence can be attributed to FCPEMs. The medication adherence of patients with hypertension or diabetes improved after the implementation FCPEMs in Taizhou, although inequality did not improve consistently. In general, FCPEMs could be a protective factor against income-related inequalities in access and adherence to medicines. Future research is needed to investigate the change mechanism and the optimal design of similar interventions.

“…Among the countries, 54 had full coverage for essential medicines and 56 for chronic diseases [4]. FCPMs is also increasingly studied and implemented in hypertension and diabetes interventions in the United States [5,6], Canada [7], Brazil [8], Spain [9,10], Madagascar [11], India [12], and Burkina Faso [13].…”

Section: Introductionmentioning

confidence: 99%

Effects of the Full Coverage Policy of Essential Medicines on Inequality in Medication Adherence: A Longitudinal Study in Taizhou, China

Zheng

et al. 2021

Preprint

Background: The full coverage policy for essential medicines (FCPEMs) was proposed and implemented in Taizhou city of Zhejiang Province of China to promote equal access and adherence to medicines. This study aimed to examine the effects of FCPEMs on the inequality in medication adherence among local patients with hypertension and diabetes, and to explore their influencing factorsMethods: We collected electronic health records of patients with hypertension and diabetes of three districts of Taizhou from 2011-2016. With the implementation time of FCPEMs being different, we applied a retrospective longitudinal study design and selected the records of 1 baseline year before and 3 follow-up years after following the implementation of FCPEMs. All data entries of the same patient were aggregated and generated a dataset with 4-year longitudinal data. The concentration index (CI) and its decomposition method were employed to measure the factors contributing to inequality in medication adherence and the role played by FCPEMs.Results: The sample size of the 4 years retrospective longitudinal data rose from 264,836 to 315,677, 340,512 and 355,676 individuals and the proportion of the patient taking the free medicines were 17.6% to 25.0% and 29.8% after FCPEMs. The proportion of patients with high adherence increased from 39.9% to 51.6%, 57.2%, 60.5% and CI changed from 0.073 to -0.011, -0.029, -0.035, where the rate of the contribution of FCPEMs were 54.792%, 1.223% and -19.092% and ranked 2nd, 7th and 2nd after the implementation of FCPEMs. The changes in CI of medication adherence for every two years were -0.084, -0.018, -0.006, and the contribution of FCPEMs were -0.006, 0.006, 0.007, ranking the 2nd, 2nd and 1st and mainly attributed to the changes of CI of FCPEMs.Conclusions: The medication adherence of patients with hypertension and diabetes improved after the implementation FCPEMs in Taizhou, but the inequality did not show a consistent rate of improvement. In general, FCPEMs contributed to improvements in the inequality in medication adherence. FCPEMs could be a protective factor against the income-related inequalities, but this would need further investigations and to be accompanied by other systematic efforts.