Abstract
ObjectivesTo test the heterogeneity of the effect of a change in pharmaceutical cost-sharing by therapeutic groups in a Spanish region.MethodsData: random sample (provided by the Canary Islands Health Service) of 40,471 people covered by the Spanish National Health System (SNHS) in the Canary Islands. The database includes individualised monthly-dispensed medications (prescribed by the SNHS) from one year before (August 2011) to one year after (June 2013) the Royal Decree Law 16/2012 (RDL 16/2012). Sample: two intervention groups (low-income pensioners and middle-income working population) and one control group (low-income working population). Empirical model: quasi-experimental difference-in-differences design to study the change in consumption (measured in number of monthly Defined Daily Dose (DDDs) per individual) among 13 therapeutic groups. The policy break indicator (three-level categorical variable) tested the existence of stockpiling between the reform’s announcement and its implementation. We ran 16 linear regression models (general, by therapeutic groups and by comorbidities) that considered whether the exclusion of some drugs from public provision impacted on consumption more than the co-payment increase.ResultsGeneral: Reduction (-13.04) in consumption after the reform’s implementation, which was fully compensated by a previous increase (16.60 i.e., stockpiling) among low-income pensioners. The middle-income working population maintained its trend of increasing consumption. Therapeutic groups: Reductions in consumption after the reform’s implementation among low-income pensioners in 7 of the 13 groups, which were fully compensated for by a previous increase (i.e., stockpiling) in 4 groups and partially compensated for in the remaining 3. The analysis without the excluded medicines provided fewer negative coefficients. Comorbidities: Reduction in consumption that was only slightly compensated for by a previous increase (i.e., stockpiling).ConclusionsThe negative impact of cost-sharing produced, among low-income pensioners, a risk of loss of adherence to treatments, which could deteriorate the health status of individuals, especially among pensioners within the most inelastic therapeutic groups (associated with chronic diseases) and patients with comorbidities (also, associated with chronic diseases). Notwithstanding the above, this risk was more related to the exclusion of some drugs from provision than to the cost-sharing increase.
Highlights
The nature of the disease to be treated is a key factor to understand the behaviour of individuals’ pharmaceutical consumption [1]
We first report the estimated coefficients; we report in parentheses robust standard errors
Our analysis shows the heterogeneity that exists of the cost-sharing effect by therapeutic groups with more marked reductions among the most inelastic therapeutic groups, which are those that mainly contain medicines for the treatment of chronic diseases
Summary
The nature of the disease to be treated (e.g., chronic versus acute or severe versus mild) is a key factor to understand the behaviour of individuals’ pharmaceutical consumption [1]. A recent study using 15 different therapeutic drug groups, following ATC code rules (drugs grouped according to their Anatomical, Therapeutic and Chemical characteristics), analysed the sensitivity of each of these groups to a cost-sharing change and found that there were different price-elasticities depending on the therapeutic group [5]. In this regard, it is important to consider the heterogeneity of the effect of a pharmaceutical co-payment by therapeutic groups because the establishment of high co-payments among people with chronic diseases could become a ‘tax on illness’ [6]. The consequences of the introduction of drug co-payments could be worse among people with chronic or severe diseases than among other patients
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