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.
Highlights
Protecting all individuals against the financial consequences of ill-health is a common goal of nations [1]
To assess the existence of the common trend in the development of the share of social assistance recipients in the treatment and control groups before 2017, we inspect the monthly share of social assistance recipients among patients purchasing type 2 diabetes medicines and patients purchasing medicines for chronic hypertension or hyperlipidemia
We studied this by analyzing the effect of a reform increasing co-payments of type 2 diabetes medicines on the receipt of social assistance, a last-resort form of financial aid in Finland
Summary
Protecting all individuals against the financial consequences of ill-health is a common goal of nations [1]. In OECD countries, an increasing share of the gross domestic product (GDP) has been spent on health care [5]. Several countries have introduced cost containment policies aiming to curb this spending. The measures taken have included increasing cost sharing between patients and public payers [6]. Cost sharing refers to the third party payers requiring patients’ to pay directly a share of the costs for care, service or product received. It can take such forms as user fees paid by patients when using health services, or co-payments representing a share of reimbursed medicine’s price which patients pay out-of-pocket. In their review of health care cost-containment policies, Stadhouders et al [6] found evidence of cost sharing containing health-related expenditures
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