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Ando T, Maruyama T, Tamai A, Murakami T, Kido Y, Ishida T, Taya H, Haruta J, Sugiyama D, Fujishima S. Disparities in co-payments for influenza vaccine among the elderly, during the COVID-19 pandemic in Japan. J Infect Chemother 2022; 28:896-901. [PMID: 35339383 PMCID: PMC8940574 DOI: 10.1016/j.jiac.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 03/06/2022] [Accepted: 03/14/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Seasonal influenza vaccination for the elderly is highly recommended during the COVID-19 pandemic. In Japan, the amount of subsidy for influenza differs among municipalities. Thus, we investigated the amount of and variation in subsidy for influenza vaccination for the elderly in 2020. METHODS This was an ecological study of 1,922 municipalities in Japan. The amount of subsidy for influenza vaccines for the elderly in each municipality was surveyed through websites or via telephone. Geographic and financial data for municipalities and prefectures were obtained from the open data. The amount of co-payment for the influenza vaccine and the geographical and financial status of each municipality were compared, according to the aging rate. Univariate logistic regression analysis was performed to explore factors related to the free influenza vaccine. RESULTS Municipalities with higher aging rates tended to have higher median co-payments for vaccines in 2020. (0 yen vs 1000 yen, p < 0.001) In addition, they tended to have worse financial conditions and lower per capita incomes. A similar trend was observed in the analysis by prefecture, i.e., a higher influenza mortality rate in prefectures with a higher aging rate. Despite having lower incomes, municipalities and prefectures with higher aging populations had higher mortality rates from influenza and higher co-payments for influenza vaccination. CONCLUSIONS In Japan, there is a disparity among elderly people; areas with an aging population have higher co-payments for influenza vaccines despite lower incomes, suggesting that the government needs to implement corrective measures to reduce this disparity.
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Affiliation(s)
- Takayuki Ando
- Center for General Medicine Education, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Tomoki Maruyama
- Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Aki Tamai
- Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Taro Murakami
- Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yasuaki Kido
- Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Toru Ishida
- Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hajime Taya
- Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Junji Haruta
- Medical Education Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Daisuke Sugiyama
- Faculty of Nursing And Medical Care, Keio University, 4411 Endo, Fujisawa, Kanagawa, 252-0883, Japan
| | - Seitaro Fujishima
- Center for General Medicine Education, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Seaman K, Sanfilippo F, Bulsara M, Roughead E, Kemp-Casey A, Bulsara C, Watts GF, Preen D. Increased risk of 2-year death in patients who discontinued their use of statins. J Health Serv Res Policy 2020; 26:95-105. [PMID: 33161778 DOI: 10.1177/1355819620965610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study examined the association between statin usage (discontinued, reduced or continued) and two-year death following a 21% increase in the Pharmaceutical Benefits Scheme (PBS) consumer co-payment in Western Australia. METHODS A retrospective observational study in Western Australia using linked administrative Commonwealth PBS data and State hospital inpatient and death data (n = 207,066) was undertaken. We explored the two-year all-cause and ischemic heart disease(IHD)/stroke-specific-death in individuals who discontinued, reduced or continued statin medication following the January 2005 PBS co-payment increase, overall, by beneficiary status (general population vs. social security recipients) and by a history of admission for ischemic heart disease or stroke. Non-cardiovascular (CVD)-related death was also considered. RESULTS In the first six months of 2005, 3.3% discontinued, 12.5% reduced and 84.2% continued statin therapy. We found those who discontinued statins were also likely to discontinue at least two other medicines compared to those who continued therapy. There were 4,607 all-cause deaths. For IHD/stroke-specific death, there were 1,317. For all non-CVD-related death, there were 2,808 deaths during the 2-year follow-up period. Cox regression models, adjusted for demographic and clinical characteristics, showed a 39%-61% increase in the risk of all-cause death for individuals who reduced or discontinued statin medication compared to those who continued their statin medication (Discontinued: Adj HR = 1.61, 95% CI 1.40-1.85; Reduced: Adj HR = 1.39, 95% CI 1.28-1.51). For IHD/stroke-specific death, there was an increased risk of death by 28-76% (Discontinued: Adj sHR = 1.76, 95% CI 1.37-2.27; Reduced: Adj sHR = 1.28, 95% CI 1.10-1.49), and for non-CVD-related death, there was an increased risk of death by 44-57% (Discontinued: Adj sHR = 1.57, 95% CI 1.31-1.88; Reduced: Adj sHR = 1.44, 95% CI 1.30-1.60), for individuals who discontinued or reduced their statin medication compared to those who continued. CONCLUSIONS Patients who discontinued their statin therapy had a significantly increased risk of IHD and stroke death. Health professionals should be aware that large co-payment changes may be associated with patients discontinuing or reducing medicines to their health detriment. Factors that lead to such changes in patient medication-taking behaviour need to be considered and addressed at the clinical and policy levels.
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Affiliation(s)
- Karla Seaman
- PhD Candidate, Research Fellow, School of Health Sciences, University of Notre Dame, Australia.,Research Fellow, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Australia
| | - Frank Sanfilippo
- Principal Research Fellow, Cardiovascular Research Group, School of Population and Global Health, the University of Western Australia, Australia
| | - Max Bulsara
- Chair of Biostatistics, Institute for Health Research, University of Notre Dame, Australia
| | - Elizabeth Roughead
- Research Professor, Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Australia
| | - Anna Kemp-Casey
- Research Fellow, Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Australia.,Research Fellow, Centre for Health Services Research, School of Population and Global Health, the University of Western Australia, Australia
| | - Caroline Bulsara
- Academic Researcher, Institute for Health Research, University of Notre Dame, Australia
| | - Gerald F Watts
- Winthrop Professor and Senior Consultant Physician, Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, Australia.,Winthrop Professor and Senior Consultant Physician, Medical School, University of Western Australia, Australia
| | - David Preen
- Chair in Public Health, Centre for Health Services Research, School of Population and Global Health, the University of Western Australia, Australia
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Pulok MH, van Gool K, Hall J. Inequity in physician visits: the case of the unregulated fee market in Australia. Soc Sci Med 2020; 255:113004. [PMID: 32371271 DOI: 10.1016/j.socscimed.2020.113004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/03/2020] [Accepted: 04/18/2020] [Indexed: 10/24/2022]
Abstract
Equity is one of the key goals of universal healthcare coverage (UHC). Achieving this goal does not just depend on the presence of UHC, but also on its design and organisation. In Australia, out-of-hospital medical services are provided by private physicians in a market where fees are unregulated. This makes an interesting case to study equity. Using data from the Australian National Health Survey of 2014-15, we distinguish between the probability of any visit and the number of visits conditional on having any visit to analyse income-related inequity in general practitioner (GP) and specialist visits. We apply the horizontal inequity approach to measure the extent of inequity, and the decomposition method to explain the factors accounting for inequity. Our results show a small pro-rich inequity in the probability of any GP visit, but the distribution of conditional GP visits was concentrated among the poor. Inequity in the probability of any specialist visit was pro-rich. However, there was almost no inequity in conditional specialist visits. We find holding a concession card explained pro-poor inequity while income, education, and private health insurance contributed to pro-rich inequity in specialist visits. Although Australia has a universal health insurance system, there is unequal use (adjusted for health need) of physician services by socioeconomic status. This has implications for insurance design in other countries.
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Affiliation(s)
- Mohammad Habibullah Pulok
- Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney (UTS), Australia, PO Box 123 Broadway, NSW 2007, Australia; Nova Scotia Health Authority, 5955 Veteran's Memorial Lane, Halifax, NS, B3H 2E1, Canada.
| | - Kees van Gool
- Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney (UTS), Australia, PO Box 123 Broadway, NSW 2007, Australia.
| | - Jane Hall
- Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney (UTS), Australia, PO Box 123 Broadway, NSW 2007, Australia.
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O'Brien GL, Sinnott SJ, O' Flynn B, Walshe V, Mulcahy M, Byrne S. Out of pocket or out of control: A qualitative analysis of healthcare professional stakeholder involvement in pharmaceutical policy change in Ireland. Health Policy 2020; 124:411-418. [PMID: 32139171 DOI: 10.1016/j.healthpol.2020.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/18/2020] [Accepted: 02/21/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Mandatory co-payments attached to prescription medicines on the Irish public health insurance [General Medical Services (GMS)] scheme have undergone multiple iterations since their introduction in October 2010. To date, whilst patients' opinions on said co-payments have been evaluated, the perspectives of community pharmacists and general practitioners (GPs) have not. OBJECTIVE To explore the involvement and perceptions of community pharmacists and GPs on this pharmaceutical policy change. METHODS A qualitative study using purposive sampling alongside snowballing recruitment was used. Nineteen interviews were conducted in a Southern region of Ireland. Data were analysed using the Framework Approach. RESULTS Three major themes emerged: 1) the withered tax-collecting pharmacist; 2) concerns and prescribing patterns of physicians; and 3) the co-payment system - impact and sustainability. Both community pharmacists and GPs accepted the theoretical concept of a co-payment on the GMS scheme as it prevents moral hazard. However, there were multiple references to the burden that the current method of co-payment collection places on community pharmacists in terms of direct financial loss and reductions in workplace productivity. GPs independently suggested that a co-payment system may inhibit moral hazard by GMS patients in the utilisation of GP services. It was unclear to participants what evidence is guiding the GMS co-payment fee changes. CONCLUSION Interviewees accepted the rationale for the co-payment system, but reform is warranted.
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Affiliation(s)
- Gary L O'Brien
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, College Road, Cork, Ireland.
| | - Sarah-Jo Sinnott
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, WC1E7HT, UK
| | - Bridget O' Flynn
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, College Road, Cork, Ireland
| | - Valerie Walshe
- National Finance Division, Health Service Executive, Model Business Park, Model Farm Road, Cork, Ireland
| | - Mark Mulcahy
- Department of Accounting, Finance and Information Systems, Cork University Business School, University College Cork, Cork, Ireland
| | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, College Road, Cork, Ireland
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Färdow J, Broström L, Johansson M. Co-payment for Unfunded Additional Care in Publicly Funded Healthcare Systems: Ethical Issues. J Bioeth Inq 2019; 16:515-524. [PMID: 31236758 PMCID: PMC6937223 DOI: 10.1007/s11673-019-09924-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 06/14/2019] [Indexed: 06/09/2023]
Abstract
The burdens of resource constraints in publicly funded healthcare systems urge decision makers in countries like Sweden, Norway and the UK to find new financial solutions. One proposal that has been put forward is co-payment-a financial model where some treatment or care is made available to patients who are willing and able to pay the costs that exceed the available alternatives fully covered by public means. Co-payment of this sort has been associated with various ethical concerns. These range from worries that it has a negative impact on patients' wellbeing and on health care institutions, to fears that co-payment is in conflict with core values of publicly funded health care systems. This article provides an overview of the main ethical issues associated with co-payment, and ethical arguments both in support of and against it will be presented and analyzed.
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Affiliation(s)
- Joakim Färdow
- Medical ethics, Department of Clinical Sciences Lund, Lund university, 221 84 Lund, Sweden
| | - Linus Broström
- Medical ethics, Department of Clinical Sciences Lund, Lund university, 221 84 Lund, Sweden
| | - Mats Johansson
- Medical ethics, Department of Clinical Sciences Lund, Lund university, 221 84 Lund, Sweden
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Vogler S, Schneider P, Dedet G, Bak Pedersen H. Affordable and equitable access to subsidised outpatient medicines? Analysis of co-payments under the Additional Drug Package in Kyrgyzstan. Int J Equity Health 2019; 18:89. [PMID: 31196109 PMCID: PMC6567501 DOI: 10.1186/s12939-019-0990-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 05/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Out-of-pocket (OOP) payments can constitute a major barrier for affordable and equitable access to essential medicines. Household surveys in Kyrgyzstan pointed to a perceived growth in OOP payments for outpatient medicines, including those covered by the benefits package scheme (the Additional Drug Package, ADP). The study aimed to explore the extent of co-payments for ADP-listed medicines and to explain the reasons for developments. METHODS A descriptive statistical analysis was performed on prices and volumes of prescribed ADP-listed medicines dispensed in pharmacies during 2013-2015 (1,041,777 prescriptions claimed, data provided by the Mandatory Health Insurance Fund). Additionally, data on the value and volume of imported medicines in 2013-2015 (obtained from the National Medicines Regulatory Agency) were analysed. RESULTS In 2013-2015, co-payments for medicines dispensed under the ADP grew, on average, by 22.8%. Co-payments for ADP-listed medicines amounted to around 50% of a reimbursed baseline price, but as pharmacy retail prices were not regulated, co-payments tended to be higher in practice. The increase in co-payments coincided with a reduction in the number of prescriptions dispensed (by 14%) and an increase in average amounts reimbursed per prescription in nearly all therapeutic groups (by 22%) in the study period. While the decrease in prescriptions suggests possible underuse, as patients might forego filling prescriptions due to financial restraints, the growth in average amounts reimbursed could be an indication of inefficiencies in public funding. Variation between the regions suggests regional inequity. Devaluation of the national currency was observed, and the value of imported medicines increased by nearly 20%, whereas volumes of imports remained at around the same level in 2013-2015. Thus, patients and public procurers had to pay more for the same amount of medicines. CONCLUSIONS The findings suggest an increase in pharmacy retail prices as the major driver for higher co-payments. The national currency devaluation contributed to the price increases, and the absence of medicine price regulation aggravated the effects of the depreciation. It is recommended that Kyrgyzstan should introduce medicine price regulation and exemptions for low-income people from co-payments to ensure a more affordable and equitable access to medicines.
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Affiliation(s)
- Sabine Vogler
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich GmbH (GÖG / Austrian Public Health Institute), Vienna, Austria
| | - Peter Schneider
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich GmbH (GÖG / Austrian Public Health Institute), Vienna, Austria
| | - Guillaume Dedet
- Organisation for Economic Co-operation and Development (OECD), Paris, France
| | - Hanne Bak Pedersen
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark
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Inoue M, Kachi Y. Should co-payments for financially deprived patients be lowered? Primary care physicians' perspectives using a mixed-methods approach in a survey study in Tokyo. Int J Equity Health 2017; 16:38. [PMID: 28228140 PMCID: PMC5322579 DOI: 10.1186/s12939-017-0534-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 02/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Japan's stagnant economy has produced increasing income disparities, and the effect of poverty on health and health-care utilization is a significant issue. Co-payments could be a trade-off for patients when seeking medical care and limit health-care utilization. We sought primary care physicians' experiences in dealing with financially deprived patients and their perspectives about reducing co-payments by low-income patients. METHODS We used a convergent mixed-methods approach in a mail survey; it was distributed to 1989 primary care physicians practicing in areas with the highest proportions of socially disadvantaged individuals in Tokyo. The survey items included an open-ended question, seeking the participants' perspectives about reducing co-payments by low-income patients from the current 30%, and closed questions, asking their experience of patient behavior related to financial burdens during the previous 6 months. RESULTS We analyzed the responses of 365 physicians. Sixty-two percent of the primary care physicians agreed with lowering co-payments for financially deprived patients; however, the remainder disagreed or were uncertain. Those who disagreed were less likely to have experienced patient behavior related to financial burdens. The participants suggested challenges and potential measures for reducing co-payments by low-income patients in light of tight governmental financial resources and rapidly increasing health-care expenditures in Japan. The physicians were also concerned about the moral hazard in health-care utilization among patients receiving social welfare who obtain care at no cost. CONCLUSIONS From their experience in having dealt with low-income patients, the majority of physicians were positive about lowering co-payments by such patients; the remainder were negative or uncertain. It may be necessary to raise awareness of patients' socioeconomic status among primary care physicians as a possible deterrent for seeking care. To maintain health-care equity, policy makers should consider balancing co-payments among individuals with differing financial levels and health-care needs.
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Affiliation(s)
- Machiko Inoue
- Beth Israel Deaconess Medical Center, Harvard Medical School, 1309 Beacon St, Brookline, MA, 02446, USA.
| | - Yuko Kachi
- Department of Hygiene and Public Health, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan
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Baum Z, Simmons MR, Guardiola JH, Smith C, Carrasco L, Ha J, Richman P. Potential impact of co-payment at point of care to influence emergency department utilization. PeerJ 2016; 4:e1544. [PMID: 26819839 PMCID: PMC4727971 DOI: 10.7717/peerj.1544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/08/2015] [Indexed: 11/22/2022] Open
Abstract
Background. Many proponents for healthcare reform suggest increased cost-sharing by patients as a method to reduce overall expenditures. Prior studies on the effects of co-payments for ED visits have generally not been directed toward understanding patient attitudes/behavior at point of care. Objectives. We conducted a survey at point of care to test our hypothesis that a significant number of patients with urgent chief complaints might have avoided the ED if asked to provide a co-payment. Methods. Cross-sectional study design. Stable, oriented, consenting patients at an inner-city, academic ED were consecutively enrolled at hours in which trained research associates were available to assist with data collection. Enrolled patients completed a written survey providing demographic/chief complaint information, and then were asked whether 13 interval amounts of co-payment ranging from 0 to >500 would have impacted their decision to visit the ED. Categorical data are presented as frequency of occurrence and analyzed by chi-square; continuous data presented as means ± standard deviation, analyzed by t-tests. ORs and 95% confidence intervals provided. Primary outcome parameter was the % of patients who would have avoided the ED if asked to pay any co-payment for several urgent chief complaints: chest pain, SOB, and abdominal pain. Results. A total of 581 patients were enrolled; 63.1% female, mean age 42.4 ± 15.1 years, 65% Hispanic, 71.2% income less than 20,000, 28.6% less than high school graduate, 81.3% had primary care physician, 57.6% had 2 or more ED visits/past year. Overall, 30.2% of patients chose 0 as the maximum they would have been willing to pay if it was required to be seen in the ED. 16/58 (28%; 95% CI [18–40%]) of chest pain patients, 9/43 (20.9%; 95% CI [11–35%]) of SOB patients, and 24/127 (26.8%; 95% CI [13–27%]) of abdominal pain patients would have been unwilling to pay a co-pay. Patients with income >20,000 were more willing to pay a co-payment (OR = 2.55; 95% CI [1.59–4.10]). No significant relationship was identified between willingness to pay for: gender, race, education, established primary care provider, and frequency of ED visits. Conclusion. Overall, 30.2% of our patients would not have accepted a co-pay in order to be seen, including more than 20% of the patients with chest pain, shortness of breath, and abdominal pain respectively.
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Affiliation(s)
- Zachary Baum
- Department of Emergency Medicine, Christus Spohn/Texas A & M Health Science Center , Corpus Christi, TX , United States
| | - Michael R Simmons
- Department of Emergency Medicine, Christus Spohn/Texas A & M Health Science Center , Corpus Christi, TX , United States
| | - Jose H Guardiola
- Department of Mathematics, Texas A & M University-Corpus Christi , Corpus Christi, TX , United States
| | - Cynthia Smith
- Department of Emergency Medicine, Christus Spohn/Texas A & M Health Science Center , Corpus Christi, TX , United States
| | - Lynn Carrasco
- Graduate Medical Education, Christus Spohn/Texas A & M Health Science Center , Corpus Christi, TX , United States
| | - Joann Ha
- Department of Emergency Medicine, Christus Spohn/Texas A & M Health Science Center , Corpus Christi, TX , United States
| | - Peter Richman
- Department of Emergency Medicine, Christus Spohn/Texas A & M Health Science Center , Corpus Christi, TX , United States
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Lefevere E, Theeten H, Hens N, De Smet F, Top G, Van Damme P. From non school-based, co-payment to school-based, free Human Papillomavirus vaccination in Flanders (Belgium): a retrospective cohort study describing vaccination coverage, age-specific coverage and socio-economic inequalities. Vaccine 2015; 33:5188-95. [PMID: 26254978 DOI: 10.1016/j.vaccine.2015.07.088] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/13/2015] [Accepted: 07/28/2015] [Indexed: 11/28/2022]
Abstract
School-based, free HPV vaccination for girls in the first year of secondary school was introduced in Flanders (Belgium) in 2010. Before that, non school-based, co-payment vaccination for girls aged 12-18 was in place. We compared vaccination coverage, age-specific coverage and socio-economic inequalities in coverage - 3 important parameters contributing to the effectiveness of the vaccination programs - under both vaccination systems. We used retrospective administrative data from different sources. Our sample consisted of all female members of the National Alliance of Christian Mutualities born in 1995, 1996, 1998 or 1999 (N=66,664). For each vaccination system we described the cumulative proportion HPV vaccination initiation and completion over time. We used life table analysis to calculate age-specific rates of HPV vaccination initiation and completion. Analyses were done separately for higher income and low income groups. Under non school-based, co-payment vaccination the proportions HPV vaccination initiation and completion slowly rose over time. By age 17, the proportion HPV vaccination initiation/completion was 0.75 (95% CI 0.74-076)/0.66 (95% CI 0.65-0.67). The median age at vaccination initiation/completion was 14.4 years (95% CI 14.4-14.5)/15.4 years (95% CI 15.3-15.4). Socio-economic inequalities in coverage widened over time and with age. Under school-based, free vaccination rates of HPV vaccination initiation were substantially higher. By age 14,the proportion HPV vaccination initiation/completion was 0.90 (95% CI 0.90-0.90)/0.87 (95% CI 0.87-0.88). The median age at vaccination initiation/completion was 12.7 years (95% CI 12.7-12.7)/13.3 years (95% CI 13.3-13.3). Socio-economic inequalities in coverage and in age-specific coverage were substantially smaller.
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Affiliation(s)
- Eva Lefevere
- Herman Deleeck Centre for Social Policy, University of Antwerp, St Jacobstraat 2, 2000 Antwerp, Belgium.
| | - Heidi Theeten
- Centre for the Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Niel Hens
- Center for Statistics (CenStat), Hasselt University, Agoralaan, Building 3, 3590 Diepenbeek, Belgium; Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Frank De Smet
- National Alliance of Christian Mutualities, Haachtsesteenweg 579, 1031 Brussel, Belgium; Department of Public Health and Primary Care, Environment and Health, KU Leuven, Kapucijnenvoer 35 blok D, Box 7001, 3000 Leuven, Belgium.
| | - Geert Top
- Agency for Care and Health, Infectious Disease Control and Vaccinations, K. Albert II laan 35 Box 33, 1030 Brussels, Belgium.
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
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Emmerick ICM, do Nascimento JM, Pereira MA, Luiza VL, Ross-Degnan D. Farmácia Popular Program: changes in geographic accessibility of medicines during ten years of a medicine subsidy policy in Brazil. J Pharm Policy Pract 2015; 8:10. [PMID: 25926990 PMCID: PMC4403833 DOI: 10.1186/s40545-015-0030-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 02/17/2015] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The Brazilian constitution guarantees the right to health, including access to medicines. In May 2004, Brazil's government announced the "Farmácia Popular" Program (FPP) as a new mechanism to improve the Brazilian population's access to medicines. Under FPP, a selected list of medicines is subsidized by the government and provided in public and private pharmacies. The aim of this study is to describe the historical stages of the FPP and to identify associated changes in the geographical accessibility of medicines through the FPP over time. METHODS It was performed documentary review and an ecological study assessing program coverage in terms of number of facilities and a FPP Pharmacy Facilities Density (PFD) index at national and regional levels from 2004 to 2013, using the FPP database. We used geographic information system mapping to depict a pharmaceutical facilities density (PFD) index at the municipality level on thematic maps. RESULTS A growth of the PFD index coincident with the phases of the FPP was noticed. In the public sector, the program started in 2004; by 2006, there was a sharp increase in the numbers of participating pharmacies, stabilizing in 2009. In the private sector, the program started in 2006; by 2009 the PFD ratio had increased substantially and it continued to grow through 2011. There was an increase in FPP coverage in most regions between 2006, when the private pharmacy component started, and 2013, but participating pharmacies remain unequally distributed across geographical regions. Specifically, the wealthy areas in the South and Southeast have higher coverage, with lower coverage mostly in the North and Northeast, relatively poorer areas with greater need for access to medicines, health care, and other basic services such as potable water and sanitization. CONCLUSIONS There has been a substantial increase in the number of pharmacies participating in the FPP over time. This has led to greater program coverage and has potentially improved access to FPP medicines in the country. Nevertheless, disparities in pharmacy coverage remain among the regions.
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Affiliation(s)
- Isabel Cristina Martins Emmerick
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215 USA ; Nucleus for Pharmaceutical Policies, National School of Public Health, Oswaldo Cruz Foundation, 1480, Rua Leopoldo Bulhões # 624, Manguinhos, 21021-000 Rio de Janeiro, RJ Brazil
| | - José Miguel do Nascimento
- Departamento de Assistência Farmacêutica/Secretaria de Ciência Tecnologia e Insumos estratégicos - Ministério da Saúde - Brasil - DAF/SCTIE/MS Esplanada dos Ministérios, Bloco G, 8º andar, CEP: 70058-900 Brasília, DF Brazil
| | - Marco Aurélio Pereira
- Departamento de Assistência Farmacêutica/Secretaria de Ciência Tecnologia e Insumos estratégicos - Ministério da Saúde - Brasil - DAF/SCTIE/MS Esplanada dos Ministérios, Bloco G, 8º andar, CEP: 70058-900 Brasília, DF Brazil
| | - Vera Lucia Luiza
- Nucleus for Pharmaceutical Policies, National School of Public Health, Oswaldo Cruz Foundation, 1480, Rua Leopoldo Bulhões # 624, Manguinhos, 21021-000 Rio de Janeiro, RJ Brazil
| | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215 USA
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Schwarzkopf R, Kahn TL. Patient risk taking and spending habits correlate with willingness to pay for novel total joint arthroplasty implants. Arthroplast Today 2015; 1:14-18. [PMID: 28326362 PMCID: PMC4926826 DOI: 10.1016/j.artd.2014.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 12/09/2014] [Accepted: 12/16/2014] [Indexed: 10/25/2022] Open
Abstract
In this study, we compare patients' risk-taking and spending behaviors to their willingness to pay (WTP) for novel implants in a joint arthroplasty. 210 patients were surveyed regarding risk-taking and spending behavior, and WTP for novel implants with either increased-longevity, increased-longevity with higher risk of complications, or decreased risk of complications compared to a standard implant. Patients with increased recreational risk-taking behavior were more WTP for increased-longevity. Patients who "rarely" take health-risks were more WTP for decreased risk of complications. Patients with higher combined risk scores were more WTP for all novel implants. Patients who paid more than $50,000 for their current car were more WTP for decreased complications. This study shows that patients' risk taking and spending behavior influences their WTP for novel implants.
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Affiliation(s)
- Ran Schwarzkopf
- Department of Orthopaedic Surgery, University of California, Irvine Medical Center, Orange, CA, USA
| | - Timothy L Kahn
- Department of Orthopaedic Surgery, University of California, Irvine Medical Center, Orange, CA, USA
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Sánchez DP, Guillén JJ, Torres AM, Arense JJ, López Á, Sánchez FI. [Prescription drug consumption recovery following the co-payment change: Evidence from a regional health service]. Aten Primaria 2015; 47:411-8. [PMID: 25500171 DOI: 10.1016/j.aprim.2014.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 09/30/2014] [Accepted: 10/02/2014] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES In the past few decades, increasing pharmaceutical expenditures in Spain and other western countries led to the adoption of reforms in order to reduce this trend. The aim of our study was to analyze if reforms concerning the pharmaceutical reimbursement scheme in Spain have been associated with changes in the volume and trend of pharmaceutical consumption. DESIGN Retrospective observational study. SETTING Region of Murcia. Prescription drug in primary care and external consultations. PARTICIPANTS Records of prescribed medicines between January 1, 2008 and December 31, 2013. METHOD Segmented regression analysis of interrupted time-series of prescription drug consumption. RESULTS Dispensing of all five therapeutic classes fell immediately after co-payment changes. The segmented regression model suggested that per patient drug consumption in pensioners may have decreased by about 6.76% (95% CI; -8.66% to -5.19%) in the twelve months after the reform, compared with the absence of such a policy. Furthermore the slope of the series of consumption increased from 6.08 (P<.001) to 12.17 (P<.019). CONCLUSIONS The implementation of copayment policies could be associated with a significant decrease in the level of prescribed drug use in Murcia Region, but this effect seems to have been only temporary in the five therapeutic groups analyzed, since almost simultaneously there has been an increase in the growth trend.
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