Co-payment regulation

However, these results are not applicable to compulsory pubhc insurance, nor to National Health Systems. The most notable differences between drag co-payment in an insurance market and in a National Health System or compulsory public insurance environment lie in their voluntariness or otherwise (users ability to choose their coverage) and the ultimate financing of the services (risk-adjusted premiums as opposed to taxes or social insurance contributions adjusted according to economic capacity). Hence, in compulsory public insurance systems, co-payment regulation is used not only as a health policy instrument but also as one of redistribution of income. 

All the health systems of the European Union (EU), except that of the Netherlands, require purchasers of prescription chugs to make some form of co-payment. Mossialos and Le Grand18 provide a detailed description of the co-payment regulations currently in force in Europe. 

Co-payment is an instrument that should not be used on its own. Neither efficiency in drag use nor equity nor the control of pharmaceutical expenditure can rest solely on co-payment. Its effectiveness is reinforced when it is combined with other instruments and incentives. In fact, all European countries combine, in different doses and proportions, multiple instruments that influence the behaviour of the industry, prescribes and patients. It is sufficient to recall that pharmaceutical expenditure is the product of price by quantity, and to consider the enormous international variability of drag prices,35 in order to understand the limitations of co-payment regulation in comparison with other policies that influence prices. Policies aimed at price control can be as effective as co-payment - or more so - for purposes of cost containment. 

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