Drugs co-payment

BL Harris, A Stergachis, LD Ried. The effect of drug co-payments on utilization and cost of pharmaceuticals in a health maintenance organization. Med Care 28(10) 907 917, 1990. 

More recently, large databases have been used to estimate the effect of drug co-payment in the USA under different insurance schemes.10 The conclusion reached is that there is a significant interaction effect between the behaviour of demand and prescriber incentives. Thus, larger prescription drug copayments are associated with lower expenditure when the doctor does not share the financial risk of the cost of the drugs (that is, practises in an independent practice association) but this effect is barely perceived in managed care models in which the doctor has incentives for cost containment. 

Harris, B. and A. Stergachis, "The Effect of Drug Co-payments on Utilization and Cost of Pharmaceuticals in a Health Maintenance Organization," Med. Care, 28,... 

Stuart, B. and C. Zacker, "Who Bears the Burden of Medicaid Drug Co-Payment Policies " Hlth. Affairs, 18, 201-212 (1999). 

Finally, consumers, or individual health plan members, represent another payer group within managed care. Consumers pay for healthcare through health plan premiums, deductibles, and benefit-specific co-payments, including prescription drug co-payments. To address consumer needs, as well as to expand market share, many pharmaceutical companies have invested significant... 

The calculation of direct household costs of HIV/AIDS is quite difficult. First, resource consumption is hardly documented, so that patients have to be interviewed or be asked to keep household diaries for all expenditure due to their disease. Second, it is frequently not easy to allot a certain expenditure to a specific disease. Co-payments for drugs, practitioner, and hospital services as well as transport to and from the provider are easily allocated to the COI of this disease. But other direct household costs might be even higher, such as the costs of a special diet, but it is very difficult to analyze whether these costs are really incurred due to this illness. Studies demonstrate that direct household costs might be small in developed countries, but they might make up to 50% of the total COI in developing countries (Su et al. 2006). 

Austria Does not affect 80% of the population. A percentage rate of co-payment for health care is applied to the rest, unless exempted for reasons of low income Combination of co-payment and percentage rate (with exemptions). The scheme of direct payments by the patient is limited to the first 28 days of hospitalization Co-payment for prescription drugs. Drugs not prescribed by health professionals are excluded... 

Sweden Co-payment, with maximum levels of sharing in health service bills, with the exception of hospital in-patient bills Per diem co-payment for in-patient services. Co-payment for therapeutic referrals Co-payment for the first drug prescribed, with significantly lower co-payments for subsequent prescriptions. RP system for medicines with generic equivalents... 

Switzerland Combination of annual deductibles and percentage cost-sharing rates Per diem co-payments for hospitalization User sharing in drug consumption costs, which varies between different health insurance schemes. Negative lists of medicines exclude consumption from public coverage... 

Since 1990, responsibility for containing the public pharmaceutical bill in Spain has fallen to a variety of instruments, none of which has proved particularly effective at cost containment, as can be seen from Table 6.1. These instruments have included stricter control over the National Health Service (NHS) (Sistema Nacional de Salud or SNS) budget for pharmaceuticals, modifications to the co-payment rates for certain drugs for chronic diseases, the exclusion of certain drugs from public financing (negative lists) and agreements with laboratories and pharmacies.1... 

Medicaid programme in the USA, differential co-payment for cheaper drugs, also applied in the USA, and the system based on the lowest-cost alternative in British Columbia (Canada). 

Several empirical studies attempt to estimate elasticities, differentiating between drugs on the basis of their effectiveness, or dividing them into essential and non-essential , but the results are disparate. According to some, essential drugs are less sensitive to co-payment than discretionary ones others reach the opposite conclusion. The details can be consulted in Puig-Junoy.3... 

The problem of Spain s pharmaceutical expenditure does not lie in its absolute level but in the large proportion financed publicly (74.4 per cent of the total, whereas the European average is 58.3 per cent). The absence of significant co-payments for the population as a whole and little screening in the type of drugs financed may explain this. 

Escalation of costs led to multiple measures to limit the increase in PBS expenditure, including the introduction of an authority system for new drugs from 1988. Co-payments were eventually also introduced for concessional patients -for disadvantaged patients in 1989 and for pensioners in 1990. Details of the early history of the PBS and the myriad of subsequent changes can be found in A History of the Pharmaceutical Benefits Scheme 1947-1992. ... 

The Medicare systems in China are as follows government-paid medical service for state functionaries and university/college students labor insurance medical service for employees of industrial, communication and other enterprises and various forms adopted on a voluntary basis for rural populations. Under the reforms of the healthcare system proposed by the Ministry of Public Health, co-payments were introduced in 10 provinces and cities for employees of state-owned institutions and enterprises to pay for part of their treatment, including drugs (IFPMA Compendium, 1994). Approval of drugs can be revoked after two years if no part of manufacture occurs in China (usually packaging). 

Out-of-pocket payments Members pay for non-formulary drugs (either a fixed amount/co-payment or the fee-for-service (FFS) cost of the prescription)... 

Different brands of the same drug may be listed in the PBS Schedule at different prices and the federal government subsidizes up to the price of the lowest priced brand. As a result of this policy, patients are required to pay a surcharge on their patient co-payment if they choose the higher priced brand of a drug when a lower priced generic exists. 

The notion of co-payments has been referred to briefly above in connection with reference pricing systems. It is however of broader apphcation. All that it means is that a system of pubhc health financing has chosen deliberately to limit its commitment to pay for pharmaceutical care, shifting a part of the burden onto the patient himself or herself. In some or all instances, the patient will be obliged to make a co-payment before a drug is dispensed. 

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