Cost-related barriers to use of health services and prescription medicines in Finland: a cross-sectional survey

2017

PLoS ONE

BackgroundThe unemployed more often suffer from depression than the employed. We examined whether mental health deterioration occurs already before unemployment implicating health selection, or whether it mostly occurs after becoming exposed to the experience rendering causal explanations more likely.MethodsWe used nationally representative Finnish register data to examine changes in depressive morbidity as measured by antidepressant medication in 1995–2009 over four years before and since a new onset of unemployment (N = 28 000) at the age of 30–60 compared to the employed (N = 124 136). We examined separately those who became continuously long-term unemployed, intermittently unemployed and unemployed with eventual re-employment in the second, third or fourth year since the year of onset. Annual repeated measurements were analysed using generalised estimation equations.ResultsAmong the employed antidepressant medication increased slowly but steadily over the study period and it was mainly at a lower level than among the unemployed. In the four years leading to unemployment there was excess increase in medication that was generally stronger among those with longer duration of the eventual unemployment experience. During unemployment medication decreased in all groups except among the intermittently unemployed. By the first year of re-employment antidepressant medication reached a level similar to that among the employed and afterwards followed no consistent trend.ConclusionsThe associations of unemployment and re-employment with depressive morbidity appear to be largely driven by health selection. The question of potential causal associations remains unresolved for intermittent unemployment in particular.

Section: Discussionmentioning

confidence: 98%

Trajectories of Antidepressant Medication before and after the Onset of Unemployment by Subsequent Employment Experience

Leinonen

Mäki²,

2017

PLoS ONE

“…Medicine user charges have been high in Finland compared to other western European countries [27]. According to a Finnish survey conducted in 2010, 11% of the respondents did not fill a prescription due to cost within the past year [28]. High user charges as well as reimbursement reforms can hinder patients’ economic possibilities to purchase medicines and decreasing the use of antidiabetic medicines can be especially detrimental because diabetes with poor glycemic control can lead to serious complications.…”

Section: Discussionmentioning

confidence: 99%

The effects of reimbursement reform of antidiabetic medicines from the patients’ perspective – a survey among patients with type 2 diabetes in Finland

Suviranta

Timonen

et al. 2019

BMC Health Serv Res

BackgroundIn Finland, the reimbursement rate for antidiabetic medicines other than insulins was lowered from 100 to 65% at the beginning of 2017. The objective of this study was to examine the effects of this reform experienced by patients with type 2 diabetes. The objective was also to explore if socio-economic status affects this experience.MethodsThe data were collected by conducting a survey among Finnish adults with type 2 diabetes (n = 603). The baseline survey was conducted in November–December 2016. A second follow-up survey was conducted at the end of 2017 where the participants’ experience of the reimbursement reform was surveyed with an open-ended question. Free-form inductive content analysis was used to categorize the answers. The association between the participants’ characteristics and reporting an effect caused by the reimbursement reform was studied with binomial logistic regression.Results285 (47.3%) participants reported an effect of some kind caused by the reimbursement reform. The most common reported effects were economic effects (32.7%) and annoyance (12.4%). Having financial difficulties in purchasing antidiabetic medicines (odds ratio (OR) 5.20, 95% confidence interval (Cl) 2.99–9.06) or not having annual deductible exceeded (OR 2.17, 95% CI 1.19–3.95), and use of certain antidiabetic medication groups at baseline were associated with reporting an effect. Socio-economic status was not associated with the likelihood of reporting an effect.ConclusionsAlmost half of the participants with type 2 diabetes reported an effect, most commonly economic effects, such as increased expenditure or difficulty in purchasing medicines, after the reimbursement reform. It is important to study the effects of reimbursement reforms also from the patients’ perspective.

“…The true association between SEP and statin nonadherence may be stronger than the association shown in our study because our data included only patients who initiated treatment. Finns with lower income or education have reported more often cost-related barriers to prescription medication use than individuals with higher income or education, 38 and higher income has been shown to be associated with better primary adherence. 39 Second, we may have misclassified patients' labor market status in relation to statin initiation because this variable was based on data from the last week of the calendar year of initiation.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Socioeconomic Inequalities in Statin Adherence Under Universal Coverage

Aarnio

Circ: Cardiovascular Quality and Outcomes

Winn

et al. 2016

Research on the association between SEP and statin adherence has mainly defined adherence through measures that reduce longitudinal medication-taking behavior into a single number, 12,13 such as the proportion of days covered (PDC). 7,9 Although this simplification is appealing, it leads to loss of information on medication-taking patterns over time. Group-based trajectory modeling (GBTM) 15 offers an alternative method for summarizing longitudinal data on medication Background-Previous research shows that low socioeconomic position (SEP; especially low income) is associated with statin nonadherence. We investigated the relationship between SEP and statin adherence in a country with universal coverage using group-based trajectory modeling in addition to the proportion of days covered. Methods and Results-Using data from Finnish healthcare registers, we identified 116 846 individuals, aged 45 to 75 years, who initiated statin therapy for primary prevention of cardiovascular disease. We measured adherence as proportion of days covered over an 18-month period since initiation and identified different adherence patterns based on monthly adherence with group-based trajectory modeling. When adjusted for age, marital status, residential area, clinical characteristics, and copayment, low SEP was associated with statin nonadherence (proportion of days covered <80%) among men (eg, lowest versus highest income quintile: odds ratio, 1.41; 95% confidence interval, 1.32-1.50; basic versus higher-degree education: odds ratio, 1.18; 95% confidence interval, 1.13-1.24; unemployment versus employment: odds ratio, 1.17; 95% confidence interval, 1.10-1.25). Among women, the corresponding associations were different (P<0.001 for sex-byincome quintile, sex-by-education level, and sex-by-labor market status interactions) and mainly nonsignificant. Results based on adherence trajectories showed that men in low SEP were likely to belong to trajectories presenting a fast decline in adherence. Conclusions-Low SEP was associated with overall and rapidly increasing statin nonadherence among men. Conversely, in women, associations between SEP and nonadherence were weak and inconsistent. adherence. GBTM accounts for the dynamic nature of adherence and identifies long-term patterns of the repeatedly measured adherence and groups of individuals with similar patterns. 16,17 Statin adherence trajectories have also been shown to predict cardiovascular events. 18Despite the universal healthcare, socioeconomic disparities in CVD have been documented also in Finland: lower SEP has been associated with higher CVD morbidity and mortality, lower use of statins, and lower revascularization rates. 3,[19][20][21] The aim of our study was to determine the association of SEP with nonadherence and adherence trajectories in Finnish patients initiating statin therapy for primary prevention of CVD. To refine the estimation of the effect of SEP on statin nonadherence, we measured adherence as 18-month adherence trajectories in addition to a conventional dichot...