Estimating the economic effects of pharmaceutical reimbursement scheme reform by microsimulation

Aaltonen, Katri; Heino, Pekka; Ahola, Elina; Martikainen, Jaana E.

doi:10.51815/fjsr.110763

Cited by 4 publications

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“…Medication copayments increased notably, and these increases mainly affected individuals with chronic illnesses. Previous studies revealed coinciding decrease in medication consumption and increase in economic problems 15–18. I complement previous evidence by examining financial access to medicines as part of more general patterns of economic hardship.…”

Section: Introductionmentioning

confidence: 60%

“…Previous studies revealed coinciding decrease in medication consumption and increase in economic problems. [15][16][17][18] I complement previous evidence by examining financial access to medicines as part of more general patterns of economic hardship. I ask whether austerity coincided with exacerbation of inequalities, and whether hardship related to medications developed differently than other economic problems.…”

Section: Original Researchmentioning

confidence: 84%

“…21 The incidence of catastrophic health spending, driven by prescription medicines and outpatient care, is higher than that in other Nordic countries, and unmet needs are more prevalent than in many other Western European countries. 19 During the study period, the following health payment increases were implemented: public healthcare user charges were increased in 2015 and 2016, and copayment increase was targeted to prescription medications in 2013, 2016 and 2017, with the latter two leading to increase particularly among the chronically ill. [16][17][18][19] Cuts on reimbursements for private healthcare and private dental care were implemented in 2015 and 2016, and reimbursements for travel costs to healthcare were reduced in 2013, 2015, 2016 and 2018. 19 In terms of tax benefit policies, the three governments that operated during the period differed in their approaches.…”

Section: Methods Settingsmentioning

confidence: 99%

“…During the study period, the following health payment increases were implemented: public healthcare user charges were increased in 2015 and 2016, and copayment increase was targeted to prescription medications in 2013, 2016 and 2017, with the latter two leading to increase particularly among the chronically ill 16–19. Cuts on reimbursements for private healthcare and private dental care were implemented in 2015 and 2016, and reimbursements for travel costs to healthcare were reduced in 2013, 2015, 2016 and 2018 19…”

Section: Methodsmentioning

confidence: 99%

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Austerity, economic hardship and access to medications: a repeated cross-sectional population survey study, 2013–2020

Aaltonen

2023

J Epidemiol Community Health

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BackgroundIn Finland, austerity measures included an increase in medication and healthcare copayments and a decrease in many social security allowances. This study examines whether austerity coincided with an increase in socioeconomic inequality in access to medications (going short of medications because of lack of money) and whether medication access problems increased more than other forms of economic hardship (going short of food or physician visits).MethodsPooled cross-sectional population surveys collected in 2013–2015, 2018 and 2020 (n=139 324) and multinomial logistic regression, with interaction between study year and economic activity (EA) (full-time work vs part-time work/retirement; old age retirement; unemployment; disability/illness; family; student), were used to estimate the effect of EA on the probability of experiencing economic hardship (no hardship/hardship including medication problems/hardship excluding medication problems) and how it varies across years.ResultsWorking-age adults outside full-time employment have a higher risk of economic hardship than full-time workers, and old age retirees have a lower risk. In 2018, when austerity was most pronounced, economic hardship including medication problems increased for the disabled/ill (women and men), unemployed (women) and part-time workers/retirees (men), significantly more than for full-time workers. Hardship excluding medication access problems either decreased or remained unchanged.ConclusionAusterity coincided with increasing economic hardship among vulnerable groups, thus exacerbating socioeconomic inequalities. Strengthening the role for medication access problems suggests that medication copayment increases contributed to this accumulating disadvantage.

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Section: Introductionmentioning

confidence: 60%

Section: Original Researchmentioning

confidence: 84%

Section: Methods Settingsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Austerity, economic hardship and access to medications: a repeated cross-sectional population survey study, 2013–2020

Aaltonen

2023

J Epidemiol Community Health

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“…The results and development reports of the early versions of the health payment simulation tool have been published as working papers (Tervola et al, 2018). A sub-model for medicine reimbursements was developed based on earlier models (Aaltonen et al, 2017). In the linked 2017 data, 79% of individuals and 92% of households made at least some health payments.…”

Section: Health Payment Datamentioning

confidence: 99%

Analysing the Effects of Healthcare Payment Policies on Poverty: A Microsimulation Study with Real-World Healthcare Data

2023

IJM

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In Europe, many people experience financial hardship due to healthcare payments, despite (near-)universal healthcare. In Finland and other countries, austerity has further widened the gaps in coverage through increases in patient payments. However, distributional analyses of austerity have solely concentrated on the effects of tax-benefit policies. We present a method for examining how health payment policies and tax-benefit policies affect household income in conjunction to evaluate the total effect of implemented and planned policies. We linked the national tax-benefit microsimulation model, SISU, and its nationally representative 15% sample of households in 2017 (n=826,001) with administrative real-world healthcare data (Finnish Institute for Health and Welfare Care Register for Health Care, HILMO, and Social Insurance Institution of Finland, Kela, National Health Insurance reimbursement registers). As a case study, we analysed the effects on the relative poverty risk and poverty gap during two government terms. We found that between 2011 and 2015, tax-benefit policies contributed to decreasing relative poverty, and health payment changes had no measurable effects. From 2015 to 2019, the poverty risk rate and the average gap increased due to tax-benefit policies, and health payment changes strengthened the effects by 10% to 20%. Health payments and their increases deteriorated the position of older adults; nevertheless, their poverty risk remained close to the population average. Social assistance had an important buffering effect on the under 65-year-old population. Health payment increases thus exacerbated the effects of austerity on the oldest age groups. Furthermore, based on tax-benefit analyses alone, they were relatively well-protected.

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Citizens’ opinions and experiences related to costs and reimbursements for medications in times of retrenchment: cross-sectional population surveys in 2015 and 2017

Aaltonen

Niemelä

Prix

2022

Int J Equity Health

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Background Finland has universal coverage for prescription medications under the National Health Insurance. Eligibility schemes target higher reimbursements to individuals with chronic illness. Nevertheless, co-payments always apply, and austerity reforms implemented in 2016 and 2017 led to further increases in co-payments. We examined the extent to which people with chronic illness experienced financial difficulties in purchasing medications, how perceptions of fairness regarding the national reimbursements differs by exposure to policies and medicine use, and in what way do these experiences and opinions vary between surveys collected before and after the reforms. Methods We used two waves of Medicines Barometer (2015 and 2017, pooled n = 10,801), a national, biennial, cross-sectional population survey. Logistic regression analyses were performed with experiences of financial difficulties and perceptions of fairness as dependent variables. We compared people with and without prescription medication use, eligibilities, and/or diabetes (exposure groups), controlling for age, gender, survey type and geographic area (NUTS2). To examine the modifying effect of study year, we fitted models with an interaction term between group and year. Results Respondents with diabetes or eligibility based on chronic illness had a notably higher risk than other respondents with at least some prescription medication use to have experienced financial difficulties in affording medications. The share of respondents experiencing difficulties increased the most among people with diabetes. Three-quarters of respondents were either critical or unsure of whether the reimbursements for medications were fair and just. People with recent prescription medication use tended to be more sceptical than people without. Overall, scepticism tended to be more prevalent in 2017 than in 2015. Conclusions Despite the protective policies in place, individuals with chronic illness were disproportionately burdened by costs of medications already before the reforms. Among individuals with diabetes, financial difficulties were even more prevalent in 2017 than in 2015, which is likely attributed to the particularly high co-payment increases targeted to type 2 diabetes medicines. Perceived fairness of the processes and outcomes of policies and regulations is a key dimension of trust in public policy. Thus, increasing scepticism implies that retrenchment may also have implications in terms of public legitimacy.

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Estimating the economic effects of pharmaceutical reimbursement scheme reform by microsimulation

Cited by 4 publications

References 0 publications

Austerity, economic hardship and access to medications: a repeated cross-sectional population survey study, 2013–2020

Austerity, economic hardship and access to medications: a repeated cross-sectional population survey study, 2013–2020

Analysing the Effects of Healthcare Payment Policies on Poverty: A Microsimulation Study with Real-World Healthcare Data

Citizens’ opinions and experiences related to costs and reimbursements for medications in times of retrenchment: cross-sectional population surveys in 2015 and 2017

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