Medication Use and Health Care Utilization After a Cost-sharing Increase in Schizophrenia

Hamina, Aleksi; Tanskanen, Antti; Tiihonen, Jari; Taipale, Heidi

doi:10.1097/mlr.0000000000001369

Cited by 9 publications

(11 citation statements)

References 30 publications

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“…It should also be noted that the group of respondents with eligibility is more heterogeneous than the diabetes group; thus, focusing on another high-risk patient group might have revealed further differences across years. For example, patients with severe mental health disorders also seem at high risk based on previous evidence [ 15 , 42 ]. However, this patient group was small and was largely undetectable in our survey.…”

Section: Discussionmentioning

confidence: 99%

“…In Finland, an increase in medication co-payments has been a recurrent policy used to create savings. Recent studies applying quasi-experimental analytical strategies have shown coinciding negative effects: decreases in the purchasing of medications among patients with schizophrenia and stagnation in the preceding decreasing trend in psychiatric hospitalisations [ 15 ]; decreases in the consumption of type 2 diabetes medications and worsening glycaemic control [ 16 ], and increases in the use of last-resort social assistance vouchers to pay for type 2 diabetes medications [ 17 ]. In longitudinal studies using survey data, increases in financial problems in buying medications and dissatisfaction among people with type 2 diabetes have been observed [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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“…In the recent decades however, medicine co-payment increases have been common also in European countries [ 44 , 45 ]. A Finnish study showed reduction in medicine use among persons with schizophrenia after a medicine co-payment increase, coinciding a halt in the preceding decreasing trend in psychiatric hospitalizations, but with no other significant differences in health care utilization [ 46 ]. A Spanish study showed marked decreases in consumption after institution of small copayment for medicines among older age groups whom previously were completely exempt [ 47 ].…”

Section: Introductionmentioning

confidence: 99%

The effect of pharmaceutical co-payment increase on the use of social assistance—A natural experiment study

Rättö

Aaltonen

2021

PLoS ONE

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Health care out-of-pocket payments can create barriers to access or lead to financial distress. Out-of-pocket expenditure is often driven by outpatient pharmaceuticals. In this nationwide register study, we study the causal relationship between an increase in patients’ pharmaceutical expenses and financial difficulties by exploiting a natural experiment design arising from a 2017 reform, which introduced higher co-payments for type 2 diabetes medicines in Finland. With difference-in-differences estimation, we analyze whether the reform increased the use of social assistance, a last-resort financial aid. We found that after the reform the share of social assistance recipients increased more among type 2 diabetes patients than among a patient group not affected by the co-payment increase, suggesting the reform increased the use of social assistance among those subject to it. The results indicate that increases in patients’ pharmaceutical expenses can lead to serious financial difficulties even in countries with a comprehensive social security system.

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“…11,12 Larger inconsistencies are found among mental health patients, [13][14][15] for whom critical economic assumptions, such as individual rationality are not met, 16 and an increase in patient cost-sharing seems to be associated with poorer medication adherence and outcomes. [17][18][19] Additionally, relative price changes (i.e., from 10 to 20%) are known to produce smaller consumption reductions than free-to-fee increases (i.e., 0 to 10%). 20 We explored these questions with a quasi-experimental design by taking advantage of a natural experiment in Spain.…”

mentioning

confidence: 99%

“… 11 , 12 Larger inconsistencies are found among mental health patients, 13 , 14 , 15 for whom critical economic assumptions, such as individual rationality are not met, 16 and an increase in patient cost‐sharing seems to be associated with poorer medication adherence and outcomes. 17 , 18 , 19 Additionally, relative price changes (i.e., from 10 to 20%) are known to produce smaller consumption reductions than free‐to‐fee increases (i.e., 0 to 10%). 20 …”

mentioning

confidence: 99%

Cost‐Sharing Increase, Medication Adherence, and Hospitalizations in Schizophrenia Patients: A Natural Experiment

Serra-Burriel

Hurtado

Sanfélix‐Gimeno

et al. 2021

Clin Pharma and Therapeutics

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Study Highlights WHAT IS THE CURRENT KNOWLEDGE ON THE TOPIC? Cost-sharing increases in medication have been associated with decreases in adherence, however, no causal link between raises and hospitalization events has been proven. WHAT QUESTION DID THIS STUDY ADDRESS? Is a free-to-fee (0 to 10%) cost-sharing increase in antipsychotic medication associated with poorer adherence and hospitalization events for patients with schizophrenia? WHAT DOES THIS STUDY ADD TO OUR KNOW-LEDGE? Cost-sharing increases for vulnerable mental health populations have severe unintended effects leading to psychiatric hospitalizations. HOW MIGHT THIS CHANGE CLINICAL PHARMA-COLOGY OR TRANSLATIONAL SCIENCE?  Cost-sharing increases for psychiatric patients should be avoided or specific countermeasures of patient surveillance should be adopted and evaluated simultaneously.

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Medication Use and Health Care Utilization After a Cost-sharing Increase in Schizophrenia

Abstract: Supplemental Digital Content is available in the text.

Cited by 9 publications

References 30 publications

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

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

The effect of pharmaceutical co-payment increase on the use of social assistance—A natural experiment study

Cost‐Sharing Increase, Medication Adherence, and Hospitalizations in Schizophrenia Patients: A Natural Experiment

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