When patients have to pay a share of drug costs: effects on frequency of physician visits, hospital admissions and filling of prescriptions

Anis, Aslam H.; Guh, Daphne; Lacaille, Diane; Marra, Carlo A.; Rashidi, Amir Adel; Li, Xin; Esdaile, John M.

doi:10.1503/cmaj.045146

Cited by 51 publications

(34 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The opposing effects of reduced use and expenditure for pharmacy and increased expenditures for all other medical care are strongly consistent with previously cited findings for drug copayments applied to welfare recipients in Quebec (Tamblyn et al 2001), among Medicaid and Medicare recipients with capped drug benefits (Soumerai et al 1991(Soumerai et al , 1994Hsu et al 2006b), among Canadians with drug cost-sharing generally (Anis et al 2005), and for Medicaid copayments applied in California during the late 1970s (Helms, Newhouse, and Phelps 1978). Alternatively, reductions in use and expenditures have been generally found in prescription drug cost-sharing studies, regardless of whether offsets in other medical care have been measured or found (Gibson, Ozminkowski, and Goetzel 2005).…”

Section: Discussionsupporting

confidence: 89%

“…Several of these studies apply to low-income individuals in public insurance settings (Helms, Newhouse, and Phelps 1978;Soumerai et al 1991Soumerai et al , 1994Tamblyn et al 2001), and also extend to higher income individuals and private insurance settings (Huskamp et al 2003;Anis et al 2005;Rosen et al 2005;Hsu et al 2006b). Newhouse (2006) summarizes this body of research and notes their consistency with recent economic findings that some individuals may discount future benefits so significantly that they will forgo current activities, such as taking medication, which would prevent future losses in health status and/or health expenditures.…”

mentioning

confidence: 99%

See 1 more Smart Citation

How Effective Are Copayments in Reducing Expenditures for Low‐Income Adult Medicaid Beneficiaries? Experience from the Oregon Health Plan

Wallace

McConnell

Gallia³

et al. 2008

Health Services Research

View full text Add to dashboard Cite

Objectives. To determine the impact of introducing copayments on medical care use and expenditures for low‐income, adult Medicaid beneficiaries. Data Sources/Study Setting. The Oregon Health Plan (OHP) implemented copayments and other benefit changes for some adult beneficiaries in February 2003. Study Design. Copayment effects were measured as the “difference‐in‐difference” in average monthly service use and expenditures among cohorts of OHP Standard (intervention) and Plus (comparison) beneficiaries. Data Collection/Extraction Methods. There were 10,176 OHP Standard and 10,319 Plus propensity score‐matched subjects enrolled during November 2001–October 2002 and May 2003–April 2004 that were selected and assigned to 59 primary care‐based service areas with aggregate outcomes calculated in six month intervals yielding 472 observations. Results. Total expenditures per person remained unchanged (+2.2 percent, p=.47) despite reductions in use (−2.7 percent, p<.001). Use and expenditures per person decreased for pharmacy (−2.2 percent, p<.001; −10.5 percent, p<.001) but increased for inpatient (+27.3 percent, p<.001; +20.1 percent, p=.03) and hospital outpatient services (+13.5 percent, p<.001; +19.7 percent, p<.001). Ambulatory professional (−7.7 percent, p<.001) and emergency department (−7.9 percent, p=.03) use decreased, yet expenditures remained unchanged (−1.5 percent, p=.75; −2.0 percent, p=.68, respectively) as expenditures per service user rose (+6.6 percent, p=.13; +7.9 percent, p=.03, respectively). Conclusions. In the Oregon Medicaid program applying copayments shifted treatment patterns but did not provide expected savings. Policy makers should use caution in applying copayments to low‐income Medicaid beneficiaries.

show abstract

Section: Discussionsupporting

confidence: 89%

mentioning

confidence: 99%

How Effective Are Copayments in Reducing Expenditures for Low‐Income Adult Medicaid Beneficiaries? Experience from the Oregon Health Plan

Wallace

McConnell

Gallia³

et al. 2008

Health Services Research

View full text Add to dashboard Cite

show abstract

“…Such dynamics presumably underlie the conclusions of Shang and Goldman (2007) and Anis et al (2005) that drugs can be a substitute for physician care.…”

Section: Drug Consumption Drug Financing and Use Of Physician Servicesmentioning

confidence: 99%

Inequity in publicly funded physician care: what is the role of private prescription drug insurance?

Allin

Hurley

2009

Health Economics

View full text Add to dashboard Cite

This study examines the impact that private financing of prescription drugs in Canada has on equity in the utilization of publicly financed physician services. The complementary nature of prescription drugs and physician service use alongside the reliance on private finance for drugs may induce an income gradient in the use of physicians. We use established econometric methods based on concentration curves to measure equity in physician utilization and its contributors in the province of Ontario. We find that individuals with prescription drug insurance make more physician visits than do those without insurance, and the effect on utilization is stronger for the likelihood of a visit than the conditional number of visits, and for individuals with no chronic conditions than those with at least one condition. Results of the equity analyses reveal the most important contributors to the pro-rich inequity in physician utilization are income and private insurance, while public insurance, which covers older people and those on social assistance, has a pro-poor effect. These findings highlight that inequity in access to and use of publicly funded services may arise from the interaction with privately financed health services that are complements to the use of public services. ALLIN S., HURLEY J.CHEPA Working Paper 08-02 2

show abstract

“…24,[31][32][33][34][35][36][37] Moreover, physicians often lack awareness about price differentials across drugs, about patients' out of-pocket costs, and about the formulary status of medications. [38][39][40][41] Furthermore, lack of communication about drug prices between physicians and patients 39,40 might contribute to physicians not selecting the most cost-effective medications.…”

Section: Discussionmentioning

confidence: 99%

Coping Strategies Used by Patients Infected with Hepatitis C Virus Who Are Facing Medication Costs

Sanyal

Ingram

Sketris³

et al. 2011

CJHP

View full text Add to dashboard Cite

show abstract

When patients have to pay a share of drug costs: effects on frequency of physician visits, hospital admissions and filling of prescriptions

Abstract: In a predominantly publicly funded health care system, the implementation of cost-containment policies such as prescription drug cost-sharing may have the unintended effect of increasing overall health utilization among elderly patients with rheumatoid arthritis.

Cited by 51 publications

References 9 publications

How Effective Are Copayments in Reducing Expenditures for Low‐Income Adult Medicaid Beneficiaries? Experience from the Oregon Health Plan

How Effective Are Copayments in Reducing Expenditures for Low‐Income Adult Medicaid Beneficiaries? Experience from the Oregon Health Plan

Inequity in publicly funded physician care: what is the role of private prescription drug insurance?

Coping Strategies Used by Patients Infected with Hepatitis C Virus Who Are Facing Medication Costs

Contact Info

Product

Resources

About