McManus P, Donnelly N, Henry D, Hall W, Primrose J, Lindner J
Department of Human Services & Health, Canberra, ACT, Australia.
Pharmacoepidemiol Drug Saf. 1996 Nov;5(6):385-92. doi: 10.1002/(SICI)1099-1557(199611)5:6<385::AID-PDS246>3.0.CO;2-8.
In November 1990 major patient co-payment changes were introduced into the Pharmaceutical Benefits Scheme (PBS), which accounts for around 90% of all community prescriptions in Australia. Interrupted time series analyses were performed to assess the impact of these co-payment changes on the prescription levels of defined groups of 'discretionary' and 'essential' drugs for both the general community and for a subgroup comprising elderly returned servicemen and women. While the co-payment changes themselves had a significant immediate effect on lowering the use of both categories of drugs, the effects were substantially larger for the 'discretionary' groups in both cases. Notably there was a clear post-intervention trend for increased prescriptions of 'essential' drugs after the initial decline, which was not evident for the 'discretionary' drugs. The introduction of programmes to compensate high risk groups in Australia may have enabled the co-payment to become a more selective policy instrument than has been shown in other settings.
1990年11月，澳大利亚对药品福利计划（PBS）进行了重大的患者自付费用调整，该计划涵盖了澳大利亚约90%的社区处方。采用中断时间序列分析来评估这些自付费用调整对普通人群以及包括老年退伍军人在内的一个亚组中“非必需”和“必需”药物特定类别处方水平的影响。虽然自付费用调整本身对降低这两类药物的使用有显著的即时影响，但在两种情况下，对“非必需”药物组的影响要大得多。值得注意的是，在最初下降之后，“必需”药物的处方出现了明显的干预后上升趋势，而“非必需”药物则没有这种趋势。澳大利亚引入补偿高风险群体的计划可能使自付费用成为一种比其他情况更具选择性的政策工具。
