Atella Vincenzo, Schafheutle Ellen, Noyce Peter, Hassell Karen
Centre of International Studies on Economic Growth (CEIS) -- Dipartimento di Studi Economico-Finanziari e Metodi Quantitativi (SEFEMEQ), Faculty of Economics, University of Rome Tor Vergata, Rome, Italy.
Appl Health Econ Health Policy. 2005;4(1):23-35. doi: 10.2165/00148365-200504010-00005.
Studies have demonstrated that co-payments on medication reduce the consumption of both non-essential and essential drugs, and that the latter can lead to worse health outcomes. Far less is known about how patients cope with the cost of medication, particularly if affordability is an issue, and how this compares across two countries with different prescription charge policies. Therefore, the aim of this article is to explore empirically how, and to what extent, costs incurred by patients influence their decision-making behaviour in accessing medicines.
Based on the findings from focus groups, a questionnaire was designed that addressed medication cost issues relevant to patients in both the UK and Italy. Using an econometric model, several hypotheses are tested regarding patients' decision-making behaviour and how it is influenced by health status, sociodemographic characteristics and the novel concept of a self-rated affordability measure.
Quite a large percentage of patients (70.3% in the UK and 66.5% in Italy) stated they have to think about the cost of medicines at least sometimes. Respondents adopted numerous cost-reducing strategies, subdivided into (i) those initiated by patients and (ii) those involving self-medication. Their use was strongly influenced by income and drug affordability problems, but the self-rated affordability measure was a stronger predictor. Commonly used strategies were not to get prescribed drugs dispensed at all, prioritizing by not getting all prescribed items dispensed or delaying until the respondent got paid. Furthermore, respondents with affordability issues were also cost-conscious when self-medicating with over-the-counter (OTC) products for minor conditions such as dyspepsia. Despite patients in both countries using cost-reducing strategies, their use was more pronounced in the UK, where the prescription charge was significantly higher than in Italy.
DISCUSSION/CONCLUSION: The results from this study provide detail on the kinds of strategies patients use to reduce the cost burden of prescription charges, and support previous research showing they may be foregoing essential medication. Because the same questionnaire was applied in two European countries, where the national health systems aim to provide healthcare services that are accessible to all citizens in need, it offers interesting insights for policy makers in other countries, where patients may have to pay a larger share of their drugs out-of-pocket, such as the US.
研究表明，药物共付费用会减少非必需药物和必需药物的消费，而后者可能导致更差的健康结果。对于患者如何应对药物费用，尤其是在支付能力成为问题的情况下，以及在两个实行不同处方收费政策的国家中情况如何比较，我们所知甚少。因此，本文的目的是通过实证研究探讨患者所承担的费用如何以及在多大程度上影响他们获取药物的决策行为。
基于焦点小组的研究结果，设计了一份问卷，该问卷涉及英国和意大利患者的药物费用问题。使用计量经济学模型，对有关患者决策行为及其如何受到健康状况、社会人口特征和自我评定支付能力这一新概念影响的若干假设进行了检验。
相当大比例的患者（英国为70.3%，意大利为66.5%）表示他们至少有时必须考虑药物费用。受访者采取了多种降低费用的策略，这些策略可细分为（i）患者主动采取的策略和（ii）涉及自我药疗的策略。这些策略的使用受到收入和药物支付能力问题的强烈影响，但自我评定支付能力这一指标是更强的预测因素。常用的策略包括根本不拿药、优先不全拿所开药物或推迟到发薪时再拿药。此外，在使用非处方（OTC）产品自我治疗消化不良等小病时，有支付能力问题的受访者也会考虑费用。尽管两国患者都采用了降低费用的策略，但在英国这些策略的使用更为明显，因为英国的处方收费显著高于意大利。
讨论/结论：本研究结果详细说明了患者为减轻处方收费负担所采用的策略类型，并支持了先前的研究，即他们可能会放弃必需药物。由于在两个欧洲国家使用了相同的问卷，而这两个国家的国家卫生系统旨在为所有有需要的公民提供可及的医疗服务，因此对于其他国家（如美国）的政策制定者而言，本研究提供了有趣的见解，在这些国家患者可能需要自掏更多腰包支付药费。
