Puig-Junoy Jaume, Rodríguez-Feijoó Santiago, Lopez-Valcarcel Beatriz G
Department of Economics and Business, Pompeu Fabra University, Ramon Trias Fargas 25-27, 34-08005, Barcelona, Catalunya, Spain,
Appl Health Econ Health Policy. 2014 Jun;12(3):279-87. doi: 10.1007/s40258-014-0097-6.
After more than three decades of free medicines for the elderly in Spain, in the context of heavy austerity reforms of public financing, a set of cost-sharing reforms on pharmaceutical prescriptions with regional variants have been established in Spain since July 2012.
The purpose of this analysis is to present the first attempt to provide accurate estimates of the overall impact at the regional level of these cost-sharing reforms.
We estimated the impact of the reforms on the quantity of dispensed medicines during the first 14 months. We estimated 17 autoregressive integrated moving average (ARIMA) time series models of the monthly number of prescriptions dispensed in pharmacies for the period January 2003-May 2012 in each one of the 17 regions (Autonomous Communities) of Spain. We calculated dynamic forecasts for the horizon June 2012-July 2013 in order to estimate the counterfactual (number of prescriptions that would had been observed without the intervention), and we estimated the impact of cost-sharing changes as the difference between the observed number of accumulated prescriptions at 3, 6, 12, and 14 months and the number predicted by our time-series models (in percentages).
During the last decade the number of dispensed prescriptions has experienced rapid and continuous increases. In the first 14 months after the co-payment reform, the total number of prescriptions decreased dramatically, by more than 20% in Catalunya, Valencia, and Galicia, by more than 15% in nine other regions, and by more than 10% in 15 of the 17 Spanish regions. The results of our model suggest that the new co-payment caused an abrupt shift in the mean level of the time series. No shift in trend has been detected; the previous positive trend remains unchanged in most of the Autonomous Communities.
After decades of unsuccessfully trying to reduce drug spending in the Spanish National Health System through actions on prices and on prescribers, the co-payment established in mid-2012 led to a dramatic reduction in the use of drugs. The health effects of this reduction are not known.
在西班牙为老年人提供免费药品三十多年后，在公共财政大幅紧缩改革的背景下，自2012年7月起西班牙建立了一系列具有地区差异的药品处方费用分担改革措施。
本分析的目的是首次尝试准确估计这些费用分担改革在地区层面的总体影响。
我们估计了改革在最初14个月内对配药数量的影响。我们为西班牙17个自治区中的每个地区估计了2003年1月至2012年5月期间药店每月处方配药数量的17个自回归积分移动平均（ARIMA）时间序列模型。我们计算了2012年6月至2013年7月期间的动态预测，以估计反事实情况（即无干预时本应观察到的处方数量），并将费用分担变化的影响估计为3个月、6个月、12个月和14个月时观察到的累计处方数量与我们的时间序列模型预测数量之间的差异（以百分比表示）。
在过去十年中，配药处方数量持续快速增长。在共付改革后的前14个月，处方总数大幅下降，加泰罗尼亚、巴伦西亚和加利西亚下降超过20%，其他九个地区下降超过15%，西班牙17个地区中的15个下降超过10%。我们模型的结果表明，新的共付措施导致时间序列的均值水平突然转变。未检测到趋势变化；在大多数自治区，之前的积极趋势保持不变。
在西班牙国家卫生系统通过控制价格和开处方者行为来降低药品支出数十年未成功之后，2012年年中实施的共付措施导致药品使用量大幅减少。这种减少对健康的影响尚不清楚。
