Centre for Policy Studies, University College Cork, Cork, Ireland.
Department of Public Health and Epidemiology, University College Cork, Cork, Ireland.
Eur J Health Econ. 2018 Jun;19(5):687-695. doi: 10.1007/s10198-017-0913-7. Epub 2017 Jun 21.
This paper aims to explore how GMS drug costs depend on age, gender, income, health status, community drug scheme coverage rates and whether they display significant differences across regions of Ireland. We also aim to find out whether the GMS drug costs of high and low income cohorts respond similarly to changes in their health status. The paper projects GMS drug costs in 2026 and examines the separate cost of population ageing and population growth over the period. We also aim to simulate the estimated model to show how much giving free prescription drugs to all persons aged 'under 5' would add to 2026 GMS drug costs, and also how much giving universal GMS coverage to all persons in 2026 would add to 2026 GMS drug costs.
We construct a multivariate logistic regression model of GMS community drug costs in Ireland. We progress the methodology used in earlier studies by explicitly modelling how regional incomes and regional health status interact in determining GMS drug costs in Ireland. An age cohort and region breakdown of the simulated GMS drug costs, of both projected demographic trends and public policy measures that have been adopted or are under consideration, are also investigated.
We find that GMS drug costs depend on age-but not gender-on income, health status, community drug scheme coverage rates, and they are significantly lower for all age cohorts in Donegal and the North West region. The GMS drug costs of high income cohorts tend to increase as their health status improves, whereas they tend to decrease as the health status of low income cohorts improves. A uniform 1% gain in health status has little impact on total GMS prescribing costs. Similarly, if the health status of all Irish regions improved to match that of the East region in 2010 it would only have reduced public prescription costs by around 32 € million of the 1.8 € billion GMS drugs bill. We find that giving free prescription drugs to all persons aged 'under 5' in 2010 would have only a minor impact on 2010 GMS drug costs, whereas giving universal GMS coverage to all persons would have doubled public prescription costs from 1.8 € billion to circa 3.6 € billion.
本文旨在探讨 GMS 药物成本如何取决于年龄、性别、收入、健康状况、社区药物计划覆盖范围以及在爱尔兰各地区是否存在显著差异。我们还旨在了解高收入和低收入人群的 GMS 药物成本对其健康状况变化的反应是否相似。本文预测了 2026 年 GMS 药物成本，并考察了该期间人口老龄化和人口增长对 GMS 药物成本的单独影响。我们还旨在模拟估计模型，以显示向所有“5 岁以下”人群免费提供处方药物将如何增加 2026 年 GMS 药物成本，以及向 2026 年所有人群提供普遍 GMS 覆盖范围将如何增加 2026 年 GMS 药物成本。
我们构建了爱尔兰 GMS 社区药物成本的多元逻辑回归模型。我们通过明确建模爱尔兰地区收入和地区健康状况如何相互作用来确定 GMS 药物成本，从而改进了早期研究中使用的方法。我们还研究了模拟 GMS 药物成本的年龄组和地区细分，包括预测的人口趋势和已经采取或正在考虑的公共政策措施。
我们发现 GMS 药物成本取决于年龄，但与性别、收入、健康状况、社区药物计划覆盖范围有关，在多尼戈尔和西北地区，所有年龄组的 GMS 药物成本都明显较低。高收入人群的 GMS 药物成本随着健康状况的改善而增加，而低收入人群的 GMS 药物成本随着健康状况的改善而降低。健康状况统一提高 1%对总 GMS 处方费用影响不大。同样，如果所有爱尔兰地区的健康状况都提高到 2010 年东部地区的水平，那么这只会使公共处方费用减少约 3200 万欧元，而 GMS 药物账单为 18 亿欧元。我们发现，2010 年向所有“5 岁以下”人群免费提供处方药物只会对 2010 年 GMS 药物成本产生轻微影响，而向所有人提供普遍的 GMS 覆盖范围将使公共处方成本从 18 亿欧元增加到约 36 亿欧元。
