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处方药与非处方药之间的替代。

Substitution between prescribed and over-the-counter medications.

作者信息

Leibowitz A

机构信息

Rand Corporation, Santa Monica, CA 90406.

出版信息

Med Care. 1989 Jan;27(1):85-94. doi: 10.1097/00005650-198901000-00008.

Abstract

Using data from the Health Insurance Experiment (HIE), this article examines use of over-the-counter drugs (OTC) in a general, nonelderly population. Families from six areas of the country were assigned to health insurance plans that varied in the amount of medical care cost sharing. Thus, the out-of-pocket prices of OTC relative to prescription drugs were experimentally varied. The sites were chosen to represent markets with differing access to physician services. Multivariate methods were used to relate OTC use (collected from bi-weekly health diaries) to cost sharing and demographic variables. The empirical results do not support the expectation that people assigned less generous insurance for prescription drugs substitute OTC for prescriptions. People with complete insurance coverage purchased more of both types of drugs, suggesting OTC are an adjunct to formal medical care, rather than a substitute for it. Better educated and more knowledgeable consumers used more OTC drugs and spent more of their drug budget on OTC products. That there was greater OTC drug use in HIE sites with poorer access to formal medical care suggests there was some substitution between formal care and self-care with OTC drugs. Overall, however, better financial access to formal care promotes rather than substitutes for OTC use.

摘要

本文利用健康保险实验(HIE)的数据,研究了普通非老年人群中非处方药(OTC)的使用情况。来自美国六个地区的家庭被分配到医疗费用分担额度不同的健康保险计划中。因此,非处方药相对于处方药的自付价格在实验中有所变化。这些地点被选来代表获得医生服务机会不同的市场。采用多变量方法将非处方药的使用情况(从每两周一次的健康日记中收集)与费用分担及人口统计学变量联系起来。实证结果并不支持这样的预期,即被分配到处方药保险不太慷慨的人群会用非处方药替代处方药。拥有全面保险覆盖范围的人购买了更多这两种类型的药物,这表明非处方药是正规医疗护理的辅助手段,而非替代品。受教育程度更高、知识更丰富的消费者使用了更多的非处方药,并且在药物预算中把更多的钱花在了非处方药产品上。在获得正规医疗护理机会较差地区的健康保险实验地点,非处方药的使用量更大,这表明在正规护理和使用非处方药进行自我护理之间存在一定程度的替代。然而,总体而言,获得正规护理的更好经济条件促进了非处方药的使用,而非替代。

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