Departamento de Economía Aplicada y Métodos Cuantitativos, Facultad de Economía, Empresa y Turismo, Universidad de La Laguna (ULL), San Cristóbal de La Laguna, Spain.
Departamento de Métodos Cuantitativos en Economía y Gestión, Facultad de Economía, Empresa y Turismo, Universidad de Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria, Spain.
PLoS One. 2019 Mar 27;14(3):e0213403. doi: 10.1371/journal.pone.0213403. eCollection 2019.
To test the heterogeneity of the effect of a change in pharmaceutical cost-sharing by therapeutic groups in a Spanish region.
Data: random sample (provided by the Canary Islands Health Service) of 40,471 people covered by the Spanish National Health System (SNHS) in the Canary Islands. The database includes individualised monthly-dispensed medications (prescribed by the SNHS) from one year before (August 2011) to one year after (June 2013) the Royal Decree Law 16/2012 (RDL 16/2012). Sample: two intervention groups (low-income pensioners and middle-income working population) and one control group (low-income working population). Empirical model: quasi-experimental difference-in-differences design to study the change in consumption (measured in number of monthly Defined Daily Dose (DDDs) per individual) among 13 therapeutic groups. The policy break indicator (three-level categorical variable) tested the existence of stockpiling between the reform's announcement and its implementation. We ran 16 linear regression models (general, by therapeutic groups and by comorbidities) that considered whether the exclusion of some drugs from public provision impacted on consumption more than the co-payment increase.
General: Reduction (-13.04) in consumption after the reform's implementation, which was fully compensated by a previous increase (16.60 i.e., stockpiling) among low-income pensioners. The middle-income working population maintained its trend of increasing consumption. Therapeutic groups: Reductions in consumption after the reform's implementation among low-income pensioners in 7 of the 13 groups, which were fully compensated for by a previous increase (i.e., stockpiling) in 4 groups and partially compensated for in the remaining 3. The analysis without the excluded medicines provided fewer negative coefficients. Comorbidities: Reduction in consumption that was only slightly compensated for by a previous increase (i.e., stockpiling).
The negative impact of cost-sharing produced, among low-income pensioners, a risk of loss of adherence to treatments, which could deteriorate the health status of individuals, especially among pensioners within the most inelastic therapeutic groups (associated with chronic diseases) and patients with comorbidities (also, associated with chronic diseases). Notwithstanding the above, this risk was more related to the exclusion of some drugs from provision than to the cost-sharing increase.
检验西班牙某地区按治疗组划分的药品费用共付变化效果的异质性。
数据：来自西班牙加那利群岛卫生服务机构的 40471 名参保者的随机抽样（由西班牙国家卫生系统提供）。该数据库包含一年前（2011 年 8 月）至一年后（2013 年 6 月）个人每月配药情况（由西班牙国家卫生系统开具）。抽样：两个干预组（低收入养老金领取者和中等收入劳动人口）和一个对照组（低收入劳动人口）。实证模型：准实验性双重差分设计，研究 13 个治疗组中消费（以个体每月用药剂量单位（DDD）数衡量）的变化。政策突破指标（三分类变量）检验了改革公布与实施之间是否存在囤药现象。我们共运行了 16 个线性回归模型（总体模型，以及按治疗组和合并症分类的模型），考虑了从公共供应中剔除某些药物是否比共付额增加对消费的影响更大。
总体：改革实施后消费减少（-13.04），但这一减少被低收入养老金领取者此前的消费增加（16.60，即囤药）完全抵消。中等收入劳动人口的消费增长趋势保持不变。治疗组：改革实施后，低收入养老金领取者的 13 个治疗组中有 7 个组的消费减少，其中 4 个组通过此前的消费增加（即囤药）完全抵消，3 个组部分抵消。不包括剔除药物的分析得出的负系数更少。合并症：消费减少，此前的消费增加（即囤药）仅略有补偿。
共付变化对低收入养老金领取者产生了负面影响，导致治疗依从性风险增加，这可能会恶化个人的健康状况，特别是在最缺乏弹性的治疗组（与慢性病相关）和合并症患者（也与慢性病相关）的养老金领取者中。尽管如此，这种风险更多地与药物供应的剔除有关，而不是共付额的增加。
