Trivedi Amal N, Kelaher Margaret
Amal N. Trivedi ( Amal_Trivedi@brown. edu ) is a professor in the Department of Health Services, Policy, and Practice, Brown University School of Public Health, and a research investigator at the Providence Veterans Affairs Medical Center, both in Providence, Rhode Island.
Margaret Kelaher is a professor in the Centre for Health Policy, Melbourne School of Population and Global Health, in Parkville, Australia.
Health Aff (Millwood). 2020 Feb;39(2):289-296. doi: 10.1377/hlthaff.2019.01089.
Australian health policy has prioritized efforts to close the ten-year life expectancy gap between indigenous and nonindigenous Australians, a disparity largely driven by cardiovascular disease and diabetes. Because out-of-pocket spending poses a barrier to accessing medications for chronic conditions, in 2010 the Australian government reduced or eliminated medication copayments for indigenous people with chronic disease or risk factors for chronic disease. In this quasi-experimental study we found that the copayment reductions were associated with a 39 percent relative increase in the use of medications and a 61 percent reduction in out-of-pocket spending. Among indigenous Australians who qualified for the largest copayment reductions, overall use of medications increased by 156 percent-including increases of 26-109 percent in the use of lipid-lowering, hypertension, and diabetes medications. These findings suggest that Australia's novel strategy of targeted copayment reductions improved access to prescription medications among indigenous Australians, a population with a high burden of chronic conditions and marked social disadvantage.
澳大利亚的卫生政策将缩小澳大利亚原住民与非原住民之间十年预期寿命差距作为优先事项，这种差距很大程度上是由心血管疾病和糖尿病导致的。由于自付费用对慢性病患者获取药物构成障碍，2010年澳大利亚政府减少或取消了患有慢性病或有慢性病风险因素的原住民的药物共付费用。在这项准实验研究中，我们发现共付费用的减少与药物使用量相对增加39%以及自付费用减少61%有关。在符合最大共付费用减免条件的澳大利亚原住民中，药物总体使用量增加了156%，包括降脂药、高血压药和糖尿病药的使用量增加了26%至109%。这些发现表明，澳大利亚有针对性地减少共付费用的新策略改善了慢性病负担沉重且社会处境明显不利的澳大利亚原住民获取处方药的情况。
