Department of Clinical Medicine, Miguel Hernández University, 03550 Alicante, Spain.
Primary Care Pharmacy Service, General University Hospital of Elda, 03600 Alicante, Spain.
Int J Environ Res Public Health. 2021 Jul 29;18(15):8009. doi: 10.3390/ijerph18158009.
No studies have evaluated the influence of pharmaceutical copayment on hospital admission rates using time series analysis. Therefore, we aimed to analyze the relationship between hospital admission rates and the influence of the introduction of a pharmaceutical copayment system (PCS). In July 2012, a PCS was implemented in Spain, and we designed a time series analysis (1978-2018) to assess its impact on emergency hospital admissions. Hospital admission rates were estimated between 1978 and 2018 each month using the Hospital Morbidity Survey in Spain (the number of urgent hospital admissions per 100,000 inhabitants). This was conducted for men, women and both and for all-cause, cardiovascular and respiratory hospital discharges. Life expectancy was obtained from the National Institute of Statistics. The copayment variable took a value of 0 before its implementation (pre-PCS: January 1978-June 2012) and 1 after that (post-PCS: July 2012-December 2018). ARIMA (Autoregressive Integrated Moving Average) (2,0,0)(1,0,0) models were estimated with two predictors (life expectancy and copayment implementation). Pharmaceutical copayment did not influence hospital admission rates (with -values between 0.448 and 0.925) and there was even a reduction in the rates for most of the analyses performed. In conclusion, the PCS did not influence hospital admission rates. More studies are needed to design health policies that strike a balance between the amount contributed by the taxpayer and hospital admission rates.
尚未有研究通过时间序列分析评估药品共付额对住院率的影响。因此，我们旨在分析住院率与引入药品共付额制度（PCS）的影响之间的关系。2012 年 7 月，西班牙实施了 PCS，我们设计了一项时间序列分析（1978-2018 年），以评估其对急诊住院的影响。使用西班牙医院发病率调查（每 10 万居民中紧急住院人数），我们在 1978 年至 2018 年期间每月估算住院率。这项研究针对男性、女性以及两性，涵盖所有病因、心血管和呼吸系统的住院出院情况。预期寿命数据来自国家统计局。共付额变量在实施之前（PCS 前：1978 年 1 月至 2012 年 6 月）取值为 0，在之后（PCS 后：2012 年 7 月至 2018 年 12 月）取值为 1。采用带有两个预测因子（预期寿命和共付额实施）的 ARIMA（自回归综合移动平均）（2,0,0）（1,0,0）模型进行估算。药品共付额并未影响住院率（-值介于 0.448 和 0.925 之间），而且在大多数分析中，住院率甚至有所降低。总之，PCS 并未影响住院率。需要开展更多研究，以制定在纳税人缴费额和住院率之间取得平衡的卫生政策。
