Department of Social Research, University of Turku, Turku, Finland.
Kela research, the Social Insurance Institution of Finland, Helsinki, Finland.
Int J Equity Health. 2022 Mar 9;21(1):33. doi: 10.1186/s12939-022-01631-6.
Finland has universal coverage for prescription medications under the National Health Insurance. Eligibility schemes target higher reimbursements to individuals with chronic illness. Nevertheless, co-payments always apply, and austerity reforms implemented in 2016 and 2017 led to further increases in co-payments. We examined the extent to which people with chronic illness experienced financial difficulties in purchasing medications, how perceptions of fairness regarding the national reimbursements differs by exposure to policies and medicine use, and in what way do these experiences and opinions vary between surveys collected before and after the reforms.
We used two waves of Medicines Barometer (2015 and 2017, pooled n = 10,801), a national, biennial, cross-sectional population survey. Logistic regression analyses were performed with experiences of financial difficulties and perceptions of fairness as dependent variables. We compared people with and without prescription medication use, eligibilities, and/or diabetes (exposure groups), controlling for age, gender, survey type and geographic area (NUTS2). To examine the modifying effect of study year, we fitted models with an interaction term between group and year.
Respondents with diabetes or eligibility based on chronic illness had a notably higher risk than other respondents with at least some prescription medication use to have experienced financial difficulties in affording medications. The share of respondents experiencing difficulties increased the most among people with diabetes. Three-quarters of respondents were either critical or unsure of whether the reimbursements for medications were fair and just. People with recent prescription medication use tended to be more sceptical than people without. Overall, scepticism tended to be more prevalent in 2017 than in 2015.
Despite the protective policies in place, individuals with chronic illness were disproportionately burdened by costs of medications already before the reforms. Among individuals with diabetes, financial difficulties were even more prevalent in 2017 than in 2015, which is likely attributed to the particularly high co-payment increases targeted to type 2 diabetes medicines. Perceived fairness of the processes and outcomes of policies and regulations is a key dimension of trust in public policy. Thus, increasing scepticism implies that retrenchment may also have implications in terms of public legitimacy.
芬兰的国家健康保险为处方药提供全民覆盖。资格计划针对慢性病患者提供更高的报销比例。然而，仍然需要共同支付，2016 年和 2017 年实施的紧缩改革导致共同支付进一步增加。我们研究了慢性病患者在购买药物方面遇到财务困难的程度，以及对国家报销政策的公平性看法因政策和药物使用而有所不同，以及这些经历和观点在改革前后的调查中存在哪些差异。
我们使用了两次药品晴雨表（2015 年和 2017 年，合并 n=10801），这是一项全国性的、两年一次的、横断面的人口调查。使用逻辑回归分析将财务困难和公平性感知作为因变量。我们将有和没有处方药使用、资格和/或糖尿病的人进行比较（暴露组），控制年龄、性别、调查类型和地理区域（NUTS2）。为了检验研究年份的调节效应，我们拟合了包含组和年份之间交互项的模型。
患有糖尿病或慢性病资格的受访者在负担得起药物方面遇到财务困难的风险明显高于其他至少使用一些处方药的受访者。最近有处方药使用的人比没有使用的人更怀疑报销是否公平合理。总体而言，2017 年比 2015 年更普遍存在怀疑态度。
尽管有保护政策，但慢性病患者已经在改革前就承受了药物成本的不成比例负担。在患有糖尿病的人中，2017 年的财务困难甚至比 2015 年更为普遍，这可能归因于针对 2 型糖尿病药物的特别高的共同支付增加。对政策和法规过程和结果的公平性看法是对公共政策信任的一个关键维度。因此，怀疑态度的增加意味着紧缩政策也可能会对公共合法性产生影响。
