Stuart B, Grana J
Department of Health Policy and Administration, Pennsylvania State University, University Park 16802, USA.
Med Care. 1995 May;33(5):487-501. doi: 10.1097/00005650-199505000-00004.
This article examines the influence of insurance coverage on the selection of over-the-counter (OTC) and prescribed (Rx) medicines in treating less serious health problems. Because health insurance policies typically provide no coverage for OTC products, a low list price for an OTC may exceed the after-insurance expense associated with a much higher-priced prescription. Under these circumstances, rational individuals with insurance will choose prescribed medicines even if OTCs are equally effective. Ten common health problems typically managed with either Rx or OTC medicines were selected for analysis. The study population consists of elderly Pennsylvanians surveyed during 1990 who reported suffering one or more of these conditions (N = 2,962). Multivariate analysis confirmed that 1) people with prescription coverage are significantly more likely to medicate a given problem than are those without it; and 2) given the decision to medicate, the presence of insurance significantly increases the level of Rx use and significantly reduces the level of OTC use. As expected, the effect was strongest among people with the most complete prescription insurance coverage. The article discusses the implications of these findings in the context of national health reform and Food and Drug Administration policy regarding Rx-to-OTC switches.
本文探讨了保险覆盖范围对治疗不太严重健康问题时非处方药（OTC）和处方药（Rx）选择的影响。由于健康保险政策通常不涵盖OTC产品，一种OTC的低标价可能超过与价格高得多的处方药相关的保险后费用。在这种情况下，有保险的理性个人即使OTC同样有效也会选择处方药。选择了通常用处方药或非处方药治疗的十种常见健康问题进行分析。研究人群包括1990年接受调查的宾夕法尼亚州老年人，他们报告患有这些疾病中的一种或多种（N = 2,962）。多变量分析证实：1）有处方药保险的人比没有保险的人更有可能针对特定问题用药；2）在决定用药的情况下，保险的存在显著增加了处方药的使用水平，并显著降低了非处方药的使用水平。正如预期的那样，这种影响在拥有最全面处方药保险覆盖的人群中最为明显。本文在国家卫生改革以及食品药品监督管理局关于处方药转换为非处方药政策的背景下讨论了这些发现的意义。
