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The effect of pharmaceutical co-payment increase on the use of social assistance-A natural experiment study.

ABSTRACT: Health care out-of-pocket payments can create barriers to access or lead to financial distress. Out-of-pocket expenditure is often driven by outpatient pharmaceuticals. In this nationwide register study, we study the causal relationship between an increase in patients' pharmaceutical expenses and financial difficulties by exploiting a natural experiment design arising from a 2017 reform, which introduced higher co-payments for type 2 diabetes medicines in Finland. With difference-in-differences estimation, we analyze whether the reform increased the use of social assistance, a last-resort financial aid. We found that after the reform the share of social assistance recipients increased more among type 2 diabetes patients than among a patient group not affected by the co-payment increase, suggesting the reform increased the use of social assistance among those subject to it. The results indicate that increases in patients' pharmaceutical expenses can lead to serious financial difficulties even in countries with a comprehensive social security system.

SUBMITTER: Ratto H

PROVIDER: S-EPMC8099050 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

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The effect of pharmaceutical co-payment increase on the use of social assistance-A natural experiment study.

Rättö Hanna H Aaltonen Katri K

PloS one 20210505 5

Health care out-of-pocket payments can create barriers to access or lead to financial distress. Out-of-pocket expenditure is often driven by outpatient pharmaceuticals. In this nationwide register study, we study the causal relationship between an increase in patients' pharmaceutical expenses and financial difficulties by exploiting a natural experiment design arising from a 2017 reform, which introduced higher co-payments for type 2 diabetes medicines in Finland. With difference-in-differences ...[more]

PMID: 33951077

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Project description:BackgroundThe Alberta Immunization Program offers a vaccine against the Human Papillomavirus (HPV) free of charge to all girls in Grades 5 and 9. The vaccine is provided in two different service delivery models depending upon the acceptance of the program by the local school board. Vaccinations may be provided "in-school" or in "community" through appointments at Public Health Clinics. The purpose of this study was to determine whether there was a difference in vaccine uptake in Calgary between the two service delivery models, "in-school" and "community", and to examine if socioeconomic status (SES) was a contributing factor.MethodsIndividual data from the Calgary Zone Public Health vaccination database for all grade 5 and 9 girls in Calgary for school years 2008-2011 were analyzed using descriptive statistics. These data included vaccination records for 35,592 girls. Logistic regression was used to examine the effect of delivery system and SES status on being vaccinated, controlling for school type.ResultsHPV vaccination completion rates were 75% (95% confidence interval = 74.7%, 75.8%) for girls with an "in-school" compared to 36% (95% confidence interval = 35.3%, 37.2%) for girls in schools with a "community" service delivery model. A girl's neighbourhood SES was related to the likelihood of being HPV vaccinated depending on the service delivery model available to her. For girls attending a Public school with an "in-school" delivery model, the proportion completing vaccination increased as SES decreased (high SES = 79%; medium SES = 79%; low SES = 83%; p-value<0.001). For girls attending Calgary Catholic School District schools with the "community" delivery model there was a decrease in immunization rates from high and mid to low SES (high SES = 41%; medium SES = 42%; low SES = 34%; p-value<0.001). These results show that those with lower SES were differentially disadvantaged by not having access to an "in-school" vaccination delivery model.ConclusionService delivery models make a difference in HPV vaccination completion rates and create inequities for health protection and disease prevention based on socioeconomic status.

Dataset Information

The effect of pharmaceutical co-payment increase on the use of social assistance-A natural experiment study.

Publications

The effect of pharmaceutical co-payment increase on the use of social assistance-A natural experiment study.

Similar Datasets

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