Publication:
Effect of copayment policies on initial medication non-adherence according to income: a population-based study.

dc.contributor.authorAznar-Lou, Ignacio
dc.contributor.authorPottegård, Anton
dc.contributor.authorFernández, Ana
dc.contributor.authorPeñarrubia-María, María Teresa
dc.contributor.authorSerrano-Blanco, Antoni
dc.contributor.authorSabés-Figuera, Ramón
dc.contributor.authorGil-Girbau, Montserrat
dc.contributor.authorFajó-Pascual, Marta
dc.contributor.authorMoreno-Peral, Patricia
dc.contributor.authorRubio-Valera, Maria
dc.date.accessioned2023-01-25T10:05:11Z
dc.date.available2023-01-25T10:05:11Z
dc.date.issued2018-03-15
dc.description.abstractCopayment policies aim to reduce the burden of medication expenditure but may affect adherence and generate inequities in access to healthcare. The objective was to evaluate the impact of two copayment measures on initial medication non-adherence (IMNA) in several medication groups and by income level. A population-based study was conducted using real-world evidence. Primary care in Catalonia (Spain) where two separate copayment measures (fixed copayment and coinsurance) were introduced between 2011 and 2013. Every patient with a new prescription issued between 2011 and 2014 (3 million patients and 10 million prescriptions). IMNA was estimated throughout dispensing and invoicing information. Changes in IMNA prevalence after the introduction of copayment policies (immediate level change and trend changes) were estimated through segmented logistic regression. The regression models were stratified by economic status and medication groups. Before changes to copayment policies, IMNA prevalence remained stable. The introduction of a fixed copayment was followed by a statistically significant increase in IMNA in poor population, low/middle-income pensioners and low-income non-pensioners (OR from 1.047 to 1.370). In high-income populations, there was a large statistically non-significant increase. IMNA decreased in the low-income population after suspension of the fixed copayment and the introduction of a coinsurance policy that granted this population free access to medications (OR=0.676). Penicillins were least affected while analgesics were affected to the greatest extent. IMNA to medications for chronic conditions increased in low/middle-income pensioners. Even nominal charge fixed copayment may generate inequities in access to health services. An anticipation effect and expenses associated with IMNA may have generated short-term costs. A reduction in copayment can protect from non-adherence and have positive, long-term effects. Copayment scenarios could have considerable long-term consequences for health and costs due to increased IMNA in medication for chronic physical conditions.
dc.identifier.doi10.1136/bmjqs-2017-007416
dc.identifier.essn2044-5423
dc.identifier.pmid29545326
dc.identifier.unpaywallURLhttps://findresearcher.sdu.dk/ws/files/154778872/Effect_of_copayment_policies_on_initial_medication_non_adherence.pdf
dc.identifier.urihttp://hdl.handle.net/10668/12244
dc.issue.number11
dc.journal.titleBMJ quality & safety
dc.journal.titleabbreviationBMJ Qual Saf
dc.language.isoen
dc.organizationValle del Guadalhorce
dc.organizationInstituto de Investigación Biomédica de Málaga-IBIMA
dc.page.number878-891
dc.pubmedtypeComparative Study
dc.pubmedtypeJournal Article
dc.pubmedtypeMulticenter Study
dc.pubmedtypeResearch Support, Non-U.S. Gov't
dc.rights.accessRightsopen access
dc.subjecthealth policy
dc.subjectpharmacoepidemiology
dc.subjectprimary care
dc.subject.meshAged
dc.subject.meshCohort Studies
dc.subject.meshDeductibles and Coinsurance
dc.subject.meshFemale
dc.subject.meshHealth Care Costs
dc.subject.meshHealth Policy
dc.subject.meshHumans
dc.subject.meshIncome
dc.subject.meshMale
dc.subject.meshMedication Adherence
dc.subject.meshMiddle Aged
dc.subject.meshPoverty
dc.subject.meshPrimary Health Care
dc.subject.meshRetrospective Studies
dc.subject.meshSocioeconomic Factors
dc.subject.meshSpain
dc.titleEffect of copayment policies on initial medication non-adherence according to income: a population-based study.
dc.typeresearch article
dc.type.hasVersionSMUR
dc.volume.number27
dspace.entity.typePublication

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