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

Objective Copayment 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...

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Autores: Aznar-Lou, I, Pottegard, A, Fernandez, A, Penarrubia-Maria, MT, Serrano-Blanco, A, Sabes-Figuera, R, Gil-Girbau, M, Fajo-Pascual, M, Moreno-Peral, P, Rubio-Valera, M
Formato: artículo
Estado:Versión publicada
Fecha de publicación:2018
País:España
Recursos:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repositorio:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p14008
Acesso em linha:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=14008
https://portal.findresearcher.sdu.dk/en/publications/effect-of-copayment-policies-on-initial-medication-non-adherence-
Access Level:acceso abierto
Palavra-chave:health policy
primary care
pharmacoepidemiology
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spelling Effect of copayment policies on initial medication non-adherence according to income: a population-based studyAznar-Lou, IPottegard, AFernandez, APenarrubia-Maria, MTSerrano-Blanco, ASabes-Figuera, RGil-Girbau, MFajo-Pascual, MMoreno-Peral, PRubio-Valera, Mhealth policyprimary carepharmacoepidemiologyObjective Copayment 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. Design A population-based study was conducted using real-world evidence. Setting Primary care in Catalonia (Spain) where two separate copayment measures (fixed copayment and coinsurance) were introduced between 2011 and 2013. Participant Every patient with a new prescription issued between 2011 and 2014 (3 million patients and 10 million prescriptions). Outcomes 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. Results 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. Conclusion 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.BMJ PUBLISHING GROUP2018info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=14008https://portal.findresearcher.sdu.dk/en/publications/effect-of-copayment-policies-on-initial-medication-non-adherence-BMJ Quality & SafetyISSN: 20445415ISSNe: 20445423reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pauinstname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)Inglésinfo:eu-repo/semantics/openAccessoai:iibsantpau.fundanetsuite.com:p140082026-06-14T12:41:47Z
dc.title.none.fl_str_mv Effect of copayment policies on initial medication non-adherence according to income: a population-based study
title Effect of copayment policies on initial medication non-adherence according to income: a population-based study
spellingShingle Effect of copayment policies on initial medication non-adherence according to income: a population-based study
Aznar-Lou, I
health policy
primary care
pharmacoepidemiology
title_short Effect of copayment policies on initial medication non-adherence according to income: a population-based study
title_full Effect of copayment policies on initial medication non-adherence according to income: a population-based study
title_fullStr Effect of copayment policies on initial medication non-adherence according to income: a population-based study
title_full_unstemmed Effect of copayment policies on initial medication non-adherence according to income: a population-based study
title_sort Effect of copayment policies on initial medication non-adherence according to income: a population-based study
dc.creator.none.fl_str_mv Aznar-Lou, I
Pottegard, A
Fernandez, A
Penarrubia-Maria, MT
Serrano-Blanco, A
Sabes-Figuera, R
Gil-Girbau, M
Fajo-Pascual, M
Moreno-Peral, P
Rubio-Valera, M
author Aznar-Lou, I
author_facet Aznar-Lou, I
Pottegard, A
Fernandez, A
Penarrubia-Maria, MT
Serrano-Blanco, A
Sabes-Figuera, R
Gil-Girbau, M
Fajo-Pascual, M
Moreno-Peral, P
Rubio-Valera, M
author_role author
author2 Pottegard, A
Fernandez, A
Penarrubia-Maria, MT
Serrano-Blanco, A
Sabes-Figuera, R
Gil-Girbau, M
Fajo-Pascual, M
Moreno-Peral, P
Rubio-Valera, M
author2_role author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv health policy
primary care
pharmacoepidemiology
topic health policy
primary care
pharmacoepidemiology
description Objective Copayment 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. Design A population-based study was conducted using real-world evidence. Setting Primary care in Catalonia (Spain) where two separate copayment measures (fixed copayment and coinsurance) were introduced between 2011 and 2013. Participant Every patient with a new prescription issued between 2011 and 2014 (3 million patients and 10 million prescriptions). Outcomes 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. Results 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. Conclusion 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.
publishDate 2018
dc.date.none.fl_str_mv 2018
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=14008
https://portal.findresearcher.sdu.dk/en/publications/effect-of-copayment-policies-on-initial-medication-non-adherence-
url https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=14008
https://portal.findresearcher.sdu.dk/en/publications/effect-of-copayment-policies-on-initial-medication-non-adherence-
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv BMJ PUBLISHING GROUP
publisher.none.fl_str_mv BMJ PUBLISHING GROUP
dc.source.none.fl_str_mv BMJ Quality & Safety
ISSN: 20445415
ISSNe: 20445423
reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
instname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
instname_str Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
reponame_str r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
collection r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15.812429

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