The impact of patient cost-sharing on low-income populations: Evidence from Massachusetts

Abstract Background Increasing medicines availability and affordability is a key goal of Brazilian health policies. “Farmácia Popular” (FP) Program is one of the government’s key strategies to achieve this goal. Under FP, antihypertension (HTN) and antiglycemic (DM) medicines have been provided at subsidized prices in private retail settings since 2006, and free of charge since 2011. We aim to assess the impact of sequential changes in FP benefits on patient affordability and government expenditures for HTN and DM treatment under the FP, and examine their implications for public financing mechanisms and program sustainability. Methods Longitudinal, retrospective study using interrupted time series to analyze: HTN and DM treatment coverage; total and per capita expenditure; percentage paid by MoH; and patient cost sharing. Analyzes were conducted in the dispensing database of the FP program (from 2006 to 2012). Results FP has increased its coverage over time; by December 2012 FP covered on average 13% of DM and 11.5% of HTN utilization, a growth of over 600 and 1500%, respectively. The overall cost per treatment to the MoH declined from R$36.43 (R$ = reais, the Brazilian currency) to 18.74 for HTN and from R$33.07to R$15.05 for DM over the period analyzed, representing a reduction in per capita cost greater than 50%. The amount paid by patients for the medicines covered increased over time until 2011, but then declined to zero. We estimate that to treat all patients in need for HTN and DM in 2012 under FP, the Government would need to expend 97% of the total medicines budget. Conclusions FP rapidly increased its coverage in terms of both program reach and proportion of cost subsidized during the period analyzed. Costs of individual HTN and DM treatments in FP were reduced after 2011 for both patients (free) and government (better negotiated prices). However, overall FP expenditures by MoH increased due to markedly increased utilization. The FP is sustainable as a complementary policy but cannot feasibly substitute for the distribution of medicines by the SUS.

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Patient Cost Sharing in Low Income Populations

The American Economic Review ◽

10.1257/aer.100.2.303 ◽

2010 ◽

Vol 100 (2) ◽

pp. 303-308 ◽

Cited By ~ 16

Author(s):

Amitabh Chandra ◽

Jonathan Gruber ◽

Robin McKnight

Keyword(s):

Low Income ◽

Cost Sharing ◽

Patient Cost

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An evaluation of the impact of patient cost sharing for antihypertensive medications on adherence, medication and health care utilization, and expenditures

Patient Preference and Adherence ◽

10.2147/ppa.s28396 ◽

2012 ◽

pp. 63

Author(s):

Kavita Nair ◽

Pesa ◽

Van Den Bos ◽

Gray ◽

Hartsig ◽

...

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Cost Sharing ◽

Care Utilization ◽

Antihypertensive Medications ◽

Patient Cost ◽

The Impact

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Affordable False Teeth: The Effects of Patient Cost Sharing on Denture Utilization and Subjective Chewing Ability

The B E Journal of Economic Analysis & Policy ◽

10.1515/bejeap-2015-0194 ◽

2016 ◽

Vol 16 (3) ◽

pp. 1387-1438 ◽

Cited By ~ 4

Author(s):

Michihito Ando ◽

Reo Takaku

Keyword(s):

Cost Sharing ◽

Social Benefit ◽

Utilization Rate ◽

Randomization Tests ◽

Japanese Study ◽

Patient Cost ◽

Chewing Ability ◽

Using Data ◽

The Impact ◽

Complementary Analysis

Abstract We evaluate the impact of patient cost sharing on the use of dentures and subjective chewing ability exploiting a sharp reduction in the coinsurance rate, the percentage of costs born by the user, from 30 % to 10 % at the age of 70 with a regression discontinuity design. Using data from the Japanese Study of Aging and Retirement (JSTAR), we find that the utilization rate of dentures increases from approximately 50 % to 63 % around the threshold, implying that the extensive margin elasticity of denture usage with respect to the coinsurance rate is about –0.41. In addition, we find this jump is almost entirely due to the change in the rate among women. On the other hand, we do not find a significant improvement in self-reported chewing ability, although chewing ability may not be the only social benefit from dentures. Our empirical findings are also confirmed by complementary analysis with randomization tests.

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PHP65 THE IMPACT AND CHALLENGES OF INCLUDING PATIENT COST SHARING IN COST-EFFECTIVENESS ANALYSES FROM THE PAYER PERSPECTIVE

Value in Health ◽

10.1016/s1098-3015(10)73514-2 ◽

2009 ◽

Vol 12 (3) ◽

pp. A90

Author(s):

DE Spackman ◽

JD Campbell

Keyword(s):

Cost Effectiveness ◽

Cost Sharing ◽

Patient Cost ◽

Payer Perspective ◽

The Impact

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PP66 Increasing Burden Of Out-Of-Pocket Healthcare Expense On Patients

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462319002162 ◽

2019 ◽

Vol 35 (S1) ◽

pp. 50-50

Author(s):

Rhythm Arora ◽

Nikhil Dugar ◽

Vandit Saxena ◽

Sunil K. Jaiswal ◽

Chitresh Kumari ◽

...

Keyword(s):

Low Income ◽

Cost Sharing ◽

Generic Substitution ◽

Group Versus ◽

The United States ◽

High Income Group ◽

Age Group ◽

Healthcare Budget ◽

Bric Countries ◽

The Impact

IntroductionWe conducted an analysis of the key factors triggering cost-sharing mechanisms to understand the status of out-of-pocket (OOP) healthcare expense in the United States (US), Europe, and emerging markets and better appreciate the implications of OOP healthcare expense on patients’ health management.MethodsA review of literature and databases including The Organisation for Economic Co-operation and Development (OECD) and World Bank was performed to understand different cost-sharing mechanisms, factors triggering OOP expenditure and the country-wise trends of OOP expenditure. Additionally, the impact of OOP expenditure on healthcare budget and on patients in terms of medication adherence, uptake of newer therapies and generic substitution was explored.ResultsThe findings reveal that patients are concerned about rising healthcare OOP costs, and we observed an increase of 134 percent in the number of articles published on OOP from 2005 to 2017. The percentage of household spending that goes OOP as healthcare expense is higher in Brazil, Russia, India, and China (BRIC countries; ~11 percent) compared to France, Germany, Italy, United Kingdom, US, Japan, and Canada (G7 countries; ~2 percent). In addition, OOP expenditure increased with age (1.9 percent of take home income in 55-64 age group versus 1.2 percent in 18-25 age group) and is higher in the low-income population (2.8 percent of take home income versus 1 percent in high-income group). Whereas, increasing OOP expenditure reduces the overall healthcare expenditure due to generic substitution (28 percent reduction) and reduction in excessive consumption of supplementary medicines, it also reduces patient adherence (~20 percent decline in dispensed prescriptions) and may foster a reluctance to adopt newer therapies.ConclusionsThe population groups most impacted by increasing OOP expense are the older population, those in the low-income bracket and in poorer countries. While OOP expense may help in the effective and judicious utilization of healthcare system resources and medicines usage, its implementation requires a cautious and considered approach.

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Demonstrating Nutrient Cost Gradients: A Brooklyn Case Study

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000210 ◽

2014 ◽

Vol 84 (5-6) ◽

pp. 244-251 ◽

Cited By ~ 2

Author(s):

Robert J. Karp ◽

Gary Wong ◽

Marguerite Orsi

Keyword(s):

Low Income ◽

Energy Content ◽

Food Selection ◽

The United States ◽

United States Department ◽

Micronutrient Deficiencies ◽

Caloric Density ◽

Low Income Families ◽

The Cost ◽

The Impact

Abstract. Introduction: Foods dense in micronutrients are generally more expensive than those with higher energy content. These cost-differentials may put low-income families at risk of diminished micronutrient intake. Objectives: We sought to determine differences in the cost for iron, folate, and choline in foods available for purchase in a low-income community when assessed for energy content and serving size. Methods: Sixty-nine foods listed in the menu plans provided by the United States Department of Agriculture (USDA) for low-income families were considered, in 10 domains. The cost and micronutrient content for-energy and per-serving of these foods were determined for the three micronutrients. Exact Kruskal-Wallis tests were used for comparisons of energy costs; Spearman rho tests for comparisons of micronutrient content. Ninety families were interviewed in a pediatric clinic to assess the impact of food cost on food selection. Results: Significant differences between domains were shown for energy density with both cost-for-energy (p < 0.001) and cost-per-serving (p < 0.05) comparisons. All three micronutrient contents were significantly correlated with cost-for-energy (p < 0.01). Both iron and choline contents were significantly correlated with cost-per-serving (p < 0.05). Of the 90 families, 38 (42 %) worried about food costs; 40 (44 %) had chosen foods of high caloric density in response to that fear, and 29 of 40 families experiencing both worry and making such food selection. Conclusion: Adjustments to USDA meal plans using cost-for-energy analysis showed differentials for both energy and micronutrients. These differentials were reduced using cost-per-serving analysis, but were not eliminated. A substantial proportion of low-income families are vulnerable to micronutrient deficiencies.

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