In this paper we argue that Australia?s pharmaceutical
cost sharing policy has been applied as if
cost sharing is unproblematic for medicine affordability
and good health outcomes. Australian and
international experience with pharmaceutical cost
sharing strongly suggests a negative impact on
affordability and quality use of medicines, disproportionately
affecting low income patients. We
argue that Australia?s use of cost sharing reflects
the currency of a cognitively powerful and morally
charged idea ? moral hazard. Moral hazard refers
to the change in behaviour induced by insurance
coverage. Applied to pharmaceuticals, this means
that low out-of-pocket cost will lead to waste.
Moral hazard mixes the explanatory power of
price with the intuitively cogent notion that if
people do not experience consequences they will
behave irresponsibly. Cost sharing policy has
gone unscrutinised and uncontested not because
cost sharing is unproblematic, but because in the
light of the idea of moral hazard it has all the
question-deadening weight of common sense.
Determinants of Change in Medicaid Pharmaceutical Cost Sharing: Does Evidence Affect Policy?