The impact of a co-payment increase on the consumption of type 2 antidiabetics - A nationwide interrupted time series analysis.

Autor: Rättö H; The Social Insurance Institution, Kela Research, Helsinki, PO Box 450, 00056 Kela, Finland. Electronic address: hanna.ratto@kela.fi., Kurko T; The Social Insurance Institution, Kela Research, Helsinki, PO Box 450, 00056 Kela, Finland. Electronic address: terhi.kurko@kela.fi., Martikainen JE; The Social Insurance Institution, Kela Research, Helsinki, PO Box 450, 00056 Kela, Finland. Electronic address: jaana.martikainen@kela.fi., Aaltonen K; The Social Insurance Institution, Kela Research, Helsinki, PO Box 450, 00056 Kela, Finland; University of Turku, Department of Social Research, Finland. Electronic address: katri.m.aaltonen@utu.fi.
Jazyk: angličtina
Zdroj: Health policy (Amsterdam, Netherlands) [Health Policy] 2021 Sep; Vol. 125 (9), pp. 1166-1172. Date of Electronic Publication: 2021 May 21.
DOI: 10.1016/j.healthpol.2021.05.007
Abstrakt: International literature suggests that co-payment increases are associated with decreased medicine use, although the effects depend on context. We examined the impact of a co-payment increase on the consumption of type 2 antidiabetics in Finland, a country with a comprehensive health and social security system including ceiling mechanisms aiming to protect patients from high co-payment expenditures. We used administrative register data on all reimbursed purchases of antidiabetics during 2014-2018. An interrupted time series design with segmented regression was used to examine the mean monthly purchase per person, measured as Defined Daily Doses (DDDs), before and after the co-payment increase. At baseline, the mean monthly purchase per person of type 2 antidiabetics was 105 DDDs (95% CI 103.8; 106.0;p<0.001) and there was a decreasing trend of 0.2 DDDs per month (95% CI -0.23;-0.13;p<0.001). A statistically significant decrease of 5.6 DDDs (95% CI -7.3;-3.8;p<0.001) was detected after the reform; however, no significant change in the trend was observed. No significant increase was detected in the mean monthly per person purchase of insulins. The results suggest that a co-payment increase decreases consumption of necessary medicines despite the presence of a medicine co-payment ceiling mechanism. Whether the decrease was associated with negative health effects remains to be further investigated.
Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest.
(Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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