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Financial Burden of Prescribed Medicines Included in Outpatient Benefits Package Schemes: Comparative Analysis of Co-Payments for Reimbursable Medicines in European Countries

Applied Health Economics and Health Policy volume 17, pages 803–816 (2019)Cite this article

Abstract

Objective

The study aimed to analyse the financial burden that co-payments for prescribed and reimbursed medicines pose on patients in European countries.

Methods

Five medicines used in acute conditions (antibiotic, analgesic) and in chronic care (hypertension, asthma, diabetes) were selected. Co-payments (standard and five defined population groups, e.g. low-income people, patients with high consumption) were surveyed based on information retrieved from national price lists (September 2017) and co-payment regulation in nine countries (Albania, Austria, England, France, Germany, Greece, Hungary, Kyrgyzstan and Sweden). The financial burden of the selected medicines (originator and lowest-priced generic) was described as the percentage of patients’ payments for 1 month’s therapy or treatment of one episode in comparison to the national minimum monthly wage.

Results

The study showed large variation in co-payments between the countries. Financial burden resulting from co-payments for reimbursed medicines tended to be higher in lower-income countries (Kyrgyzstan: 9% of minimum monthly wage for generic amlodipine; 2–4% for generic and originator salbutamol; Albania: approximately 3% for originator amoxicillin/clavulanic acid and metformin). Most studied countries applied reduction or exemption mechanisms (children were exempt in five countries, no or lower co-payments for low-income people in five countries, exemptions from co-payments upon reaching a threshold of expenses in six countries).

Conclusions

Co-payments for prescribed medicines can pose a substantial financial burden for outpatients, particularly in lower-income countries. The price of a medicine, availability of lower-priced medicines and the design of co-payments, including exemptions and reductions for specific groups, can considerably impact patients’ expenses for medicines.

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Fig. 1

Notes

  1. The WHO European region comprises 53 countries, including countries in Central Asia.

  2. While European Union (EU) legislation (Directive 2001/83/EC) provides criteria for the definition of the prescription status of medicines, the actual classification of a medicine as prescription-only or non-prescription is a national competence in the EU.

  3. Only England applies co-payments for medicines, whereas in Wales, Scotland and Northern Ireland no co-payments are charged on medicines.

  4. This research was part of a larger study of reimbursement policies in the countries of the WHO European region.

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Acknowledgements

We sincerely thank the following experts for validating the financial burden analysis for their country: Sarah Mörtenhuber, Main Association of Social Security Institutions (Austria), Dimitra Panteli, Berlin University of Technology (Germany), Chara Kani, EOPYY – National Organization for Healthcare Service Provision (Greece), Gergely Németh, Institute of Health Insurance Fund Management (Hungary), Saltanat Moldoisaeva, WHO Country Office (Kyrgyzstan), Gunilla Rönnholm, Dental and Pharmaceutical Benefits Agency (Sweden) and Stephen Lock, Department of Health and Social Care (United Kingdom). In addition, our thanks go to Peter Schneider of Gesundheit Österreich GmbH (Austrian Public Health Institute), who surveyed the medicine prices for the included EU Member States through the Pharma Price Information (PPI) service and to Manuel Alexander Haasis of Gesundheit Österreich GmbH (Austrian Public Health Institute), who was involved in surveying the co-payment regulations in European countries.

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Authors and Affiliations

  1. WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich GmbH (Austrian Public Health Institute), Stubenring 6, 1010, Vienna, Austria

    Sabine Vogler

  2. Health Division, Organisation for Economic Co-operation and Development (OECD), 75116, Paris, France

    Guillaume Dedet

  3. World Health Organization (WHO) Regional Office for Europe, 2100, Copenhagen, Denmark

    Guillaume Dedet & Hanne Bak Pedersen

Authors
  1. Sabine Vogler
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Correspondence to Sabine Vogler.

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Funding

The study was funded by the WHO Regional Office for Europe’s Health Technologies and Pharmaceuticals programme. No funding was received for the writing of the manuscript.

Conflict of interest

SV, GD and HBP have no conflicts of interest to declare. All authors submitted a signed Conflict of Interest disclosure form.

Author contributions

All authors fulfil the authorship criteria. All authors are aware of the submission and are in agreement with the manuscript. SV developed the methodology, in collaboration with GD and HBP. Data analysis was mainly done by SV, supported by GD, and SV and GD collaborated on the presentation and interpretation of the data. SV had the lead in drafting and revising the manuscript, upon comments by GD and HBP. This article reflects GD’s views and not those of the OECD. After submission of the article, HBP transferred to UNICEF.

Ethical approval

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Vogler, S., Dedet, G. & Pedersen, H.B. Financial Burden of Prescribed Medicines Included in Outpatient Benefits Package Schemes: Comparative Analysis of Co-Payments for Reimbursable Medicines in European Countries. Appl Health Econ Health Policy 17, 803–816 (2019). https://doi.org/10.1007/s40258-019-00509-z

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