Co-payment Strategies for Chronic Medications: A Qualitative and Comparative Analysis at European Level
The management of pharmacotherapy and the process of dispensing medicines is becoming critical in clinical pharmacy due to the increase of incidence and prevalence of chronic diseases, the complexity and customization of therapeutic regimens, the introduction of innovative and more expensive medicines, the unbalanced relation between expenditure and revenue as well as due to the lack of rationalization associated with medication use. For these reasons, co-payments emerged in Europe in the 70s and have been applied over the past few years in healthcare. Co-payments lead to a rationing and rationalization of user’s access under healthcare services and products, and simultaneously, to a qualification and improvement of the services and products for the end-user. This analysis, under hospital practices particularly and co-payment strategies in general, was carried out on all the European regions and identified four reference countries, that apply repeatedly this tool and with different approaches. The structure, content and adaptation of European co-payments were analyzed through 7 qualitative attributes and 19 performance indicators, and the results expressed in a scorecard, allowing to conclude that the German models (total score of 68,2% and 63,6% in both elected co-payments) can collect more compliance and effectiveness, the English models (total score of 50%) can be more accessible, and the French models (total score of 50%) can be more adequate to the socio-economic and legal framework. Other European models did not show the same quality and/or performance, so were not taken as a standard in the future design of co-payments strategies. In this sense, we can see in the co-payments a strategy not only to moderate the consumption of healthcare products and services, but especially to improve them, as well as a strategy to increment the value that the end-user assigns to these services and products, such as medicines.
[1] Catarino, I. (2012). Co-pagamentos: Da teoria à prática. Research presented to the Medicine College of Porto University to obtain approval in the 6th year Option Project, guided by Guilhermina Rego, Porto.
[2] Biondi, N., Lafortune, G., Biondi, N., Devaux, M., Cecchini, M., Sassi, F. et al., (2014). Health at a Glance: Europe 2014. (3a ed.). Paris: OECD Publishing.
[3] Simon-Tuval, T., Triki, N., Chodick, G. & Greenberg, D. (2014). Determinants of cost-related nonadherence to medications among chronically ill patients in Maccabi Healthcare Services, Israel. Value in health regional issues, 4, 41-46.
[4] Solomon, M., Goldman, D., Joyce, G. & Escarce, J. (2009). Cost-sharing and the initiation of drug therapy for the chronically ill. Arch Intern Med, 169(8), 740-749.
[5] Piettea, J., Heislerb, M., Hornec, R. & Alexanderd G. (2005). A conceptually based approach to understanding chronically ill patients’ responses to medication cost pressures. Social Science & Medicine, 62, 846–857.
[6] Teixeira, I. & Vieira, I. (2008). Pharmaceutical pricing and reimbursement information. INFARMED, I.P.
[7] Mann, B.S., Barnieh, L., Tang, K., Campbell, D., Clement, F., Hemmelgarn, B., et al. (2014). Association between drug insurance cost sharing strategies and outcomes in patients with chronic diseases: A systematic review. PLoS One, 3(9).
[8] Despacho n.º 13382/2012, de 4 de outubro (DR, 2.ª série, n.º 198, de 12 de outubro de 2012). Determina que a prescrição de medicamentos, para dispensa em regime de ambulatório pelas farmácias hospitalares, é obrigatoriamente realizada através de sistemas de prescrição eletrónica.
[9] Health Ministry. (2012). Procedimentos de cedência de medicamentos no ambulatório hospitalar. INFARMED, I.P.
[10] Boyle, S. (2011). United Kingdom (England): Health system review. Health Systems in Transition, 13(1), 1–486.
[11] Chevreul, K., Durand-Zaleski, I., Bahrami, S., Hernández-Quevedo, C. & Mladovsky, P. (2010). France: Health system review. Health Systems in Transition, 12(6), 1– 291.
[12] Busse, R. & Blümel, M. (2014). Germany: Health system review. Health Systems in Transition, 16(2), 1–296.
[13] Smith, M. (2014). Improving dental care and oral health – a call to action. Leeds: NHS England
[14] UK Government. (2014). How much will I pay for NHS dental treatment? http://www.nhs.uk/chq/Pages/1781.aspx?CategoryID=74. Accessed in October 30, 2015 in www.gov.uk/.
[15] Lacey, R. (2013). NHS Dental cost - how much you should be paying and how In http://www.moneywise.co.uk/. Accessed in October 30, 2015 in http://www.moneywise.co.uk/cut-your-costs/family-life/nhs-dental-cost-how-much-youshould- be-paying-and-how.
[16] British Dental Health Foundation. (2015). Paying for dental treatment. https://www.dentalhealth.org/tell-me-about/topic/routine-treatment/paying-for-dentaltreatment. Accessed in October 31, 2015 in www.dentalhealth.org.
[17] Age UK. (2015). Dental care: NHS and private treatment. London.
[18] Organização para a Cooperação e Desenvolvimento Económico (OCDE). (2014a). How does the United Kingdom compare? Paris: OECD Publishing.
[19] United Health Group. (2015). Health4Me Mobile App Now Enables UnitedHealthcare Plan Participants to Pay Their Medical Bills with Their Smartphones. Accessed in December 6, 2015 in http://www.unitedhealthgroup.com/newsroom/articles/feed/unitedhealthcare/2015/0216health4mebillpay
[20] Kambia-Chopin, B. & Perronnin, M. (2013). Deductibles and the demand for prescription drugs: evidence from french data. Paris: IRDES.
[21] Centre des Liaisons Européennes et Internationales de Sécurité Sociale (CLEISS). (2015). http://www.cleiss.fr/. Accessed November 2, 2015 in http://www.cleiss.fr/docs/regimes/regime_france/an_1.html.
[22] Organização para a Cooperação e Desenvolvimento Económico (OCDE). (2015). How does health spending in France compare?. Paris: OECD Publishing.
[23] Green, D., Irvine. B., Clarke, E. & Bidgood E. (2013). Healthcare Systems: France. CIVITAS.
[24] Organização para a Cooperação e Desenvolvimento Económico (OCDE). (2014b). How does Germany compare?. Paris: OECD Publishing
[25] Schreyögg, J. & Grabka, M. (2008) Copayments for ambulatory care in Germany: a natural experiment using a difference-in-difference approach. Berlin: DIW.
[26] Organização para a Cooperação e Desenvolvimento Económico (OCDE). (2011). Health at a Glance 2011 - OECD Indicators. Paris: OECD Publishing.
[27] Paris, P., & Docteur, E. (2008). Pharmaceutical pricing and reimbursement policies in Germany. Paris: OECD Publishing.
[28] Herr, A. & Suppliet, M. (2011). Pharmaceutical prices under regulation: Co-payment exemptions and reference prices in Germany. Duesseldorf: Editorial Express.
[29] The Henry J. Kaiser Family Foundation. (2009). Cost sharing for health care: France, Germany, and Switzerland. California: Autor
[30] Augurzky, B., Bauer, T. & Schaffner, S. (2006). Copayments in the German Health System: Does it work?. Bonn: IZA.
[31] How To Germany. (2015). Paying Medical Expenses/Health Insurance Claims in Germany. Accessed in December 6, 2015 in http://www.howtogermany.com/pages/healthinsurance-claims.html
[1] Catarino, I. (2012). Co-pagamentos: Da teoria à prática. Research presented to the Medicine College of Porto University to obtain approval in the 6th year Option Project, guided by Guilhermina Rego, Porto.
[2] Biondi, N., Lafortune, G., Biondi, N., Devaux, M., Cecchini, M., Sassi, F. et al., (2014). Health at a Glance: Europe 2014. (3a ed.). Paris: OECD Publishing.
[3] Simon-Tuval, T., Triki, N., Chodick, G. & Greenberg, D. (2014). Determinants of cost-related nonadherence to medications among chronically ill patients in Maccabi Healthcare Services, Israel. Value in health regional issues, 4, 41-46.
[4] Solomon, M., Goldman, D., Joyce, G. & Escarce, J. (2009). Cost-sharing and the initiation of drug therapy for the chronically ill. Arch Intern Med, 169(8), 740-749.
[5] Piettea, J., Heislerb, M., Hornec, R. & Alexanderd G. (2005). A conceptually based approach to understanding chronically ill patients’ responses to medication cost pressures. Social Science & Medicine, 62, 846–857.
[6] Teixeira, I. & Vieira, I. (2008). Pharmaceutical pricing and reimbursement information. INFARMED, I.P.
[7] Mann, B.S., Barnieh, L., Tang, K., Campbell, D., Clement, F., Hemmelgarn, B., et al. (2014). Association between drug insurance cost sharing strategies and outcomes in patients with chronic diseases: A systematic review. PLoS One, 3(9).
[8] Despacho n.º 13382/2012, de 4 de outubro (DR, 2.ª série, n.º 198, de 12 de outubro de 2012). Determina que a prescrição de medicamentos, para dispensa em regime de ambulatório pelas farmácias hospitalares, é obrigatoriamente realizada através de sistemas de prescrição eletrónica.
[9] Health Ministry. (2012). Procedimentos de cedência de medicamentos no ambulatório hospitalar. INFARMED, I.P.
[10] Boyle, S. (2011). United Kingdom (England): Health system review. Health Systems in Transition, 13(1), 1–486.
[11] Chevreul, K., Durand-Zaleski, I., Bahrami, S., Hernández-Quevedo, C. & Mladovsky, P. (2010). France: Health system review. Health Systems in Transition, 12(6), 1– 291.
[12] Busse, R. & Blümel, M. (2014). Germany: Health system review. Health Systems in Transition, 16(2), 1–296.
[13] Smith, M. (2014). Improving dental care and oral health – a call to action. Leeds: NHS England
[14] UK Government. (2014). How much will I pay for NHS dental treatment? http://www.nhs.uk/chq/Pages/1781.aspx?CategoryID=74. Accessed in October 30, 2015 in www.gov.uk/.
[15] Lacey, R. (2013). NHS Dental cost - how much you should be paying and how In http://www.moneywise.co.uk/. Accessed in October 30, 2015 in http://www.moneywise.co.uk/cut-your-costs/family-life/nhs-dental-cost-how-much-youshould- be-paying-and-how.
[16] British Dental Health Foundation. (2015). Paying for dental treatment. https://www.dentalhealth.org/tell-me-about/topic/routine-treatment/paying-for-dentaltreatment. Accessed in October 31, 2015 in www.dentalhealth.org.
[17] Age UK. (2015). Dental care: NHS and private treatment. London.
[18] Organização para a Cooperação e Desenvolvimento Económico (OCDE). (2014a). How does the United Kingdom compare? Paris: OECD Publishing.
[19] United Health Group. (2015). Health4Me Mobile App Now Enables UnitedHealthcare Plan Participants to Pay Their Medical Bills with Their Smartphones. Accessed in December 6, 2015 in http://www.unitedhealthgroup.com/newsroom/articles/feed/unitedhealthcare/2015/0216health4mebillpay
[20] Kambia-Chopin, B. & Perronnin, M. (2013). Deductibles and the demand for prescription drugs: evidence from french data. Paris: IRDES.
[21] Centre des Liaisons Européennes et Internationales de Sécurité Sociale (CLEISS). (2015). http://www.cleiss.fr/. Accessed November 2, 2015 in http://www.cleiss.fr/docs/regimes/regime_france/an_1.html.
[22] Organização para a Cooperação e Desenvolvimento Económico (OCDE). (2015). How does health spending in France compare?. Paris: OECD Publishing.
[23] Green, D., Irvine. B., Clarke, E. & Bidgood E. (2013). Healthcare Systems: France. CIVITAS.
[24] Organização para a Cooperação e Desenvolvimento Económico (OCDE). (2014b). How does Germany compare?. Paris: OECD Publishing
[25] Schreyögg, J. & Grabka, M. (2008) Copayments for ambulatory care in Germany: a natural experiment using a difference-in-difference approach. Berlin: DIW.
[26] Organização para a Cooperação e Desenvolvimento Económico (OCDE). (2011). Health at a Glance 2011 - OECD Indicators. Paris: OECD Publishing.
[27] Paris, P., & Docteur, E. (2008). Pharmaceutical pricing and reimbursement policies in Germany. Paris: OECD Publishing.
[28] Herr, A. & Suppliet, M. (2011). Pharmaceutical prices under regulation: Co-payment exemptions and reference prices in Germany. Duesseldorf: Editorial Express.
[29] The Henry J. Kaiser Family Foundation. (2009). Cost sharing for health care: France, Germany, and Switzerland. California: Autor
[30] Augurzky, B., Bauer, T. & Schaffner, S. (2006). Copayments in the German Health System: Does it work?. Bonn: IZA.
[31] How To Germany. (2015). Paying Medical Expenses/Health Insurance Claims in Germany. Accessed in December 6, 2015 in http://www.howtogermany.com/pages/healthinsurance-claims.html
@article{"International Journal of Medical, Medicine and Health Sciences:74490", author = "Pedro M. Abreu and Bruno R. Mendes", title = "Co-payment Strategies for Chronic Medications: A Qualitative and Comparative Analysis at European Level", abstract = "The management of pharmacotherapy and the process of dispensing medicines is becoming critical in clinical pharmacy due to the increase of incidence and prevalence of chronic diseases, the complexity and customization of therapeutic regimens, the introduction of innovative and more expensive medicines, the unbalanced relation between expenditure and revenue as well as due to the lack of rationalization associated with medication use. For these reasons, co-payments emerged in Europe in the 70s and have been applied over the past few years in healthcare. Co-payments lead to a rationing and rationalization of user’s access under healthcare services and products, and simultaneously, to a qualification and improvement of the services and products for the end-user. This analysis, under hospital practices particularly and co-payment strategies in general, was carried out on all the European regions and identified four reference countries, that apply repeatedly this tool and with different approaches. The structure, content and adaptation of European co-payments were analyzed through 7 qualitative attributes and 19 performance indicators, and the results expressed in a scorecard, allowing to conclude that the German models (total score of 68,2% and 63,6% in both elected co-payments) can collect more compliance and effectiveness, the English models (total score of 50%) can be more accessible, and the French models (total score of 50%) can be more adequate to the socio-economic and legal framework. Other European models did not show the same quality and/or performance, so were not taken as a standard in the future design of co-payments strategies. In this sense, we can see in the co-payments a strategy not only to moderate the consumption of healthcare products and services, but especially to improve them, as well as a strategy to increment the value that the end-user assigns to these services and products, such as medicines.
", keywords = "Clinical pharmacy, co-payments, healthcare, medicines.", volume = "10", number = "12", pages = "579-5", }
