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

Sabine Vogler (), Guillaume Dedet and Hanne Bak Pedersen
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Sabine Vogler: Gesundheit Österreich GmbH (Austrian Public Health Institute)
Guillaume Dedet: Organisation for Economic Co-operation and Development (OECD)
Hanne Bak Pedersen: World Health Organization (WHO) Regional Office for Europe

Applied Health Economics and Health Policy, 2019, vol. 17, issue 6, No 6, 803-816

Abstract: 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.

Date: 2019
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DOI: 10.1007/s40258-019-00509-z

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