Co-payments have been linked to the slowing growth in pharmaceutical spending over the last five years. However, patients with health problems frequently have difficulty affording their pharmacotherapy and fail to take their medication as prescribed. We examine the relationship between co-payment amounts and four types of cost-related underuse: taking fewer doses, postponing taking a medication, failing to fill a prescription at all, and taking medication less frequently than prescribed. We conducted a nationwide survey of US adults age 50 and over who take medication for a chronic condition. Participants provided information on 17 chronic conditions, medication they take for those conditions, and whether they underused any medication due to cost. We analyzed those who reported paying co-payments for their prescriptions (n = 2,869). Analysis involved multivariate logistic regression, with adjustments for survey weights and clustering. Our data show a strong positive association between co-payments and cost-related medication underuse. Although people differ in how they underuse medications, these behaviours are strongly associated with co-payment amount. Realigning the co-payments with cost-effectiveness data, also known as value-based insurance design, warrants further investigation.
"Weale and Clark, 2010). Co-payments have been linked to lower utilization of care (Bolin et al., 2009) and to underuse of medications (Wagner et al., 2008). In fact, user charges are bound to result in underuse of care rather than the curbing of unnecessary care whenever patients are not able to differentiate between care that is necessary and unnecessary (Thomson et al., 2010). "
[Show abstract][Hide abstract] ABSTRACT: This paper assesses which policy-relevant characteristics of a healthcare system contribute to health-system efficiency. Health-system efficiency is measured using the stochastic frontier approach. Characteristics of the health system are included as determinants of efficiency. Data from 21 OECD countries from 1970 to 2008 are analysed. Results indicate that broader health-system structures, such as Beveridgian or Bismarckian financing arrangements or gatekeeping, are not significant determinants of efficiency. Significant contributors to efficiency are policy instruments that directly target patient behaviours, such as insurance coverage and cost sharing, and those that directly target physician behaviours, such as physician payment methods. From the perspective of the policymaker, changes in cost-sharing arrangements or physician remuneration are politically easier to implement than changes to the foundational financing structure of the system.
Health Economics Policy and Law 12/2011; 7(2):197-226. DOI:10.1017/S1744133111000211 · 1.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A cable-driven parallel manipulator (CDPM) possesses a number of promising advantages over the conventional rigid-link manipulators, such as the simple and lightweight mechanical structure, high-loading capacity, and large reachable workspace. However, due to the unilateral driving capability of the flexible cables, most of the well-developed modelling and analysis methods for conventional rigid-link mechanisms cannot be directly applied to CDPM. This paper focuses on the kinematics and singularity analysis of a specific type of CDPM, i.e., a completely restrained planar CDPM. Following an analytical approach, the forward displacement analysis leads to solve a fourth order polynomial equation. Hence, the solutions can be determined efficiently in symbolic forms. To verify the effectiveness of this method, a computation example is provided, in which four real solutions are found out. It is realized the Jacobian-based singularity analysis, where all cables are treated as rigid links, is incomplete for the CDPM. Based on the concept of the instantaneous center and taking into account the cable-tension condition, a new geometrical singularity analysis method is proposed, which is able to effectively identify all forward singularity configurations for a completely restrained planar CDPM.
Intelligent Robots and Systems, 2004. (IROS 2004). Proceedings. 2004 IEEE/RSJ International Conference on; 01/2004
[Show abstract][Hide abstract] ABSTRACT: Adherence to inhaled corticosteroid (ICS) medication is known to be low overall, but tends to be lower among African-American patients when compared with white patients.
To understand the factors that contribute to ICS adherence among African-American and white adults with asthma.
Eligible individuals had a prior diagnosis of asthma, one or more ICS prescriptions, and were members of a large health maintenance organization in southeast Michigan. Individuals were sent a survey that included questions about internal factors (e.g., patient beliefs, knowledge, and motivation) and external factors (e.g., socioeconomic status, barriers to care, social support, and stressors) potentially related to ICS adherence. Adherence was calculated using electronic prescription and fill data. Stepwise regression was used to identify factors associated with adherence before and after stratifying by race-ethnicity.
Surveys were returned by 1,006 (56.3%) of 1,787 eligible patients. Adjusting for internal factors, but not external factors, diminished the relationship between race-ethnicity and ICS adherence. Among African-American patients, readiness to take ICS medication was the only internal or external factor significantly associated with ICS adherence; it explained 5.6% of the variance in adherence. Among white patients, perceived ICS necessity, ICS knowledge, doctors being perceived as the source of asthma control, and readiness to take medication were the internal factors associated with ICS adherence; these accounted for 19.8% of the variance in adherence.
Factors associated with ICS adherence appear to differ between African-American and white patients, suggesting that group-specific approaches are needed to improve adherence.
American Journal of Respiratory and Critical Care Medicine 11/2008; 178(12):1194-201. DOI:10.1164/rccm.200808-1233OC · 13.00 Impact Factor
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