Determinants of self-reported medicine underuse due to cost: A comparison of seven countries

The University of Western Australia, Perth, WA 6009, Australia.
Journal of Health Services Research & Policy (Impact Factor: 1.73). 03/2010; 15(2):106-14. DOI: 10.1258/jhsrp.2009.009059
Source: PubMed


To compare the predictors of self-reported medicine underuse due to cost across countries with different pharmaceutical subsidy systems and co-payments.
We analysed data from a 2007 survey of adults in Australia, Canada, Germany, the Netherlands, New Zealand (NZ), the United Kingdom (UK) and the United States (US). The predictors of underuse were calculated separately for each country using multivariate poisson regression.
Reports of underuse due to cost varied from 3% in the Netherlands to 20% in the US. In Australia, Canada, NZ, the UK and the US, cost-related underuse was predicted by high out-of-pocket costs (RR range 2.0-4.6), below average income (RR range 1.9-3.1), and younger age (RR range 3.9-16.4). In all countries except Australia and the UK, history of depression was associated with cost-related underuse (RR range 1.2-4.1). In Australia, Canada, Germany, the UK and the US lack of patient involvement in treatment decisions was associated with cost-related underuse (RR range 1.2-1.4). In Australia, Canada and NZ, indigenous persons more commonly reported underuse due to cost (RR range 2.1-2.9).
Cost-related underuse of medicines was least commonly reported in countries with the lowest out-of-pocket costs, the Netherlands and the UK. Countries with reduced co-payments or cost ceilings for low income patients showed the least disparity in rates of underuse between income groups. Despite differences in health insurance systems in these countries, age, ethnicity, depression, and involvement with treatment decisions were consistently predictive of underuse. There are opportunities for policy makers and clinicians to support medicine use in vulnerable groups.

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Available from: Anna Kemp-Casey, Dec 12, 2014
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    • "All of the women in the study were residents of NSW at recruitment to the 45 and Up Study (2006–2009) and reported a median duration of residence in Australia of 37 years (range 26–47). NZ and the UK are culturally similar to Australia, have comparable public pharmaceutical insurance (Kemp et al. 2010), and NZ and UK immigrants to Australia are the most frequent of any countries (Australian Bureau of Statistics 2013). Therefore we consider it unlikely that social marginalisation or unfamiliarity with the health system underpins this higher discontinuation. "
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