E-drug: Bamako Initiative (cont'd)
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The results that Kathy Holloway cites from the Rand Health Insurance
Experiment are different from the ones that I have seen in a paper by
Foxman et al (Journal of Chronic Diseases 1987;40(5):429-437). That
paper found that cost sharing reduced inappropriate and appropriate
antibiotic use to a similar degree. Moreover, all of the other work in
this area shows that although there is a drop in nonessential drug use
there is also a drop in essential drug use, although sometimes the drop
in essential drug use is not as great as it is for nonessential drugs.
In terms of whether or not there are negative health outcomes
associated with cost sharing the published studies are consistent in
showing that if you look at vulnerable populations (poor, on multiple
drugs for chronic problems) that there are serious negative health
consequences.
I have appended a list of references for those interested in doing
further reading on this topic.
Joel Lexchin MD
121 Walmer Rd.
Toronto, Ontario
CANADA M5R 2X8
Phone: (416)-964-7186
Fax: (416)-923-9515
e mail: joel.lexchin@utoronto.ca
Papers on Use of Essential and Nonessential Drugs with Cost Sharing
Harris BL, Stergachis A, Ried LD. The effect of drug co-payments on
utilization and cost of pharmaceuticals in a health maintenance
organization. Med Care 1990;28:907-17.
Hux JE, Naylor CD, Fielding DA. The Ontario Drug Benefit Program
copayment: its impact on access for Ontario seniors and charges to
the program. Toronto: Institute for Clinical Evaluative Sciences in
Ontario, April 24, 1997.
Martin BC, McMillan JA. The impact of implementing a more
restrictive prescription limit on Medicaid recipients: effects on cost,
therapy, and out-of-pocket expenditures. Med Care 1996;34:686-701.
McManus P, Donnelly N, Henry D, Hall W, Primrose J, Lindner J.
Prescription drug utilization following patient co-payment changes in
Australia. Pharmacoepidemiol Drug Safety 1996;5:385-92.
Reeder CE, Nelson AA. The differential impact of copayment on drug
use in a Medicaid population. Inquiry 1985;22:396-403.
Soumerai SB, Avorn J, Ross-Degnan D, Gortmaker S. Payment
restrictions for prescription drugs under Medicaid: effects on therapy,
cost, and equity. N Engl J Med 1987;317:550-6.
Soumerai SB, Ross-Degnan D, Avorn J, McLaughlin TJ, Choodnovskiy
I. Effects of Medicaid drug-payment limits on admission to hospitals
and nursing homes. N Engl J Med 1991;325:1072-7.
Soumerai SB, McLaughlin TJ, Ross-Degnan D, Casteris CS, Bollini P.
Effects of limiting Medicaid drug-reimbursement benefits on the use of
psychotropic agents and acute mental health services by patients with
schizophrenia. N Engl J Med 1994;331:650-5.
Papers on Health Outcomes Associated with Cost Sharing
Johnson RE, Goodman MJ, Hornbrook MC, Eldredge MB. The impact
of increasing patient prescription drug cost sharing on therapeutic
classes of drugs received and on the health status of elderly HMO
members. HSR: Health Serv Res 1997;32:103-22.
Soumerai SB, Ross-Degnan D, Avorn J, McLaughlin TJ, Choodnovskiy
I. Effects of Medicaid drug-payment limits on admission to hospitals
and nursing homes. N Engl J Med 1991;325:1072-7.
Soumerai SB, McLaughlin TJ, Ross-Degnan D, Casteris CS, Bollini P.
Effects of limiting Medicaid drug-reimbursement benefits on the use of
psychotropic agents and acute mental health services by patients with
schizophrenia. N Engl J Med 1994;331:650-5.
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