Academic journal article Australian Health Review

From the City to the Bush: Increases in Patient Co-Payments for Medicines Have Impacted on Medicine Use across Australia

Academic journal article Australian Health Review

From the City to the Bush: Increases in Patient Co-Payments for Medicines Have Impacted on Medicine Use across Australia

Article excerpt

Introduction

Despite the universal pharmaceutical subsidies available to Australians under the Pharmaceutical Benefits Scheme (PBS) inequities remain in access to, and utilisation of, prescription medicines.1-4 The prevalence of many chronic diseases including cardiovascular disease, diabetes and cancer is higher in regional and remote Australia than in cities, and higher in socially disadvantaged groups than among those less disadvantaged.1,3 In contrast to need, use of prescription medicines is generally lowest in geographically remote and socially disadvantaged areas.1,3,4

In addition to physical distance from health services and pharmacies, out-of-pocket costs are a key barrier to prescription medicine use for many patients.5,6 Recent surveys have reported that between 12 and 20% of Australian patients have skipped doses of medication or not filled scripts due to cost.5,7,8 The patients most likely to skip medicines because of costs were those with high out-of-pocket costs, low incomes or chronic illness, those reporting poor relationships with their doctors, and Aboriginal or Torres Strait Islanders.9 Presumably, these groups would be the most vulnerable to increases in medicine costs.

In January 2005,PBSpatient charges (co-payments) increased by 21% (from $3.80 to $4.60 for concessional patients and from $23.70 to $28.60 for general patients).10 Following this increase and two related PBS safety net changes,11 use of many medicines fell.11,12Astudy of dispensing trends before and after the 2005 copayments increase found significant declines of between 3 and 11% for 12 of the 17 medicine categories examined including proton pump inhibitors (PPIs), statins, combination asthma medicines and osteoporosis treatments.12 Significantly larger declines in dispensing were observed for concessional patients than for general patients.12 These findings indicate that the 21% co-payments increase adversely influenced use of medicines in Australia, particularly for concessional patients. It is not known whether the 2005 co-payments increase affected all areas of Australia or if the effect was specific to particular remoteness or disadvantage groups. This study aimed to determine whether the 2005 21% co-payments increase affected all remoteness and disadvantage groups.

Method

Data source and extraction

Data were sourced from the Australian Drug Utilisation Sub-Committee of the Pharmaceutical Benefits Advisory Committee. Aggregate prescription data were extracted for PPIs and statins dispensed to patients residing in 1392 statistical local areas (SLA) of Australia for 2004 and 2006 ('observed' dispensing). PPIs and statins were selected for the study as they are the two highest volume medicines subsidised under the PBS, costing an estimated $1.0 billion and $0.5 billion in 2010.13 Also, use of these two classes of medicines fell significantly following the 2005 rise in co-payments.11 Aggregate dispensing data were also extracted for PPIs and statins dispensed nationally to patients in 5-year age categories (0-4 years through to 80-84 years, and 85 years and over) for 2004 and 2006. PPIs included all PBS items with Anatomical Therapeutic Classification (ATC) codes A02BC01-A02BC05, and statins all items with ATC codes C10AA01-C10AA07.

Observed dispensing for 2004 was adjusted to remove the lowdose products that fell below the co-payment thresholds in 2006 (i.e. those priced under $29.50) as these items were not included in the 2006 data capture.10 Had these low-dose products not been removed from the 2004 data the effect of the 2005 co-payments increase would have been exaggerated. The proportion of dispensing removed from 2004 observed figures was 0.1% of statins and 0.6% of PPIs.

SLAs are a spatial unit within the Australian Standard Geographical Classification, developed by the Australian Bureau of Statistics (ABS) for coding data to areas within Australia.14 The areas are based on local government areas and so vary in their geographic and population size. …

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