d2064d27dd873d0972a280f27823c977 pmc_33806543.pdf a0d909e4466c955e525af9708c1827add9b886ac pmc_33806543.pdf 647797ddb91f2cf7fb47a503eacd80a286f2252ff6f926dc1febcbdb9015cd76 pmc_33806543.pdf Title: The Effect of Changes in Cost Sharing on the Consumption of Prescription and Over-the-Counter Medicines in Catalonia Subject: Many universal health care systems have increased the share of the price of medicines paid by the patient to reduce the cost pressure faced after the Great Recession. This paper assesses the impact of cost-sharing changes on the propensity to consume prescription and over-the-counter medicines in Catalonia, a Spanish autonomous community, affected by three new cost-sharing policies implemented in 2012. We applied a quasi-experimental difference-in-difference method using data from 2010 to 2014. These reforms were heterogeneous across different groups of individuals, so we define three intervention groups: (i) middle-income working population—co-insurance rate changed from 40% to 50%; (ii) low/middle-income pensioners—from free full coverage to 10% co-insurance rate; (iii) unemployed individuals without benefits—from 40% co-insurance rate to free full coverage. Our control group was the low-income working population whose co-insurance rate remained unchanged. We estimated the effects on the overall population as well as on the group with long-term care needs. We evaluated the effect of these changes on the propensity to consume prescription or over-the-counter medicines, and explored the heterogeneity effects across seven therapeutic groups of prescription medicines. Our findings showed that, on average, these changes did not significantly change the propensity to consume prescription or over-the-counter medicines. Nonetheless, we observed that the propensity to consume prescription medicines for mental disorders significantly increased among unemployed without benefits, while the consumption of prescribed mental disorders medicines for low/middle-income pensioners with long-term care needs decreased after becoming no longer free. We conclude that the propensity to consume medicines was not affected by the new cost-sharing policies, except for mental disorders. However, our results do not preclude potential changes in the quantity of medicines individuals consume. Keywords: prescription drugs; healthcare financing; public policy; cost-sharing Author: Mario Martínez-Jiménez, Pilar García-Gómez and Jaume Puig-Junoy Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Mon Mar 8 11:24:35 2021 CET ModDate: Mon Mar 8 11:28:00 2021 CET Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 21 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1014055 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- IBICCA+URWPalladioL-Ital Type 1 Custom yes yes no 10 0 FLMKIA+URWPalladioL-Bold Type 1 Custom yes yes no 15 0 UCHWOW+URWPalladioL-Roma Type 1 Custom yes yes no 19 0 XWOCXD+VnURWPalladioL-Bold Type 1 Custom yes yes no 23 0 AZBFJT+VnURWPalladioL Type 1 Custom yes yes no 28 0 LWQXII+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 36 0 IRWHZX+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 39 0 MCBCCI+SourceSansRoman-Regular Type 1C Custom yes yes no 61 0 MCBCCM+SourceSansRoman.613wght Type 1C Custom yes yes no 65 0 MCBCCO+SourceSansRoman-Bold Type 1C Custom yes yes no 69 0 UJUUJI+PazoMath Type 1 Builtin yes yes no 81 0 WREHKF+CMSY10 Type 1 Builtin yes yes no 88 0 GIGFZE+CMR10 Type 1 Builtin yes yes no 98 0 EBEECQ+EURM10 Type 1 Builtin yes yes no 102 0 EOBJOC+PalatinoLinotype TrueType WinAnsi yes yes no 119 0 EOBJOC+PalatinoLinotype TrueType WinAnsi yes yes no 170 0 EOBKEC+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 173 0 RYVCUX+VnURWPalladioL-Italic Type 1 Custom yes yes no 180 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-10-02 03:24:34 CEST RepresentationInformation: pmc_33806543.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2023-03-31 12:09:31 CEST Size: 1014055 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 319 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Material and Methods Destination: section.2 Children: Item: Title: Study Design and Data Destination: subsection.2.1 Item: Title: Outcome Variables Destination: subsection.2.2 Item: Title: Statistical Analysis Destination: subsection.2.3 Children: Item: Title: Primary Analysis Destination: subsubsection.2.3.1 Item: Title: Common Trends Assumption Destination: subsubsection.2.3.2 Item: Title: Results Destination: section.3 Children: Item: Title: Impact on Propensity to Consume Prescription and Over-the-Counter (OTC) Medicines Destination: subsection.3.1 Item: Title: Impact on Propensity to Consume Prescription Medicines by Therapeutic Group Destination: subsection.3.2 Item: Title: Impact on the Population with Long-Term Care Needs Destination: subsection.3.3 Item: Title: Sensitivity Analyses Destination: subsection.3.4 Item: Title: Discussion Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: Destination: section.A. Item: Title: References Destination: figure.caption.19 Info: Title: The Effect of Changes in Cost Sharing on the Consumption of Prescription and Over-the-Counter Medicines in Catalonia Author: Mario Martínez-Jiménez, Pilar García-Gómez and Jaume Puig-Junoy Subject: Many universal health care systems have increased the share of the price of medicines paid by the patient to reduce the cost pressure faced after the Great Recession. This paper assesses the impact of cost-sharing changes on the propensity to consume prescription and over-the-counter medicines in Catalonia, a Spanish autonomous community, affected by three new cost-sharing policies implemented in 2012. We applied a quasi-experimental difference-in-difference method using data from 2010 to 2014. These reforms were heterogeneous across different groups of individuals, so we define three intervention groups: (i) middle-income working population co-insurance rate changed from 40% to 50%; (ii) low/middle-income pensioners from free full coverage to 10% co-insurance rate; (iii) unemployed individuals without benefits from 40% co-insurance rate to free full coverage. Our control group was the low-income working population whose co-insurance rate remained unchanged. We estimated the effects on the overall population as well as on the group with long-term care needs. We evaluated the effect of these changes on the propensity to consume prescription or over-the-counter medicines, and explored the heterogeneity effects across seven therapeutic groups of prescription medicines. Our findings showed that, on average, these changes did not significantly change the propensity to consume prescription or over-the-counter medicines. Nonetheless, we observed that the propensity to consume prescription medicines for mental disorders significantly increased among unemployed without benefits, while the consumption of prescribed mental disorders medicines for low/middle-income pensioners with long-term care needs decreased after becoming no longer free. We conclude that the propensity to consume medicines was not affected by the new cost-sharing policies, except for mental disorders. However, our results do not preclude potential changes in the quantity of medicines individuals consume. 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