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Reimbursement for drugs: a register study comparing economic outcome for five healthcare centres in areas with different socioeconomic conditions
University of Kalmar, School of Human Sciences.ORCID iD: 0000-0002-4064-3815
University of Kalmar, School of Pure and Applied Natural Sciences. (eHälsoinstitutet)
Linköpings universitet.
2009 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 37, no 6, p. 647-653Article in journal (Refereed) Published
Abstract [en]

AIMS

Previous studies have indicated the negative effects of socioeconomic deprivation on health status and morbidity. Nevertheless, the economic assignment systems for pharmaceutical benefits in Sweden do not take socioeconomic status (SES) into account. The aim of the study was, therefore, to compare reimbursement for subsidized drugs at primary healthcare centres (HCCs) with differing socioeconomic conditions in relation to real costs. The word reimbursement is used to denote economic compensation to the HCCs from the county council for drug benefit costs.

METHODS

The numbers of individuals dispensed drugs, total costs and reimbursement at five HCCs with different socioeconomic conditions were compared. A socioeconomic index was calculated for each HCC on the basis of information from the municipality registries on income (with negative sign), assistance allowance, education, foreign background, and unemployment. Register data on drug benefit costs were retrieved from the National Corporation of Pharmacies (Apoteket AB) and the Swedish Prescribed Drug Register at the National Board of Health and Welfare. Data on listed and unlisted citizens at the Kalmar County Council and on public statistics from registers at the HCC municipalities where the HCCs were situated were retrieved.

RESULTS

There was an almost inverse linear relationship between total cost compensation and the socioeconomic index (n = 5; r =-0.99; p = 0.001). The HCCs with the lowest SES received lower cost compensation.

CONCLUSIONS

HCCs responsible for citizens with lower SES appeared to be disadvantaged by the prevalent reimbursement system in Sweden, thereby increasing differences in the state of health of the citizens. This, in turn, hampers health preventing programmes and lifestyle interventions. An HCC-specific standardized summary of socioeconomic burden is presented.

Place, publisher, year, edition, pages
2009. Vol. 37, no 6, p. 647-653
Keywords [en]
Reimbursement, Primary healthcare, Drug benefit, Socioeconomic conditions
National Category
Medical and Health Sciences
Research subject
Natural Science, Biomedical Sciences
Identifiers
URN: urn:nbn:se:hik:diva-2332DOI: 10.1177/1403494809106544PubMedID: 19546143OAI: oai:DiVA.org:hik-2332DiVA, id: diva2:274984
Available from: 2009-11-02 Created: 2009-11-02 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Patient characteristic, perceived health and drug prescription in primary care
Open this publication in new window or tab >>Patient characteristic, perceived health and drug prescription in primary care
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Individuella faktorer, skattad hälsa och läkemedelsförskrivning inom primärvård
Abstract [en]

Patients have increased demands for information and involvement in decision-making including drug selection.  At the same time, society needs to limit costs, e.g. for subsidized drugs, thus entailing a challenge to in particular primary care. The overall aim of this thesis was to describe different factors influencing drug prescription in primary care and perceived health.

In a register study, the actual costs of prescribed subsidized drugs at five health care centers (HCCs) in areas of varying socioeconomic status (SES) were compared to the assigned drug budget. It revealed that HCCs with many citizens in the catchment area with low SES showed a deficit at year’s end. HCCs in areas with citizens with a higher SES showed a surplus.

In another register study, the prescription of drugs at lower or higher price levels for the diagnoses of chronic obstructive bronchitis, depression, diabetes and osteoporosis was studied. Drug prescription was then compared with individual factors for age, sex, education, income and country of birth, and whether the care provider was private or public. It was found that certain individual and provider factors appear to influence the prescribing of drugs of different price levels.

To investigate patient involvement in the decision to start long-term drug treatment, respondents who had recently begun taking medication were interviewed. The study showed that patient participation was important, but that participation implied different things to different patients. One view was that participation could be achieved without sharing the decision-making process, whereas another view was that participation was more or less willingness to become involved in decision-making. Prerequisites for patient participation were knowledge in the relevant area and trust in the physician.

A fourth study examined how individuals aged 65-80 years rated their health. The study showed that health was assessed much lower in respondents with depressive symptoms compared to those without corresponding symptoms. Health was also assessed as worse for people with hypertension and in those treated with drugs for depression and hypertension. Health was perceived as better in the younger age groups, in individuals with higher educational levels, and for men. 

Drug prescription in primary care is controlled, in addition to medical necessity, by economic constraints, and that patients need an opportunity to influence decisions about their care and treatment. However, economic constraints make it difficult for physicians to support patients in their choice of medication. This may influence patient adherence to medication.

Place, publisher, year, edition, pages
Växjö: Linnaeus University Press, 2013. p. 72
Series
Linnaeus University Dissertations ; 136/2012
National Category
Nursing
Research subject
Natural Science, Biomedical Sciences
Identifiers
urn:nbn:se:lnu:diva-25640 (URN)978-91-87427-29-9 (ISBN)
Public defence
2013-05-29, N2007 Västergård, Smålandsgatan 26a, Kalmar, 09:43 (Swedish)
Opponent
Supervisors
Available from: 2013-05-23 Created: 2013-05-14 Last updated: 2017-05-30Bibliographically approved

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Semark, BirgittaÅstrand, Bengt

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