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Cost to the Patient or Cost to the Healthcare System? Which one Matters the Most for GP Prescribing Decisions? A UK-Italy Comparison

  • Vincenzo Atella

    ()

    (University of Rome II - Faculty of Economics)

  • Karen Hassell

    ()

    (University of Manchester - School of Pharmacy & Pharmaceutical Sciences)

  • Ellen Schafheutle

    ()

    (University of Manchester - School of Pharmacy & Pharmaceutical Sciences)

  • Marjorie C. Weiss

    ()

    (University of Bristol - Division of Primary Care)

  • Peter R. Noyce

    ()

    (University of Manchester - School of Pharmacy & Pharmaceutical Sciences)

Charges for health services help contain healthcare costs. Despite showing that medicine consumption decreases when charges are increased research has not yet identified how doctors 'manage' the charge system to help patients who cannot afford treatment. This paper describes how the charge system influences the prescribing decisions of Italian and UK physicians. The data are from the qualitative stage of a multi-stage study exploring cost related influences on GP and patient decision-making regarding medicine use. The analysis presented is based on transcripts of focus groups conducted with general practitioners. To help patients who have difficulties affording their medication Italian GPs rely on a smaller number of cost reduction strategies compared to their UK counterparts. They use 'samples' left by pharmaceutical companies, or diagnose patients with pathologies that allow exemption. Occasionally they recommend some delay or change therapy to a cheaper but less effective alternative. Italian and UK GPs have firm views about patients abusing the NHS and believe costs to the system are as important as costs to the individual patient. Prescribing budgets were not viewed in a positive light by Italian GPs. Due to the nature of the charge system in Italy GPs there are able to choose a reimbursable product for patients, so have less need than UK doctors to look for other means of reducing costs. Conversely, the UK GPs have developed a large number of cost reduction strategies, probably because of the charge system itself and the relatively high charges incurred by patients.

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Paper provided by Tor Vergata University, CEIS in its series CEIS Research Paper with number 1.

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Length: 11
Date of creation: 31 Jan 2003
Date of revision:
Handle: RePEc:rtv:ceisrp:1
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  1. O'Brien, Bernie, 1989. "The effect of patient charges on the utilisation of prescription medicines," Journal of Health Economics, Elsevier, vol. 8(1), pages 109-132, March.
  2. Schoen, Cathy & Davis, Karen & DesRoches, Catherine & Donelan, Karen & Blendon, Robert, 2000. "Health insurance markets and income inequality: findings from an international health policy survey," Health Policy, Elsevier, vol. 51(2), pages 67-85, March.
  3. Huttin, C. & Andral, J., 2000. "How the reimbursement system may influence physicians' decisions results from focus groups interviews in France," Health Policy, Elsevier, vol. 54(2), pages 67-86, November.
  4. Lundberg, Lena & Johannesson, Magnus & Isacson, Dag G. L. & Borgquist, Lars, 1998. "Effects of user charges on the use of prescription medicines in different socio-economic groups," Health Policy, Elsevier, vol. 44(2), pages 123-134, May.
  5. Noyce, Peter R. & Huttin, Christine & Atella, Vicenzo & Brenner, Gerhard & Haaijer-Ruskamp, Flora M. & Hedvall, Maj-Britt & Mechtler, Reli, 2000. "The cost of prescription medicines to patients," Health Policy, Elsevier, vol. 52(2), pages 129-145, June.
  6. Atella, Vincenzo, 2000. "Drug cost containment policies in Italy: are they really effective in the long-run?: The case of minimum reference price," Health Policy, Elsevier, vol. 50(3), pages 197-218, January.
  7. Ryan, Mandy & Birch, Stephen, 1991. "Charging for health care: Evidence on the utilisation of NHS prescribed drugs," Social Science & Medicine, Elsevier, vol. 33(6), pages 681-687, January.
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