IDEAS home Printed from
   My bibliography  Save this paper

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.

Suggested Citation

  • Vincenzo Atella & Karen Hassell & Ellen Schafheutle & Marjorie C. Weiss & Peter R. Noyce, 2003. "Cost to the Patient or Cost to the Healthcare System? Which one Matters the Most for GP Prescribing Decisions? A UK-Italy Comparison," CEIS Research Paper 1, Tor Vergata University, CEIS.
  • Handle: RePEc:rtv:ceisrp:1

    Download full text from publisher

    File URL:
    Download Restriction: no

    References listed on IDEAS

    1. 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.
    2. 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.
    3. 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.
    4. 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.
    5. 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.
    6. 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.
    7. 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.
    Full references (including those not matched with items on IDEAS)


    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.

    Cited by:

    1. Lambrelli D & O’Donnell O, 2009. "Why Does the Utilization of Pharmaceuticals Vary So Much Across Europe? Evidence from Micro Data on Older Europeans," Health, Econometrics and Data Group (HEDG) Working Papers 09/06, HEDG, c/o Department of Economics, University of York.
    2. Björn Wettermark & Brian Godman & Bengt Jacobsson & Flora Haaijer-Ruskamp, 2009. "Soft regulations in pharmaceutical policy making," Applied Health Economics and Health Policy, Springer, vol. 7(3), pages 137-147, September.
    3. Laura González & Giuliano Masiero, 2011. "Disentangling spillover effects of antibiotic consumption: a spatial panel approach," Quaderni della facoltà di Scienze economiche dell'Università di Lugano 1106, USI Università della Svizzera italiana.
    4. Piette, John D. & Heisler, Michele & Horne, Robert & Caleb Alexander, G., 2006. "A conceptually based approach to understanding chronically ill patients' responses to medication cost pressures," Social Science & Medicine, Elsevier, vol. 62(4), pages 846-857, February.
    5. Vincenzo Atella & Peter R. Noyce & Ellen Schafheutle & Karen Hassell, 2005. "Affordability of Medicines and Patients' Cost Reduction Behaviors: Empirical Evidence Based on SUR Estimates from Italy and the United Kingdom," CEIS Research Paper 71, Tor Vergata University, CEIS.
    6. Tsiantou, Vasiliki & Moschandreas, Joanna & Bertsias, Antonis & Papadakaki, Maria & Saridaki, Aristoula & Agius, Dominic & Alper, Zuleyha & Faresjo, Tomas & Klimkova, Martina & Martinez, Luc & Samouti, 2015. "General Practitioners’ intention to prescribe and prescribing patterns in selected European settings: The OTCSOCIOMED project," Health Policy, Elsevier, vol. 119(9), pages 1265-1274.
    7. Hafner, Lucas & Reif, Simon & Seebauer, Michael, 2017. "Physician behavior under prospective payment schemes: Evidence from artefactual field and lab experiments," FAU Discussion Papers in Economics 18/2017, Friedrich-Alexander University Erlangen-Nuremberg, Institute for Economics.

    More about this item


    patient charges; health care system; decision-making; prescribing;

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health


    Access and download statistics


    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:rtv:ceisrp:1. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Barbara Piazzi). General contact details of provider: .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.