IDEAS home Printed from https://ideas.repec.org/p/rtv/ceisrp/1.html
   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

Author

Listed:
  • 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)

Abstract

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
    as

    Download full text from publisher

    File URL: https://ceistorvergata.it/RePEc/rpaper/No-01-Atellaetal.pdf
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    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

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


    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. L. G. González Ortiz & G. Masiero, 2013. "Disentangling spillover effects of antibiotic consumption: a spatial panel approach," Applied Economics, Taylor & Francis Journals, vol. 45(8), pages 1041-1054, March.
    3. Line Bjørnskov Pedersen & Julie Riise & Arne Risa Hole & Dorte Gyrd-Hansen, 2014. "GPs' shifting agencies in choice of treatment," Applied Economics, Taylor & Francis Journals, vol. 46(7), pages 750-761, March.
    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. Simon Reif & Lucas Hafner & Michael Seebauer, 2020. "Physician Behavior under Prospective Payment Schemes—Evidence from Artefactual Field and Lab Experiments," IJERPH, MDPI, vol. 17(15), pages 1-37, July.
    8. 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.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. 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.
    2. Fiorio, Carlo V. & Siciliani, Luigi, 2010. "Co-payments and the demand for pharmaceuticals: Evidence from Italy," Economic Modelling, Elsevier, vol. 27(4), pages 835-841, July.
    3. Dhippayom, Teerapon & Walker, Roger, 2008. "Impact of the reduction of the prescription charge in Wales on the prescribing of non-sedating antihistamines in primary care," Health Policy, Elsevier, vol. 87(3), pages 309-315, September.
    4. Paul V. Grootendorst & Mitchell Levine, 2002. "Do Drug Plans Matter? Effects of Drug Plan Eligibility on Drug Use Among the Elderly, Social Assistance Recipients and the General Population," Social and Economic Dimensions of an Aging Population Research Papers 73, McMaster University.
    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. Bentur, Netta & Gross, Revital & Brammli-Greenberg, Shuli, 2004. "Satisfaction with and access to community care of the chronically ill in Israel's health system," Health Policy, Elsevier, vol. 67(2), pages 129-136, February.
    7. Merja Halme & Kari Linden & Kimmo Kääriä, 2009. "Patients’ Preferences for Generic and Branded Over-the-Counter Medicines," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 2(4), pages 243-255, December.
    8. Vincenzo Atella & Joanna Kopinska, 2014. "The impact of cost-sharing schemes on drug compliance in Italy: evidence based on quantile regression," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 59(2), pages 329-339, April.
    9. Jiménez-Rubio, Dolores & Hernández-Quevedo, Cristina, 2010. "Explaining the demand for pharmaceuticals in Spain: Are there differences in drug consumption between foreigners and the Spanish population?," Health Policy, Elsevier, vol. 97(2-3), pages 217-224, October.
    10. Dag Morten Dalen & Marilena Locatelli & Enrico Sorisio & Steinar Str?m, 2014. "Does the Identity of the Third-Party Payer Matter for Prescribing Doctors?," Applied Economics and Finance, Redfame publishing, vol. 1(1), pages 39-54, May.
    11. Paraponaris, A. & Verger, P. & Desquins, B. & Villani, P. & Bouvenot, G. & Rochaix, L. & Gourheux, J. C. & Moatti, J. P. AU -, 2004. "Delivering generics without regulatory incentives?: Empirical evidence from French general practitioners about willingness to prescribe international non-proprietary names," Health Policy, Elsevier, vol. 70(1), pages 23-32, October.
    12. Mielck, Andreas, 1998. "Perception of health inequalities in different social classes, by health professionals and health policy makers in Germany and the United Kingdom," Discussion Papers, Research Group Public Health P 98-202, WZB Berlin Social Science Center.
    13. Huixia Liu & Linxiu Zhang & Gale Summerfield & Yaojiang Shi, 2009. "A gendered view of reforming health care access for farmers in China," China Agricultural Economic Review, Emerald Group Publishing Limited, vol. 1(2), pages 194-211, January.
    14. Sarma, Sisira & Basu, Kisalaya & Gupta, Anil, 2007. "The influence of prescription drug insurance on psychotropic and non-psychotropic drug utilization in Canada," Social Science & Medicine, Elsevier, vol. 65(12), pages 2553-2565, December.
    15. Marc Perronnin & Bidénam Kambia-Chopin, 2013. "Deductibles and the Demand for Prescription Drugs: Evidence from French Data," Working Papers DT54, IRDES institut for research and information in health economics, revised Feb 2013.
    16. Calltorp, Johan, 1999. "Priority setting in health policy in Sweden and a comparison with Norway," Health Policy, Elsevier, vol. 50(1-2), pages 1-22, December.
    17. Chiara Bonassi & Laura Magazzini & Fabio Pammolli & Massimo Riccaboni & Nicola Carmine Salerno, 2007. "La spesa farmaceutica territoriale convenzionata: il modello FarmaRegio per l'analisi della variabilità regionale," Working Papers CERM 03-2007, Competitività, Regole, Mercati (CERM).
    18. Dalen Dag Morten & Locatelli Marilena & Sorisio Enrico & Strom Steinar, 2011. "A Probability Approach to Pharmaceutical Demand and Price Setting: Does the Identity of the Third-Party Payer Matters for Prescribing Doctors?," Department of Economics and Statistics Cognetti de Martiis. Working Papers 201110, University of Turin.
    19. Yi Tao & Kizito Henry & Qinpei Zou & Xiaoni Zhong, 2014. "Methods for measuring horizontal equity in health resource allocation: a comparative study," Health Economics Review, Springer, vol. 4(1), pages 1-10, December.
    20. Özden Gür Ali & Başak Topaler, 2011. "How removing prescription drugs from reimbursement lists increases the pharmaceutical expenditures for alternatives," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(6), pages 553-562, December.

    More about this item

    Keywords

    patient charges; health care system; decision-making; prescribing;
    All these keywords.

    JEL classification:

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

    Statistics

    Access and download statistics

    Corrections

    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.

    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 bibliographic 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.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Barbara Piazzi (email available below). General contact details of provider: https://edirc.repec.org/data/csrotit.html .

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

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.