Impact of the phased abolition of co‐payments on the utilisation of selected prescription medicines in Wales

• Published in: Health economics Vol. 27; no. 1; pp. 236 - 243
• Main Authors: Alam, M. Fasihul, Cohen, David, Dunstan, Frank, Hughes, Dyfrig, Routledge, Philip
• Format: Journal Article
• Language: English
• Published: England Wiley Periodicals Inc 01.01.2018
• Subjects: Cost Sharing - economics; co‐payment; difference‐in‐difference; dispensing; Drugs; England; General practice; Health care expenditures; Health economics; Humans; Insurance, Pharmaceutical Services - economics; Models, Econometric; Payments; Prescription drugs; Prescription Drugs - economics; Price elasticity; Socioeconomic factors; Wales; England; Wales; United Kingdom > UK; dispensing; co-payment; difference-in-difference; price-elasticity
• ISSN: 1057-9230; 1099-1050; 1099-1050
• DOI: 10.1002/hec.3530

We have taken advantage of a natural experiment to measure the impact of the phased abolition of prescription co‐payments in Wales. We investigated 3 study periods covering the phased abolition: from £6 to £4, £4 to £3, and £3 to £0. A difference‐in‐difference modelling was adopted and applied to monthly UK general practice level dispensing data on 14 selected medicines which had the highest percentage of items dispensed subject to a co‐payment prior to abolition. Dispensing from a comparator region (North East of England) with similar health and socio‐economic characteristics to Wales, and where prescription co‐payments continued during the study periods, was used to isolate any non‐price effects on dispensing in Wales. Results show a small increase in dispensing of 14 selected medicines versus the comparator. Compared with NE England, monthly average Welsh dispensing was increased by 11.93 items (7.67%; 95% CI [7.2%, 8.1%]), 6.37 items (3.38%; 95% CI [2.9%, 3.7%]) and 9.18 items (4.54%; 95% CI [4.2%, 4.9%]) per practice per 1,000 population during the periods when co‐payment was reduced. Price elasticities of the selected medicines utilisation were −0.23, −0.13, and −0.04 in 3 analyses, suggesting the abolition of co‐payment had small effect on Welsh dispensing.