The effect of pharmaceutical co-payment increase on the use of social assistance—A natural experiment study

• Published in: PloS one Vol. 16; no. 5; p. e0250305
• Main Authors: Rättö, Hanna, Aaltonen, Katri
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 05.05.2021; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Diabetes; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - economics; Emergency medical services; Evaluation; Female; Financing, Personal; Finland; GDP; Gross Domestic Product; Health aspects; Health care access; Health care expenditures; Health care policy; Health Expenditures - statistics & numerical data; Health insurance; Households; Humans; Male; Medical care, Cost of; Medicine; Medicine and Health Sciences; Middle Aged; Patients; People and Places; Public Assistance - economics; Public Assistance - statistics & numerical data; Social aspects; Social protection; Social Sciences; Socioeconomic factors; Welfare; Finland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0250305

Health care out-of-pocket payments can create barriers to access or lead to financial distress. Out-of-pocket expenditure is often driven by outpatient pharmaceuticals. In this nationwide register study, we study the causal relationship between an increase in patients’ pharmaceutical expenses and financial difficulties by exploiting a natural experiment design arising from a 2017 reform, which introduced higher co-payments for type 2 diabetes medicines in Finland. With difference-in-differences estimation, we analyze whether the reform increased the use of social assistance, a last-resort financial aid. We found that after the reform the share of social assistance recipients increased more among type 2 diabetes patients than among a patient group not affected by the co-payment increase, suggesting the reform increased the use of social assistance among those subject to it. The results indicate that increases in patients’ pharmaceutical expenses can lead to serious financial difficulties even in countries with a comprehensive social security system.