Have increases in co-payments for medicines further burdened Australians in remote and disadvantaged areas?
Published abstract of the 28th ICPE 2012
Background: To determine whether the national declines in prescription medicine use occurring after the Co-payments for publically-subsidised medicines in Australia were increased by 21% in 2005. Use of many medicines fell at the national-level after this rise in co-payments. Objectives: To determine whether the 21% increase copayments impacted on all areas of Australia or was specific to remote and disadvantaged areas. Methods: Observed dispensing of proton pump inhibitors (PPIs) and statins were obtained for 1392 statistical local areas (SLA) of Australia in 2004 and 2006. Ratios of observed/expected dispensing (dispensing ratios) for each SLA were calculated. Expected dispensing was based on national dispensing rates and age-standardised to each SLA. Expected dispensing for 2006 was based on pre-2005 prescription trends. Mean dispensing ratios for each medicine and year were calculated for all remoteness and disadvantage groups. Generalised regression models compared the percentage change in dispensing ratios from 2004 to 2006. Results: Between 2004 and 2006 PPIs dispensing fell significantly in major cities (-13.7%, 95% CI = -17.3 to - 9.8), inner regional (-14.0, 95% CI = -19.5 to -8.2), outer regional (-14.6%, 95% CI = -19.9 to -9.0) and remote areas (-9.4%, 95% CI = -16.4 to -1.8). Statins dispensing fell in all groups but the most remote (range 6–7%).When focussing on disadvantage, PPI dispensing fell significantly in all groups (range 12–15%). Statins dispensing did not fall significantly in the most disadvantaged areas (-2.9%, 95% CI = -8.6–3.2) but did in the least and second-least disadvantaged areas (-6.5%, 95% CI = -11.3 to -1.5, and -5.8, 95% CI = -10.5 to -0.9, respectively). Dispensing of PPIs and statins in the most remote and disadvantaged areas remained substantially below levels expected for Australia after the 21% co-payments increase. Conclusions: The findings suggest that the 2005 21% in patient co-payments adversely impacted on prescription medicine use in all areas of Australia and was not specific to remote or disadvantaged areas. Indeed, dispensing of statins fell significantly in all areas but the most remote and disadvantaged, and the existing gap in dispensing of PPIs and statins was not widened by the co-payments increase. PPIs, which are used at above-prevalence rates in Australia and have cheaper over-the-counter substitutes available, were more sensitive to co-payment increases than statins.