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

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 a...

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Main Authors: Hanna Rättö, Katri Aaltonen
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2021-01-01
Series:PLoS ONE
Online Access:https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0250305&type=printable
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author Hanna Rättö
Katri Aaltonen
author_facet Hanna Rättö
Katri Aaltonen
author_sort Hanna Rättö
collection DOAJ
description 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.
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spelling doaj-art-1fa961c899174e2ea3d9d2b7826725ed2025-08-20T03:00:49ZengPublic Library of Science (PLoS)PLoS ONE1932-62032021-01-01165e025030510.1371/journal.pone.0250305The effect of pharmaceutical co-payment increase on the use of social assistance-A natural experiment study.Hanna RättöKatri AaltonenHealth 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.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0250305&type=printable
spellingShingle Hanna Rättö
Katri Aaltonen
The effect of pharmaceutical co-payment increase on the use of social assistance-A natural experiment study.
PLoS ONE
title The effect of pharmaceutical co-payment increase on the use of social assistance-A natural experiment study.
title_full The effect of pharmaceutical co-payment increase on the use of social assistance-A natural experiment study.
title_fullStr The effect of pharmaceutical co-payment increase on the use of social assistance-A natural experiment study.
title_full_unstemmed The effect of pharmaceutical co-payment increase on the use of social assistance-A natural experiment study.
title_short The effect of pharmaceutical co-payment increase on the use of social assistance-A natural experiment study.
title_sort effect of pharmaceutical co payment increase on the use of social assistance a natural experiment study
url https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0250305&type=printable
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