Pharmaceutical expenditure is rising in high-income countries. Some countries choose to pass some of these costs on to patients through various cost-sharing strategies. In many countries, patients pay an out-of-pocket cost for prescription medicines. Out-of-pocket costs vary between different countries, the medicines being used and the patient themselves. Out-of-pocket costs for medicines can represent a significant financial burden for some patients.
The aim of this thesis is to examine the costs of prescription medicines incurred by patients in a variety of high-income Organisation for Economic Co-operation and Development (OECD) countries.
A series of model patient scenarios were used to demonstrate the cost of prescription medicines as a proportion of patient income. The model patients were placed in one of six countries; Australia, Canada, England, Finland, Germany or New Zealand. The model patients had a range of ages, income types, and medical conditions. The medical conditions included were; asthma, type 2 diabetes mellitus, schizophrenia and metastatic renal cell carcinoma. The prescription prices paid for medicines by each model patient were then compared using purchasing power parities.
The proportion of income spent on prescription medicines by the model patients ranged from 0% to over 50%. Patients with the lowest incomes spent proportionally more of their income on the same medicines compared with high-income patients. Some of the model patients were exempt from prescription charges depending upon their age, medical condition or income type. Patients in Canada generally paid more than any of the other countries, while patients in England paid the least.
This is the first study to compare prescription charges for patients across a range of countries, patient income types and medical conditions. There was considerable variation in patient out-of-pocket costs for medicines across the countries and conditions included. The co-payment systems used for prescription medicines in each country had many advantages and disadvantages for patients. The study was somewhat limited by missing data from some countries. Further research using real patient data should be considered.||