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BMC Health Services Research
Published in: BMC Health Services Research 1/2011

Open Access 01-12-2011 | Research article

Are prescribing doctors sensitive to the price that their patients have to pay in the Spanish National Health System?

Authors: Beatriz González López-Valcárcel, Julián Librero, Gabriel Sanfélix-Gimeno, Salvador Peiró, The Group for Drug Utilization Research in the Spanish National Health System (IUM-SNS Group)

Published in: BMC Health Services Research | Issue 1/2011

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Abstract

Background

This study aims to design an empirical test on the sensitivity of the prescribing doctors to the price afforded for the patient, and to apply it to the population data of primary care dispensations for cardiovascular disease and mental illness in the Spanish National Health System (NHS). Implications for drug policies are discussed.

Methods

We used population data of 17 therapeutic groups of cardiovascular and mental illness drugs aggregated by health areas to obtain 1424 observations ((8 cardiovascular groups * 70 areas) + (9 psychotropics groups * 96 areas)). All drugs are free for pensioners. For non-pensioner patients 10 of the 17 therapeutic groups have a reduced copayment (RC) status of only 10% of the price with a ceiling of €2.64 per pack, while the remaining 7 groups have a full copayment (FC) rate of 40%. Differences in the average price among dispensations for pensioners and non-pensioners were modelled with multilevel regression models to test the following hypothesis: 1) in FC drugs there is a significant positive difference between the average prices of drugs prescribed to pensioners and non-pensioners; 2) in RC drugs there is no significant price differential between pensioner and non-pensioner patients; 3) the price differential of FC drugs prescribed to pensioners and non-pensioners is greater the higher the price of the drugs.

Results

The average monthly price of dispensations to pensioners and non-pensioners does not differ for RC drugs, but for FC drugs pensioners get more expensive dispensations than non-pensioners (estimated difference of €9.74 by DDD and month). There is a positive and significant effect of the drug price on the differential price between pensioners and non-pensioners. For FC drugs, each additional euro of the drug price increases the differential by nearly half a euro (0.492). We did not find any significant differences in the intensity of the price effect among FC therapeutic groups.

Conclusions

Doctors working in the Spanish NHS seem to be sensitive to the price that can be afforded by patients when they fill in prescriptions, although alternative hypothesis could also explain the results found.
Appendix
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Metadata
Title
Are prescribing doctors sensitive to the price that their patients have to pay in the Spanish National Health System?
Authors
Beatriz González López-Valcárcel
Julián Librero
Gabriel Sanfélix-Gimeno
Salvador Peiró
The Group for Drug Utilization Research in the Spanish National Health System (IUM-SNS Group)
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2011
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-11-333

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