The impact of a reimbursement rate reduction on the utilization of antiulcer, antidepressants and antidiabetics in Portugal: A time series analysis

ABSTRACT

Background

According to international research, an increase in the patient share of pharmaceutical expenditure results in a decrease in medicines utilization. In 2010, the Portuguese government reduced the reimbursement rate for certain therapeutic classes. The aim of this study was to evaluate the impact of raising cost to the patient on the utilization of medicines.

Methods

Between January 1996 and December 2015, medicines utilization and cost to the patient per DDD of antihypertensive, antidyslipidemic, antidiabetic, antiulcer and antidepressant medicines were compared. A segmented linear regression of two time series – before and after the change in reimbursement percentage – was used.

Results

During the two time series, there was an increase in the utilization of antidepressants and antiulcer medicines. The consumption growth decelerated following the reduction in reimbursement rate. Cost to the patient decreased for both classes across the two time series, although the trend accelerated during the second.

Conclusion

These findings suggest that a decrease in the reimbursement rate had little impact on the utilization of medicines. It is reasonable to assume that the reduction in percentage covered by the Portuguese National Health System was gradually compensated by the decrease in the absolute amount that patients paid for medicines..

KEYWORDS:

• Pharmaceutical policy
• consumption
• reimbursement
• out-of-pocket
• generics
• co-payment
• patient contribution
• time series analysis

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Notes

1 Esomeprazole

2 Citalopram, Fluoxetine, Fluvoxamine, Maprotiline, Mirtazapine, Moclobemide, Paroxetine, Sertraline, Trazodone, Venlafaxine

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

António Augusto Donato

António Augusto Donato, graduated in Pharmaceutical Sciences by Faculty of Pharmacy, University of Coimbra (1990), MBA by ISEG, University of Lisbon (2004), PhD program at Faculty of Pharmacy, University of Coimbra (ongoing), Member of the Board of Directors of Pharmaceutical Industry, and teaching experience at Faculty of Pharmacy, University of Coimbra.

Daniel Figueiredo

Daniel Figueiredo concluded his PhD in 2020 where he studied and developed mathematical modeling applied to intracellular environments. During the last years, he started working about pharmacoeconomics, with special attention to market access, in AIBILI, Coimbra, Portugal. Also, he currently lectures in University of Aveiro, Portugal.

Francisco Batel-Marques

Francisco Batel Marques holds a PhD in Pharmaceutical Sciences (University of Wales, Cardiff, UK, 1995) and is currently Associate Professor at the School of Pharmacy, University of Coimbra. Drug Safety and Health Technology Assessment have been his areas of research and services providing. He has been mentor of 8 PhD and 18 MSc thesis and author of 54 peer-reviewed full papers.