Objectives In this article we investigate the causal effect of cost-sharing schemes on compliance with statins in a quantile regression framework. Methods We use the health search CSD-LPD data, a longitudinal observational dataset containing computerbased patient records collected by Italian general practitioners. We exploit a series of natural experiments referring to several introductions of co-payment schemes in some of the Italian regions between 2000 and 2009. We adopt an extended difference-in-differences approach to provide quantile estimates of the impact of co-payments on compliance. Results We find that (i) introduction of co-payments hurts residents of regions with worse quality and provision of health care; (ii) within these regions, co-payments were particularly harmful for high compliers; (iii) gender, clinical history and geographic residence are important determinants of compliance among poor compliers; (iv) compliance decreases with the potency and dosage of statins, particularly for poor compliers. Conclusions In the presence of inefficient health-care provision, co-payments are harmful for drug compliance, and this is especially true for patients who are originally good compliers.

Atella, V., Kopinska, J.a. (2014). The impact of cost-sharing schemes on drug compliance in Italy: evidence based on quantile regression. INTERNATIONAL JOURNAL OF PUBLIC HEALTH, 59(2), 329-339 [10.1007/s00038-013-0528-4].

The impact of cost-sharing schemes on drug compliance in Italy: evidence based on quantile regression

ATELLA, VINCENZO;KOPINSKA, JOANNA ALEKSANDRA
2014-01-01

Abstract

Objectives In this article we investigate the causal effect of cost-sharing schemes on compliance with statins in a quantile regression framework. Methods We use the health search CSD-LPD data, a longitudinal observational dataset containing computerbased patient records collected by Italian general practitioners. We exploit a series of natural experiments referring to several introductions of co-payment schemes in some of the Italian regions between 2000 and 2009. We adopt an extended difference-in-differences approach to provide quantile estimates of the impact of co-payments on compliance. Results We find that (i) introduction of co-payments hurts residents of regions with worse quality and provision of health care; (ii) within these regions, co-payments were particularly harmful for high compliers; (iii) gender, clinical history and geographic residence are important determinants of compliance among poor compliers; (iv) compliance decreases with the potency and dosage of statins, particularly for poor compliers. Conclusions In the presence of inefficient health-care provision, co-payments are harmful for drug compliance, and this is especially true for patients who are originally good compliers.
2014
Pubblicato
Rilevanza internazionale
Articolo
Esperti anonimi
Settore SECS-P/03 - SCIENZA DELLE FINANZE
English
Con Impact Factor ISI
Compliance; Cost sharing; Co-payments; Quantile regression; Difference-in-differences; Statins; Cholesterol
Atella, V., Kopinska, J.a. (2014). The impact of cost-sharing schemes on drug compliance in Italy: evidence based on quantile regression. INTERNATIONAL JOURNAL OF PUBLIC HEALTH, 59(2), 329-339 [10.1007/s00038-013-0528-4].
Atella, V; Kopinska, Ja
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/130295
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