The effect of a change in co-payment on prescription drug demand in a National Health System: The case of 15 drug families by price elasticity of demand.

OBJECTIVES: To test the heterogeneity of the effect of a change in pharmaceutical cost-sharing by therapeutic groups in a Spanish region. METHODS: Data: random sample (provided by the Canary Islands Health Service) of 40,471 people covered by the Spanish National Health System (SNHS) in the Canary Islands. The database includes individualised monthly-dispensed medications (prescribed by the SNHS) from one year before (August 2011) to one year after (June 2013) the Royal Decree Law 16/2012 (RDL 16/2012). Sample: two intervention groups (low-income pensioners and middle-income working population) and one control group (low-income working population). Empirical model: quasi-experimental difference-in-differences design to study the change in consumption (measured in number of monthly Defined Daily Dose (DDDs) per individual) among 13 therapeutic groups. The policy break indicator (three-level categorical variable) tested the existence of stockpiling between the reform's announcement and its implementation. We ran 16 linear regression models (general, by therapeutic groups and by comorbidities) that considered whether the exclusion of some drugs from public provision impacted on consumption more than the co-payment increase. RESULTS: General: Reduction (-13.04) in consumption after the reform's implementation, which was fully compensated by a previous increase (16.60 i.e., stockpiling) among low-income pensioners. The middle-income working population maintained its trend of increasing consumption. Therapeutic groups: Reductions in consumption after the reform's implementation among low-income pensioners in 7 of the 13 groups, which were fully compensated for by a previous increase (i.e., stockpiling) in 4 groups and partially compensated for in the remaining 3. The analysis without the excluded medicines provided fewer negative coefficients. Comorbidities: Reduction in consumption that was only slightly compensated for by a previous increase (i.e., stockpiling). CONCLUSIONS: The negative impact of cost-sharing produced, among low-income pensioners, a risk of loss of adherence to treatments, which could deteriorate the health status of individuals, especially among pensioners within the most inelastic therapeutic groups (associated with chronic diseases) and patients with comorbidities (also, associated with chronic diseases). Notwithstanding the above, this risk was more related to the exclusion of some drugs from provision than to the cost-sharing increase.

[Estimate of the 10-year risk of osteoporotic fractures in the Spanish population]. / Estimación del riesgo de fractura osteoporótica a los 10 años para la población española.

BACKGROUND AND OBJECTIVE: The QFRACTURE(®) tool allows to estimate the risk of osteoporotic fractures in 10 years. We have estimated it, both for major and hip fracture, from the data obtained from the National Health Questionnaire. We thus estimated the risk of fragility fractures in the next 10 years in the Spanish population of both genders and calculated its burden. SUBJECTS AND METHODS: We have used the QFRACTURE(®) tool which estimates the risk of any fracture and hip fracture in the next 10 years. RESULTS: A total of 552.879 women and 161.922 men will suffer a fragility fracture in the next 10 years in Spain. Most of the fractures will happen in people aged 70 years old and more. In 10 years there will be 263.351 hip fractures in women and 84.213 in men. More than half of the hip fractures in women will happen to those aged more than 77 years old. The burden of osteoporotic fractures in Spain could arise to 4.778 millions of euros in the next 10 years with a cut-off of 3% for hip fracture accepting as reference the cost of generic alendronate. CONCLUSIONS: We have a first approach to the number of osteoporotic fractures in the next 10 years and its burden. The knowledge of this figures may be useful in order to program strategies to reduce the number of osteoporotic fractures in the future.

[Human resources and their mitigatable imbalances]. / Los recursos humanos y sus desequilibrios mitigables.

In this paper, the policy-sensitive imbalances in the health professional markets are discussed. In Spain, the current staffing levels are still the result of unforeseen demographic and socio-economic developments. In some specialties and areas, there are selective shortages which in all likelihood will become more serious in the coming years due to the objective causes analyzed in this text. We propose a gradual increase in the medical schools numerus clausus and in the number of residents positions, the use of a variety of incentives to attract professionals to specific positions and, particularly, to increase the standing and quality of primary care.

Los recursos humanos y sus desequilibrios mitigables / Human resources and their mitigating unbalances

En este trabajo se discuten los desequilibrios de los mercados de profesionales sanitarios que son sensibles a las políticas. En España, las dotaciones actuales siguen siendo el resultado de fenómenos demográficos y socioeconómicos no previstos. Hay déficits selectivos en algunas especialidades y zonas, que muy probablemente se agravarán en los próximos años, por las causas objetivas que se analizan en el texto. Se propone aumentar progresivamente el numerus clausus de medicina y la oferta de plazas MIR, y utilizar incentivos de distintos tipos e intensidades para atraer y mantener a los profesionales en determinados puestos, y particularmente para aumentar el prestigio y la calidad de la atención primaria (AU)

In this paper, the policy-sensitive imbalances in the health professional markets are discussed. In Spain, the current staffing levels are still the result of unforeseen demographic and socio-economic developments. In some specialties and areas, there are selective shortages which in all likelihood will become more serious in the coming years due to the objective causes analyzed in this text. We propose a gradual increase in the medical schools’numerus clausus and in the number of resident's positions, the use of a variety of incentives to attract professionals to specific positions and, particularly, to increase the standing and quality of primary care (AU)