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THE IMPACT OF COST-SHARING CHANGES ON PRESCRIPTION ANTIBIOTIC FILL RATES IN CHILDREN WITH OTITIS MEDIA

Date

1995

Journal Title

Journal ISSN

Volume Title

Publisher

ORCID

Type

Degree Level

Doctoral

Abstract

From 1975, when the SPDP was initiated, until June 30, 1987, those with STD benefits paid a flat copayment per prescription, with the balance paid by the Province, directly to the pharmacy. On July 1, 1987 the cost-sharing scheme was changed to a deductible plus coinsurance in a nonassignment format. The assignment format returned on January 1, 1989. Children receiving SAP benefits retained first dollar coverage. The objective of the present study was to determine the impact of these changes on prescription antibiotic fill rates for children aged 0 to 14 years, with an otitis media diagnosis in the physician claims data base. Children receiving SAP benefits served as the nonequivalent control group. The hypotheses were: • the changes to STD benefits would have no impact on prescription antibiotic utilization rates in either group, and • stratification of the time series on selected variables would not reveal a statistically significant impact when comparing pre- and post-intervention periods in either population. The study was population-based and quasi-experimental, multiple time series by design. Data were gathered by record linkage of three Saskatchewan Health data bases: MCIB, PDSB, and the HIRF. Analysis included descriptive and interrupted time series analyses. Each population demonstrated a statistically significant decrease (p <0.05) in prescription antibiotic fill rates following the SPDP changes in STD benefits. However, the decrease experienced by the STD population was larger than seen in the SAP population by 2.569 prescriptions per 100 OM episodes. The second set of null hypotheses was rejected in all cases except both levels of Parent type in the SAP group, Specialist level of MD type in the SAP group, and the South level of Location in both SAP and STD groups. Interpopulation differences were found on all categories except Location-South. The STD population consistently demonstrated a decrease, while the SAP population demonstrated no changes or increases in fill rates. Overall the increased cost sharing for the SPDP STD beneficiaries negatively affected the fill rates of a necessary prescribed medication. Those considering increasing the patient cost share of a prescription drug program are cautioned that this may negatively affect the acquisition of necessary medications. This may worsen health outcome, and short-term savings may be offset by long-term expenses. Public program changes should include an evaluation component to facilitate such assessment.

Description

Keywords

Citation

Degree

Doctor of Philosophy (Ph.D.)

Department

Pharmacy and Nutrition

Program

Advisor

Committee

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DOI

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