Background: In 2007, Saskatchewan’s Ministry of Health launched the Seniors’ Drug Plan (SDP), whereby provincial beneficiaries at or above the age of 65 receive medications at a maximum self-payment of $15. The purpose of this study was to document the impact of the SDP using provincial health-administrative databases. Methods: Aggregate medication utilization and costs were described using the prescription drug database starting two years before the implementation of the SDP and continuing for two years after. Interrupted time series analysis using segmented regression models were developed to test the impact of the SDP. Also, the probability of achieving optimal medication adherence was examined among cohorts receiving medications after SDP implementation versus similar patients receiving medications before the SDP and also a group of patients <65 years who were not eligible for the SDP at all. The impact of the SDP on the outcome of optimal adherence was estimated using logistic regression models with generalized estimating equations (GEE). Results: Monthly government spending on medications increased by 47.5% following implementation of the SDP, while total medication dispensations only increased by 5.8%. The SDP was associated with more dispensations per month among prevalent users (+5.4%, 95% CI: 1.3% to 9.5%) but not incident users who did not receive the study medication in the previous 365 days (+1.3%, 95% CI: -8.0% to 10.7%). Similarly, the SDP did not appear to impact the use of blood-glucose-lowering agents, (-0.5%, 95% CI: -6.2% to 5.2%). A small but significant increase in the odds of optimal medication adherence was observed after the SDP compared with before (OR=1.08, 95% CI 1.04 to 1.11). However, the impact was only observed in prevalent users (OR=1.08, 95% CI 1.04 to 1.12), but not incident users (OR=1.05, 95% CI 0.98 to 1.13). Also, the impact of the SDP on medication adherence was not consistent for all medication classes examined. Discussion: In summary, the SDP resulted in substantially higher government investment into drug costs without a major effect on medication utilization and adherence. However, cost reduction for seniors must have provided substantial relief independent of the impact on adherence and utilization.

Submitted by JOSIANE SANTOS DE OLIVEIRA (josianeso) on 2017-08-01T16:51:38Z No. of bitstreams: 1 Tiago Henrique Lenhard_.pdf: 599231 bytes, checksum: 3887a7a17e0d823268ecff3b91709a7b (MD5) / Made available in DSpace on 2017-08-01T16:51:38Z (GMT). No. of bitstreams: 1 Tiago Henrique Lenhard_.pdf: 599231 bytes, checksum: 3887a7a17e0d823268ecff3b91709a7b (MD5) Previous issue date: 2017-05-15 / Nenhuma / O objetivo deste trabalho é verificar o efeito da aplicação de taxa de coparticipação como mecanismo de regulação da demanda por serviços de saúde, mais especificamente na frequência e nos custos de consultas médicas, em consultas de plantão hospitalar, em exames laboratoriais e de diagnóstico por imagem. Os dados utilizados para este trabalho são provenientes de uma operadora de planos de saúde (OPS) da modalidade de Cooperativa Médica A metodologia utilizada para avaliar os resultados da aplicação de taxa de coparticipação dos planos é o Propensity Score Matching (PSM) a partir de estimadores One to one Matching (OM), Nearest Neighbor Matching (NNM), Radius Matching (RM) e Kernel Matching (KM). Os resultados indicam a existência de risco moral em indivíduos que possuem plano sem taxa de coparticipação na demanda por consultas médicas e em plantão hospitalar. Para os custos gerados para a OPS por esses serviços o resultado é semelhante. Para os exames laboratoriais o risco moral não foi evidenciado pela ausência de coparticipação nos planos. Já para os exames de diagnóstico por imagem o risco moral foi evidenciado. Os custos para a OPS nesses exames apresentaram um aumento significativo para os indivíduos sem taxa nos dois grupos de exames. Os resultados obtidos por este trabalho indicam que o efeito causado pela taxa de coparticipação é positivo para a OPS, pois a aplicação desse mecanismo reduz significativamente a demanda e os custos para os serviços considerados nesta análise, evidenciando a ocorrência do risco moral em planos sem taxa de coparticipação. / The goal of our study is to investigate the role of copayment as a regulatory mechanism in health services demand. Specifically, we want to understand the effect of copayment on the number and costs related to appointments, emergency appointments, and laboratory and imaging tests. Our dataset was obtained from a health insurance cooperative company (HIC). To evaluate the effects of copayment application in the health care utilization we apply a Propensity Score Matching (PSM) method, using the following estimators: One to one Matching (OM), Nearest Neighbor Matching (NNM), Radius Matching (RM) and Kernel Matching (KM). The results indicate the evidence of moral hazard effects in appointments and emergency appointments demand for those individuals with health insurance without copayment. Similar results are obtained when we consider the costs incurred by the HIC when providing these services. As for laboratory tests, there was no evidence on moral hazard effects. However, when we consider imaging tests, moral hazard effects were evidenced. HIC provision costs of laboratory and imaging tests showed a significant increase for those individuals with health care plan without copayment. Our results indicate that charging a copayment reduces demand and costs of those health care services considered in out study, highlighting the incentives due to the moral hazard existence in the health care insurance market.

Made available in DSpace on 2016-08-18T18:55:14Z (GMT). No. of bitstreams: 1 Dissertacao Gilvan.pdf: 1087916 bytes, checksum: 772c2a9288529374ef15a50ce6996356 (MD5) Previous issue date: 2012-03-29 / The Popular Pharmacy of Brazil Program was created in 2004 with the purpose of reducing of treatment abandonment caused by the impact that the acquisition of medications for chronic diseases occasioned in the long run, the budget of families who sought to obtain these medicines in the network private. In the 2006, the program was expanded through the creation of an axis called Has Popular Pharmacy Here , which allowed private pharmacies establish agreements with the Ministry of Health for distribution of medications subsidized with resources of this program. The central issue about this program is the fact that it uses the system of copayment in its engineering, which means that users of the program must spend a small amount to get the medication needed, resulting in double taxation of the same social benefit, since the citizen finances the production of medications at the moment that pays taxes and makes a second payment at the moment of the acquisition of such medications. This work makes a political evaluation of this program from the principles established by the Unified Health System, to which all services and action of health of the country must be submitted. To reach this objective I opted for an evaluation with qualitative approach and a methodology called political evaluation of the policy (SILVA, 2008), in which I use as technical the bibliographical research and the documentary research to collect information that allows the elucidation of the evaluative dimensions defined for this study, namely: the determinants that conditioned the formulation of the policy, ethical and political framework and the principles of social justice base that it, the model of intervention of the program and its strategies of action and, finally, its sources of resources and its way of financing. I conclude with this evaluation that the Popular Pharmacy of Brazil Program had as main determinative the neoliberal politics that foments the reduction of State action through, among other measures, the creation of programs that perform the management of public services in partnership with private institutions, imposing to the population a part of the financing of the given services. In addition, the program in question violates the three doctrinal principles of the Unified Health System, does not possess legal endorsement for the accomplishment of economic subventions, being therefore illegal, beyond the fact of that the Federal Constitution to hinder the destination of public resources for private institutions with lucrative ends, which is done by the program, of where if also concludes that it is unconstitutional. Finally, the Court of Accounts of the Union points that there are no studies to justify the existence of the program, because there is no evidence of better cost-effective compared it with the programs that provide medications free of charge for the Brazilian population. / O Programa Farmácia Popular do Brasil foi criado em 2004 com o objetivo de reduzir o abandono de tratamento provocado pelo impacto que a aquisição de medicamentos contra doenças crônicas ocasionava, em longo prazo, no orçamento de famílias que buscavam a obtenção desses remédios na rede privada. Em 2006, o programa foi expandido mediante a criação de um eixo chamado Aqui Tem Farmácia Popular , que permitia que farmácias privadas estabelecessem convênios com o Ministério da Saúde para a distribuição de medicamentos subsidiados com recursos desse programa. A grande questão em torno desse programa é o fato de que ele utiliza o sistema de copagamento em sua engenharia, o que significa que os usuários do programa devem despender uma pequena quantia para obter o medicamento necessitado, o que resulta na bitributação do mesmo benefício social, visto que o cidadão financia a produção de medicamentos no momento em que paga impostos e realiza um segundo pagamento no momento da aquisição desses mesmos medicamentos. Este trabalho realiza uma avaliação política desse programa a partir dos princípios estabelecidos pelo Sistema Único de Saúde, aos quais todos os serviços e ações de saúde do país devem estar submetidos. Para atingir esse objetivo optei pela realização de uma avaliação com abordagem qualitativa e uma metodologia denominada avaliação política da política (SILVA, 2008), na qual utilizo como técnicas a pesquisa bibliográfica e a pesquisa documental para a coleta de informações que permitem o esclarecimento acerca das dimensões de avaliação delimitadas para este estudo, a saber: os determinantes que condicionaram a formulação da política, o referencial éticopolítico e os princípios de justiça social que o fundamentam, o modelo de intervenção do programa e suas estratégias de ação e, finalmente, suas fontes de recursos e seu modo de financiamento. Concluo com esta avaliação que o Programa Farmácia Popular do Brasil teve como principal determinante a política neoliberal que fomenta a redução da atuação do Estado através, dentre outras medidas, da criação de programas que realizem a gestão de serviços públicos em parceria com instituições privadas, impondo à população uma parte do financiamento dos serviços prestados. Além disso, o programa em pauta fere os três princípios doutrinários do Sistema Único de Saúde; não possui respaldo legal para a realização de subvenções econômicas, sendo por isso ilegal; além do fato de que a Constituição Federal impede a destinação de recursos públicos a instituições privadas com fins lucrativos, o que é realizado pelo programa, donde se conclui que ele é também inconstitucional. Por fim, o Tribunal de Contas da União aponta que não há estudos que justifiquem a existência do programa, pois não existe comprovação de melhor relação custobenefício dele em comparação com os programas que fornecem medicamentos de forma gratuita para a população brasileira.