Summary of findings 3. Fixed co‐payment.
|
Patient or population: seniors and general population Settings: high‐income countries (US, CN, Sweden) Intervention: implementation of or increase in fixed co‐payment Comparison: lower value of fixed co‐payment or full medicines coverage | |||||
| Outcomes | Impact | Number of studies | Certainty of the evidence (GRADE) | Plain language summary | Comments |
| Medicine use | |||||
| Overall use of medicines | Small decrease | 2 (ITS1) | ⊕⊖⊖⊖ Very low5 | Effect of intervention on overall use of medicines is uncertain. However, it may decrease use of medicines for symptomatic and asymptomatic conditions |
Use of all medicines in these studies decreased after implementation of/increase in co‐payment, with the exception of oral hypoglycaemics, for which the increase in co‐payment was low |
| Use of medicines for symptomatic conditions | Small decrease | 3 (ITS2) | ⊕⊕⊖⊖ Low | ||
| Use of medicines for asymptomatic conditions | Small decrease | 3 (ITS3) | ⊕⊕⊖⊖ Low | ||
| Cost | |||||
| Patient perspective | No studies | 0 | – | Intervention may slightly decrease insurer expenditures on medicines. Effect on patient expenditures and insurer expenditures on health care was not reported | Magnitude of decrease in insurer expenditures on medicine was variable, ranging from ‐16.9% to 0.1% |
| Insurer perspective (expenditures on medicines) | Small decrease | 3 (ITS 4) | ⊕⊕⊖⊖ Low | ||
| Insurer perspective (expenditures on health care) | No studies | 0 | – | ||
| Healthcare utilisation | |||||
| Overall healthcare utilisation | No studies | 0 | – | No studies were found that reported effects of this intervention on healthcare utilisation | ‐ |
| Emergency department and hospitalisation | No studies | 0 | – | ||
| Outpatient care | No studies | 0 | – | ||
| Health outcome | No studies | 0 | – | No studies were found that reported effects of this intervention on health outcomes | ‐ |
| GRADE Working Group grades of evidence.
High certainty: This research provides a very good indication of the likely effect. The likelihood that the effect will be substantially different† is low. Moderate certainty: This research provides a good indication of the likely effect. The likelihood that the effect will be substantially different† is moderate. Low certainty: This research provides some indication of the likely effect. However, the likelihood that it will be substantially different† is high. Very low certainty: This research does not provide a reliable indication of the likely effect. The likelihood that the effect will be substantially different† is very high. † Substantially different = a large enough difference that it might affect a decision. | |||||
1. Nelson 1984; Hux 1997.
2. Hux 1997; Ong 2003; Reeder 1985
3. Reeder 1985; Hux 1997; Roblin 2005
4. Sawyer 1982; Nelson 1984; Hux 1997.
5. Downgraded because of risk of bias.