Effects of increased drug copayments on the demand for drugs and physician visits in Germany

'Background: On July 1, 1997, the German government raised drug copayment by EUR2.60 to EUR 4.60, EUR 5.60 or EUR 6.60 per prescription, depending on package size. The aim of this study was to examine the effects of increased copayments on the demand for drugs and physician visits one year later. Lower income groups and the chronically ill were analysed separately. Methods: A survey of 695 non-exempted adult pharmacy customers who suffered from acute or chronic health conditions in the previous 12 months was conducted. Logistic regression was performed to analyse the effect of different income levels on the demand for drugs and physician visits. Results: Of the respondents, 19.9% reported reduced physician visits, 22.6% reported reduced prescription drug purchases, 44.9% reported increased use of over-the-counter products and 46.3% reported increased use of non-drugs such as household remedies. A total of 11.2% waived more than one visit to the physician. Almost all of those respondents who reduced their purchases of prescription packages waived 1 to 5 packages (82.5%). There was distinctly less change in purchasing patterns among persons with chronic diseases. Logistic regression confirmed that lower income households were more likely to change demand patterns than households in other income brackets. Conclusion: Increased copayments had little effect on drugs and physician visits of adult pharmacy customers, especially among those with chronic conditions. Negative effects on low income households were observed.' (excerpt)