The reference price system and socioeconomic differences in ... - KCE

54 Reference Price System KCE reports 126
Patient choice: MM and GMR
Interestingly, the two variables reflecting the choice of patients in the health care system
were associated with a higher probability of using low cost alternatives in several groups
of drugs. Patients enrolled in a “medical house” (MM) financed by lump sum payments,
are more likely to receive low cost alternatives in 7 groups: indapamide, atenolol &
bisoprolol, other beta-blockers, piroxicam, tramadol, citalopram and acetylcysteine.
Also, patients holding a global medical record (GMR) were more likely to use low cost
alternatives in 11 out of 12 groups (except for lanzoprazole).
Physician characteristics
Specialists were less likely to prescribe a low cost alternative than GPs, except for
quinolone and tramadol.
Physician gender plays a role in prescribing behavior in 5 groups. Compared to female
physicians, male doctors prescribe more low cost alternatives for altenolol & bisoprolol,
piroxicam and less low cost alternatives for quinolone, citalopram and acetylcysteine.
Physician age was also associated with prescribing behavior. Compared to younger
doctors (less than 35 years) those aged more than 55 were less likely to prescribe low
cost drugs. This result was statistically significant in 8 groups (lanzoprazole, other
diuretics, atenolol & bisoprolol, diltiazem, piroxicam, tramadol, citalopram and
acetylcysteine). This tendency was less clear-cut when comparing prescribing behavior
of low cost drugs by younger doctors with that of physicians in other age groups (36-45
and 46-55). Only for quinolone and diltiazem younger physicians were less likely to
prescribe low cost alternatives.
Education by SS
Patients living in small areas with low education levels were more likely to use low cost
alternatives for 7 types of drugs: other diuretics (chlortalidone, furosemide, torasemide
and spironolactone), atenolol & bisoprolol, other beta-blockers (propanolol, sotalol,
metroprolol, acebutol and celiprolol), quinolone, piroxicam, tramadol and citalopram.
Only for acetylcysteine the opposite result was found: individuals living in more
educated areas were more likely to use a low cost alternative.