Inequalities in medicine use in Central Eastern Europe: an empirical investigation of socioeconomic determinants in eight countries

International Journal for Equity in Health

Susanne Mayer²  August Österle³  Sabine Vogler¹ 

[1] Department of Health Economics, WHO Collaborating Centre for Pricing and Reimbursement Policies, Gesundheit Österreich GmbH (Austrian Public Health Institute), Vienna, Austria;Department of Health Economics, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, Vienna, 1090, Austria;Department of Socioeconomics, Institute for Social Policy, Vienna University of Economics and Business, Vienna, Austria

关键词: Co-payments;    Availability;    Affordability;    Income;    Education;    Inequalities;    Use;    Access;    Medicines;   

Others  :  1231271
DOI  :  10.1186/s12939-015-0261-0

 received in 2015-04-02, accepted in 2015-10-29,  发布年份 2015

【 摘 要 】

Background

Equitable access to essential medicines is a major challenge for policy-makers world-wide, including Central and Eastern European countries. Member States of the European Union situated in Central and Eastern Europe have publicly funded pharmaceutical reimbursement systems that should promote accessibility and affordability of, at least essential medicines. However, there is no knowledge whether socioeconomic inequalities exist in these countries. Against this backdrop, this study analyses whether socioeconomic determinants influence the use of prescribed and non-prescribed medicines in eight Central and Eastern European countries (Bulgaria, Czech Republic, Hungary, Latvia, Poland, Romania, Slovenia, Slovakia). Further, the study discusses observed (in)equalities in medicine use in the context of the pharmaceutical policy framework and the implementation in these countries.

Methods

The study is based on cross-sectional data from the first wave of the European Health Interview Survey (2007–2009). Multivariate logistic regression analyses were carried out to determine the association between socioeconomic status (measured by employment status, education, income; controlled for age, gender, health status) and medicine use (prescribed and non-prescribed medicines). This was supplemented by a pharmaceutical policy analysis based on indicators in four policy dimensions (sustainable funding, affordability, availability and accessibility, and rational selection and use of medicines).

Results

Overall, the analysis showed a gradient favouring individuals from higher socioeconomic groups in the consumption of non-prescribed medicines in the eight surveyed countries, and for prescribed medicines in three countries (Latvia, Poland, Romania). The pharmaceutical systems in the eight countries were, to varying degrees, characterized by a lack of (public) funding, thus resulting in high and growing shares of private financing (including co-payments for prescribed medicines), inefficiencies in the selection of medicines into reimbursement and limitations in medicines availability.

Conclusion

Pharmaceutical policies aiming at reducing inequalities in medicine use require not only a consideration of the role of co-payments and other private expenditure but also adequate investment in medicines and transparent and clear processes regarding the inclusion of medicines into reimbursement.

【 授权许可】

   
2015 Vogler et al.

【 图 表 】

Fig. 1.

Fig. 2.

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