Patient Charges and Decision-Making Behaviours of Consumers and Physicians


Huttin, C.

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The objective of this book (results of the ENDEP project) is to analyze whether and how costs to the patient influences physicians’ treatment choices and patients’ decision making process for pharmaceutical and primary care services. Costs to the patients are increasingly an area for cost containment strategies in health care in developed countries, and usually a dominant characteristic of health care systems in developing countries. Prescription charges are aimed to deter patients from frivolous use of services. However, they remain controversial in particular in relation with impact on prescribing changes, types of drug switches and drug or service appropriateness incurred by increase in the direct payment by patients. They also may raise concerns on equity issues, in relation with the diversity of direct out-of-pocket spendings, according to type of conditions and types of systems, and patients’ diversity in levels of cost awareness. Europe, through the diversity of complex cost-sharing arrangements existing in each health care system provides a very interesting field of experience, to explore the range of choices that may be influenced by prescription charges and the types of impacts and potential behavioural changes that may be observed, at a micro level.
The book focuses on the core policy-oriented hypothesis that were tested in order to generate some international results, comparing cost conscious and non-conscious patients, in the case of hypertension, dyspepsia and hay fever. The ENDEP/Biomed project could relate to ECHI indicators in the category of determinants of health and performance of health systems or supplement the type of health information provided with EUCOMP. Policy implications from such a project may be of paramount importance to health policy makers aiming to predict the impact of co-payment mechanisms on their public or private benefit plans and may provide them with decision tools to revise the design of these plans. The project can also provide some useful insights for educational and behavioral changes of providers and patients.