Table 6 Results — association between prescription drug insurance/cost-sharing and healthcare services utilization, for/between specific populations

Adams, Soumerai, Ross-Degnan, 2001 [15];

– US Medicare population (65+ years)

The association between prescription drug insurance/cost-sharing and healthcare services utilization were not explicitly discussed. In the New Hampshire drug cap studies, an increase in nursing home admissions for chronically ill elderly persons was affected by the cap. Hospitalizations during the period of the cap also increased but the difference was not statistically significant. For patients with schizophrenia, use of emergency mental health services and partial hospitalization during the time of the cap increased, and then decreased to near pre-cap levels after the cap was repealed;

Magnitude, elderly: elderly Medicaid enrolees in New Hampshire were almost twice as likely to be admitted to nursing homes during the period of the cap as those in New Jersey (RR 1.8; 95%CI 1.2, 2.6). In addition, there was a slight trend toward higher rates of hospitalization in the New Hampshire cohort during the period of the cap, but this difference was not statistically significant (RR 1.2; 95%CI 0.8, 1.6). For patients with schizophrenia, use of emergency mental health services and partial hospitalization during the time of the cap increased by 57%.

Magnitude, elderly vs. non-elderly: unclear.

Rice, Matsuoka, 2004 [18];

– Seniors

Results were contradictory and not conclusive for hospitalization and long-term care admission rates in response to cost-sharing or prescription drug payment limits. However, having some form of supplemental insurance was associated with more appropriate health care use, particularly when such supplemental insurance provided coverage for prescription medication.

Magnitude, elderly: unclear.

Magnitude, elderly vs. non-elderly: unclear.

Maio, Pizzi, Roumm, 2005 [20];

– Seniors

For seniors, prescription drug cost-sharing and the use of caps may have led to greater risk of hospitalization or admittance to nursing home facilities.

Magnitude, elderly: unclear.

Magnitude, elderly vs. non-elderly: unclear.

Swartz, 2010 [29];

– General population

Increased cost-sharing for prescription drugs appeared to cause increased expenditures on emergency department services and inpatient hospitalizations by elderly and welfare beneficiaries.

Magnitude, elderly: unclear.

Magnitude elderly vs non-elderly: unclear.

Lexchin, Grootendorst, 2004 [17];

– The poor and chronically ill

Some evidence that prescription drug cost-sharing led to increases in use of emergency services (acute care hospitalization, emergency room admission, long-term care admission), and nursing home admissions.

Magnitude, poor/chronically ill: unclear.

Magnitude, poor/chronically ill vs. non-poor/chronically ill: unclear.

Goldman, Joyce, Zheng, 2007 [23];

– General population

The findings from studies focusing solely on chronically ill patients were unambiguous: for patients with congestive heart failure, lipid disorders, diabetes, and schizophrenia, greater use of inpatient and emergency medical services was associated with higher cost-sharing for prescription drugs. For certain conditions, the evidence clearly indicated that more cost-sharing was associated with increased use of other medical services, such as hospitalizations and emergency department visits.

Magnitude, chronically ill: unclear

Magnitude, chronically ill vs. non-chronically ill: unclear

Remler, Greene, 2009 [25];

– General population

Some studies examined a selective reduction in cost-sharing for selected important chronic medications and found significant increases in their use that might be associated with significant reductions in emergency room and hospital usage. Some evidence suggests that pharmaceutical cost-sharing increased emergency department use and hospitalizations. There was less evidence about increases in outpatient care.

Magnitude, chronically ill: unclear.

Magnitude, chronically ill vs. non-chronically ill: unclear.

Holst, 2010 [27];

– General population

With certain chronic conditions, an increase in drug copayments led to increased use of other medical services such as consulting practitioners and hospital admissions.

Magnitude, chronically ill: unclear.

Magnitude, chronically ill vs. non-chronically ill: unclear.

Swartz, 2010 [29];

– General population

One study argued that the evidence was unambiguous for people with chronic illnesses that higher cost-sharing led to greater use of hospital inpatient and emergency department services. Low-income people in poor health were more likely to suffer adverse outcomes, such as increased rates of emergency department use, hospitalizations, admission to nursing homes when increased cost-sharing caused them to reduce their use of health care, particularly prescription drugs.

Magnitude, chronically ill: unclear.

Magnitude, chronically ill vs non-chronically ill: unclear.

Magnitude, low income: unclear.

Magnitude, low income vs high income: unclear.

Powell, Saloner, Sabik, 2016 [44];

– Medicaid beneficiaries

Reduced use of prescription drugs from nonadherence has been linked to adverse consequences. A study of Medicaid beneficiaries with cancer found that after relatively small copayments were imposed ($0.50–$3.00) in Georgia in 2002, days supply of medication decreased and odds of an ED visit increased. Outside Medicaid, there is strong evidence from a natural experiment in Québec where increased copayments for prescription drugs led to a spike in hospitalizations.

Magnitude, chronically ill: unclear.

Magnitude, chronically ill vs non-chronically-ill: unclear.

Gourzoulidis, Kourlaba, et al., 2017 [45];

– Individuals with heart failure or diabetes mellitus

Studies showed no significant association between copayment change and emergency department visits, office visits, hospitalizations or laboratory/diagnostic tests among patients with diabetes mellitus. One study found that higher drug copayments were associated with an increase in emergency department visits among patients with heart failure.

Magnitude, chronically ill: unclear.

Magnitude, chronically ill vs. non-chronically ill: unclear.

Gupta, McColl et al., 2018 [46];

– Canadians (elderly, chronically ill, poor)

A study conducted with elderly and social assistance recipients in Québec found that the introduction of cost-sharing was associated with increased rates of emergency department visits. Another study found that among elderly patients with rheumatoid arthritis, higher cost-sharing was associated with more physician visits and among those were admitted to the hospital at least once, there were more admissions.

Magnitude, poor/chronically ill: unclear.

Magnitude, poor/chronically ill vs. non-poor/chronically ill: unclear.

Mishuk, Fasina, Qian, 2019 [51];

– individuals affected by US federal and state generic drug policies

Government insurance plans with high-cost sharing on generic drugs were associated with less use of health services among children.

Magnitude, children: unclear.

Magnitude, children vs. adults: unclear.