Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
RESEARCH ARTICLE

Chronic conditions, financial burden and pharmaceutical pricing: insights from Australian consumers

Jennifer A. Whitty A B C I , Adem Sav C D , Fiona Kelly C D E , Michelle A. King C F , Sara S. McMillan C F , Elizabeth Kendall D G and Amanda J. Wheeler C D H
+ Author Affiliations
- Author Affiliations

A School of Pharmacy, The University of Queensland, Pharmacy Australia Centre of Excellence, 20 Cornwall Street, Woollongabba, Qld 4102, Australia.

B Centre for Applied Health Economics, School of Medicine, Griffith University, Meadowbrook, Qld 4131, Australia.

C Griffith Health Institute, Griffith University, Meadowbrook, Qld 4131, Australia. Email: a.sav@griffith.edu.au; f.kelly@griffith.edu.au; michelle.a.king@griffith.edu.au; s.mcmillan@griffith.edu.au; a.wheeler@griffith.edu.au

D School of Human Services and Social Work, Griffith University, Meadowbrook, Qld 4131, Australia.

E School of Pharmacy, University of Auckland, Auckland 1010, New Zealand.

F School of Pharmacy, Griffith University, Southport, Qld 4222, Australia.

G Centre for National Research on Disability Rehabilitation Medicine, Griffith Health Institute, Griffith University, Meadowbrook, Qld 4131, Australia. Email: e.kendall@griffith.edu.au

H Faculty of Medical and Health Sciences, University of Auckland, Auckland 1010, New Zealand.

I Corresponding author. Email: j.whitty@uq.edu.au

Australian Health Review 38(5) 589-595 https://doi.org/10.1071/AH13190
Submitted: 4 October 2013  Accepted: 2 June 2014   Published: 7 August 2014

Abstract

Objective To explore the perceptions of Australian consumers and carers about the financial burden associated with medicines used for the treatment of chronic conditions.

Method Semi-structured interviews were undertaken with individuals (n = 97) who identified as having a chronic condition(s) (n = 70), cared for someone with a chronic condition(s) (n = 8), or both (n = 19). Participants included individuals identifying with an Aboriginal or Torres Strait Islander (n = 23) or Culturally and Linguistically Diverse (n = 19) background. Data were analysed using the constant comparison method and reported thematically.

Results Participants described substantial costs associated with medicines use, along with aggravating factors, including the duration and number of medicines used, loss of employment, lack of pricing consistency between pharmacies and the cost of dose administration aids. Consequences included impacts on medicine adherence, displacement of luxury items and potentially a reduced financial incentive to work. Understanding and beliefs related to pharmaceutical pricing policy varied and a range of proactive strategies to manage financial burden were described by some participants.

Conclusions The financial burden associated with medicines used for the management of chronic conditions by Australian consumers is substantial. It is compounded by the ongoing need for multiple medicines and indirect effects associated with chronic conditions, such as the impact on employment.

What is known about the topic? Medicines are a common form of treatment in chronic conditions. The financial burden related to medicines use, including co-payments, is associated with reduced adherence and other cost-coping strategies. Out of pocket costs for prescription medicines are relatively high in Australia compared with some other countries, including New Zealand and the United Kingdom. Australian consumers with chronic illness are likely to be at particular risk of financial burden associated with medicines use.

What does this paper add? This paper explores the perceptions of consumers and carers around the financial burden associated with the use of medicines for the treatment of chronic conditions in Australia. It draws on the experiences and perceptions of a diverse group of consumers in Australia who identify as having, or caring for someone with, a chronic condition(s).

What are the implications for practitioners? Health professionals who assist consumers to manage their medicines need to be aware of the potential for financial burden associated with medicines use and its potential impact on adherence. There is a need for health professionals to educate and assist consumers with chronic conditions to ensure they can navigate the health system to maximum benefit and receive financial entitlements for which they are eligible.

Additional keywords: financial burden; pharmaceuticals; chronic conditions; Australia; consumer experience.


References

[1]  Sav A, King MA, Whitty JA, Kendall E, McMillan SS, Kelly F, Hunter B, Wheeler AJ. Burden of treatment for chronic illness: a concept analysis and review of the literature. Health Expect 2013;
Burden of treatment for chronic illness: a concept analysis and review of the literature.CrossRef | 23363080PubMed |

[2]  Briesacher BA, Gurwitz JH, Soumerai SB. Patients at-risk for cost-related medication nonadherence: a review of the literature. J Gen Intern Med 2007; 22 864–71.
Patients at-risk for cost-related medication nonadherence: a review of the literature.CrossRef | 17410403PubMed |

[3]  PBS Information Management Section, Pharmaceutical Policy Branch. Expenditure and prescriptions twelve months to 30 June 2012. Canberra, ACT: Australian Government Department of Health and Ageing, 2012. Available at: http://www.pbs.gov.au/statistics/2011-2012-files/expenditure-and-prescriptions-2011-2012.pdf [verified June 2013].

[4]  Duckett S, Breadon P, Ginnivan L, Venkataraman P. Australia’s bad drug deal: high pharmaceutical prices. Melbourne, Vic.: Grattan Institute; 2013. Available at: http://grattan.edu.au/publications/reports/post/australias-bad-drug-deal/ [verified 15 April 2013].

[5]  Australian Government Department of Health and Ageing. National Medicines Policy 2000. Canberra, ACT: Commonwealth of Australia; 1999. Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/nmp-objectives-policy.htm [verified August 2013].

[6]  Australian Government Department of Health and Ageing. Schedule of pharmaceutical benefits. Canberra, ACT: Australian Government Department of Health and Ageing; 2013.

[7]  Kemp A, Roughead E, Preen D, Glover J, Semmens J. Determinants of self-reported medicine underuse due to cost: a comparison of seven countries. J Health Serv Res Policy 2010; 15 106–14.
Determinants of self-reported medicine underuse due to cost: a comparison of seven countries.CrossRef | 20203082PubMed |

[8]  Australian Government Department of Health and Ageing. Alternative arrangements for medicines: Aboriginal health services and the Pharmaceutical Benefits Scheme (PBS). Canberra, ACT: Australian Government Department of Health and Ageing; 2013. Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pbs-indigenous [verified March 2013].

[9]  Australian Government Department of Health and Ageing. Closing the gap: PBS co-payment measure. Canberra, ACT: Australian Government Department of Health and Ageing; 2012. Available at: http://www.medicareaustralia.gov.au/provider/pbs/pharmacists/closing-the-gap.jsp [verified April 2013].

[10]  Reed M, Brand R, Newhouse JP, Selby JV, Hsu J. Coping with prescription drug cost sharing: knowledge, adherence, and financial burden. Health Serv Res 2008; 43 785–97.
Coping with prescription drug cost sharing: knowledge, adherence, and financial burden.CrossRef | 18370979PubMed |

[11]  Goeman DP, Aroni RA, Stewart K, Sawyer SM, Thien FC, Abramson MJ, Douglass JA. Patients’ views of the burden of asthma: a qualitative study. Med J Aust 2002; 177 295–9.
| 12225275PubMed |

[12]  Hynd A, Roughead EE, Preen DB, Glover J, Bulsara M, Semmens J. Increased patient co-payments and changes in PBS-subsidised prescription medicines dispensed in Western Australia. Aust N Z J Public Health 2009; 33 246–52.
Increased patient co-payments and changes in PBS-subsidised prescription medicines dispensed in Western Australia.CrossRef | 19630844PubMed |

[13]  Gellad WF, Donohue JM, Zhao X, Zhang Y, Banthin JS. The financial burden from prescription drugs has declined recently for the nonelderly, although it is still high for many. Health Aff (Millwood) 2012; 31 408–16.
The financial burden from prescription drugs has declined recently for the nonelderly, although it is still high for many.CrossRef | 22323172PubMed |

[14]  McLeod L, Bereza BG, Shim M, Grootendorst P. Financial burden of household out-of-pocket expenditures for prescription drugs: cross-sectional analysis based on national survey data. Open Med 2011; 5 e1–9.
| 22046212PubMed |

[15]  Doran E, Robertson J, Rolfe I, Henry D. Patient co-payments and use of prescription medicines. Aust N Z J Public Health 2004; 28 62–7.
Patient co-payments and use of prescription medicines.CrossRef | 15108749PubMed |

[16]  Australian Bureau of Statistics. Patient experiences in Australia: summary of findings, 2011–12. Catalogue number 4839.0. Canberra, ACT: Australian Bureau of Statistics; 2012. Available at: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4839.02011-12?OpenDocument [verified August 2013].

[17]  Essue B, Kelly P, Roberts M, Leeder S, Jan S. We can’t afford my chronic illness! The out-of-pocket burden associated with managing chronic obstructive pulmonary disease in western Sydney, Australia. J Health Serv Res Policy 2011; 16 226–31.
We can’t afford my chronic illness! The out-of-pocket burden associated with managing chronic obstructive pulmonary disease in western Sydney, Australia.CrossRef | 21954233PubMed |

[18]  Blendon RJ, Kim M, Benson JM. The public versus the World Health Organization on health system performance. Health Aff (Millwood) 2001; 20 10–20.
The public versus the World Health Organization on health system performance.CrossRef | 1:STN:280:DC%2BD3MrjvVeqtQ%3D%3D&md5=acb41895deee789074feb132356ef63aCAS | 11585157PubMed |

[19]  de Boer R. PBS reform: a missed opportunity? Aust Health Rev 2009; 33 176–85.
PBS reform: a missed opportunity?CrossRef | 19563306PubMed |

[20]  Searles A, Jefferys S, Doran E, Henry DA. Reference pricing, generic drugs and proposed changes to the Pharmaceutical Benefits Scheme. Med J Aust 2007; 187 236–9.
| 17564580PubMed |

[21]  Clarke PM. Challenges and opportunities for the Pharmaceutical Benefits Scheme. Med J Aust 2012; 196 153–4.
Challenges and opportunities for the Pharmaceutical Benefits Scheme.CrossRef | 22339510PubMed |

[22]  Consumers Health Forum of Australia, Choice, Australian Council of Social Service. Media release: Tuesday 20, August. 2013. Available at: https://www.chf.org.au/pdfs/med/med-CHF-ACOSS-Choice-Media-release.pdf [verified August 2013].

[23]  Sav A, Kendall E, McMillan SS, Kelly F, Whitty JA, King MA, Wheeler AJ. ‘You say treatment, I say hard work’: treatment burden among people with chronic illness and their carers in Australia. Health Soc Care Community 2013; 21 665–74.
| 23701664PubMed |

[24]  McMillan SS, Kelly F, Sav A, King MA, Whitty JA, Wheeler AJ. Consumer and carer views of Australian community pharmacy practice: awareness, experiences and expectations. J Pharm Health Services Res 2014; 5 29–36.
Consumer and carer views of Australian community pharmacy practice: awareness, experiences and expectations.CrossRef |

[25]  Sturges J, Hanrahan K. Comparing telephone and face-to-face qualitative interviewing: a research note. Qual Res 2004; 4 107–18.
Comparing telephone and face-to-face qualitative interviewing: a research note.CrossRef |

[26]  Boeije H. A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Qual Quant 2002; 36 391–409.
A purposeful approach to the constant comparative method in the analysis of qualitative interviews.CrossRef |

[27]  Glaser B. The constant comparative method of qualitative analysis. Soc Probl 1965; 12 436–45.
The constant comparative method of qualitative analysis.CrossRef |

[28]  McRae I, Yen L, Jeon YH, Herath PM, Essue B. Multimorbidity is associated with higher out-of-pocket spending: a study of older Australians with multiple chronic conditions. Aust J Prim Health 2013; 19 144–9.
Multimorbidity is associated with higher out-of-pocket spending: a study of older Australians with multiple chronic conditions.CrossRef | 22950881PubMed |

[29]  Yen L, McRae I, Jeon YH, Essue B, Herath P. The impact of chronic illness on workforce participation and the need for assistance with household tasks and personal care by older Australians. Health Soc Care Community 2011; 19 485–94.
The impact of chronic illness on workforce participation and the need for assistance with household tasks and personal care by older Australians.CrossRef | 21453439PubMed |

[30]  Jeon YH, Essue B, Jan S, Wells R, Whitworth JA. Economic hardship associated with managing chronic illness: a qualitative inquiry. BMC Health Serv Res 2009; 9 182
Economic hardship associated with managing chronic illness: a qualitative inquiry.CrossRef | 19818128PubMed |

[31]  Eaddy MT, Cook CL, O’Day K, Burch SP, Cantrell CR. How patient cost-sharing trends affect adherence and outcomes: a literature review. P T 2012; 37 45–55.
| 22346336PubMed |

[32]  Unni E, Farris KB. Determinants of different types of medication non-adherence in cholesterol lowering and asthma maintenance medications: a theoretical approach. Patient Educ Couns 2011; 83 382–90.
Determinants of different types of medication non-adherence in cholesterol lowering and asthma maintenance medications: a theoretical approach.CrossRef | 21454030PubMed |

[33]  Department of Health and Ageing. Australian Government. Pharmaceutical Benefits Scheme (PBS): PBS Safety Net 20 day rule FAQ. Commonwealth of Australia; 2013. Available at: http://www.pbs.gov.au/info/general/safety-net-faq [verified August 2013].



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