New cross-national study of prescription drug coverage

May 10, 2000

One of this year's most contentious election campaign issues -- the coverage of prescription drugs for the elderly -- is the topic of a just-published cross-national study by a group of researchers from Syracuse University and McMaster University.

Titled "Outpatient Pharmaceuticals and the Elderly: Policies in Seven Nations," the article reveals that even in countries like Australia, Canada and the United Kingdom, where universal or near-universal health care is offered, there are numerous restrictions on prescription drug accessibility. Australia, Canada, Germany, Japan, New Zealand, the United Kingdom and the United States are the OECD (Organization for Economic Cooperation and Development) nations compared in the study, published in the latest (May/June) issue of Health Affairs, a leading journal for bringing together academics and policy makers in the health care field.

Supported by the Commonwealth Fund, the research group was headed by principal investigator Deborah Freund, Syracuse University vice chancellor and provost and professor of public administration in SU's Maxwell School; and by Don Willison, assistant professor in the Department of Clinical Epidemiology and Biostatistics at McMaster University and a scientist at the Centre for the Evaluation of Medicines at St. Joseph's Hospital, both in Hamilton, Ontario.

Focusing on access to drug insurance, extent of insurance benefits coverage, and costs, the group reviewed the strategies these nations use to ensure access while controlling costs. The research team found a lack of complete coverage by countries with universal or near universal health care when it came to prescription drug policies.

The article shows that the restrictions put on outpatient drug benefits in those countries ranged from minimal to extensive. The restrictions included positive and negative drug lists that limit particular drugs that can be prescribed or reimbursed by a national health care plan; cost sharing, where patients have to pay for part of the drugs out of pocket; and restrictions on the use of "first dollar" coverage where patients needing an outpatient drug get the drug paid for when prescribed.

Despite the restrictions, though, Freund says there is clearly a difference between the policies of the United States and the other countries in the study.

"The bottom line is, for a variety of complex reasons, every other country has something while the U.S. has nothing," Freund says. "When the other countries do have some kind of outpatient pharmaceutical plan, though, it ends up being extremely expensive. So if we want to do it, we'll have to bite the bullet and learn from the other countries that the very methods we're using on the non-Medicare population, we'll have to use on the Medicare population."

The research team also included Grant Reeher, associate professor of political science, and public administration graduate student Amy Ferraro, both in the Maxwell School; Jarold Cosby, a senior research analyst at the Centre for the Evaluation of Medicines; and Bernie O'Brien, an associate professor of clinical epidemiology and biostatistics at McMaster University and associate director of the Centre for the Evaluation of Medicines.

Freund says that the researchers knew that the topic of their study "was an issue at the time we got the grant, but we didn't know it was going to be in the national presidential debate. In some ways, it's more important than it might have been in another year."
-end-


Syracuse University

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