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SECTION 3: REVIEW OF THE USE OF CO-PAYMENTS IN OTHER COUNTRIES
3.1 The Scottish Executive undertook a review of the use of co-payments in other countries to provide an evidence base and source of reference for this consultation phase. It examined and compared how much patients contribute to the cost of their medication and what exemptions and reduced payment policies are in place in Western Europe, North America, Australia and New Zealand.
3.2 The report of the overview states the position as at January 2006
3.3 In summary, the health systems in the countries surveyed are varied, and so too are how much patients pay towards their medication, exemption and reduced payment policies. The fact that each country is operating from a different baseline means that direct and precise comparisons between the different arrangements could be misleading. However, the key points to emerge from the review are:
- Patients in all countries surveyed pay some form of charge towards their medication, except the Netherlands, though this policy is currently being reformed to introduce patient co-payments, and some parts of Italy
- Overall, the system in Scotland/ UK is generally more generous than most other countries. The amount patients pay towards their medication in most of the countries surveyed relates to the cost of the drug dispensed, with patients paying a percentage of this cost. In Scotland/ UK the charge is not related to the drug price but is a fixed payment of £6.50 per item. Additionally, the exemption scheme in Scotland/ UK entitles approximately 50% of the population to have all their prescriptions free of charge.
- Although variation in the price of drugs and differences in charging policy makes it difficult to compare Scotland/ UK against other countries, in general, for very low cost drugs, patients in Scotland/ UK pay a higher charge, but face lower costs relative to other countries for medium to high priced drugs.
- No other country surveyed takes the approach of the UK countries that anyone who qualifies for exemption on the grounds of having a medical condition is exempted from charges for all prescriptions whether or not the prescription relates to the medical condition.
- Not all countries surveyed included exemption on medical grounds
- The majority of countries surveyed offer reduced payments or exemptions for older people and people on low income. In addition, most offer help for high users of services or medication in the form of reduced payments or a cap on the total payment in a given period of time. In terms of older people, most of the age thresholds relate to pensionable age or are higher than in Scotland/ UKe.g. over 70 in Ireland.
- There is little evidence from other countries of exemption policies for students and people in training
3.4 The review also concluded that there is insufficient research, particularly in the UK, to assess the degree to which prescription charging would adversely affect health status due to reduced take-up of prescriptions, or, for that matter, the degree to which non-compliance with taking medication for any reason would have this effect.
3.5 A copy of the report's summary is at Annex A which includes references to the sources used. The following Section 4 draws from the main report as appropriate. A full copy of the report (over 40 pages) can be obtained by contacting Ms Charmian Runciman (0131 244 2231).
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