Transcript Effect of drug co-payment reductions on preventable

Effects of the Closing the Gap
Pharmaceutical Benefit on
Hospitalizations among Indigenous
Australians
Amal Trivedi, MD, MPH
Providence VA Medical Center
Brown University School of Public Health
Selected Racial/Ethnic Life Expectancy Gaps
in US, New Zealand, and Australia
Policy Efforts to Increase Access to
Medications among Indigenous Persons
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Section 100 provisions (1999)
Remote Aboriginal health services
 PBS meds supplied to clients without charge
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Qumax (2008)
Non-remote ACCHS
 Copayment assistance
 Funding capped at $11 million; about 20% of clients
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Closing the Gap (2010)
Closing the Gap PBS Copayment
Measure
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Implemented in July 2010
Applied to all non-remote general practice
Reduces monthly medication copayment to
$5.40 (from max of ~$35) for non-concessional
patients and $0 for concessional
Registration through GP
“With chronic disease or at risk for chronic
disease”
Closing the Gap PBS Copayment
Measure
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Uncapped
Estimated to cover 70,000 Indigenous persons
at cost of $90 million
Most recent data: 182,000 Indigenous patients
access the benefit by 2012
Study Objective
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Evaluate the impact of the Closing the Gap PBS
Copayment Incentive on hospitalization rates of
ambulatory care-sensitive conditions
Methods – Data Sources
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Sentinel Sites Study
24 total sites across Australia
Included 16 of 24 sites (Queensland, New South
Wales, Victoria, Western Australia)
Uptake of PBS Copayment Incentive
Methods – Data Sources
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Obtained hospitalization data from each site
from 2009 to 2011 (18 months before and 18
months after policy change)
Included diagnoses; length of stay
Study population includes all residents age 15
and older residing in 16 Sentinel Sites locations
Approximately 1.7 million persons
Analyses
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Calculated population rates of admissions and
hospital days for ambulatory care-sensitive
conditions amenable to chronic drug therapy
Conditions included:
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Asthma
Chronic Obstructive Pulmonary Disease
Congestive Heart Failure
Angina
Diabetes
Hypertension
Vascular disease
Analyses
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Age-standardized rates based on population
distribution across all Sentinel Sites
Population in each Sentinel Site adjusted in each
year to reflect area-level annual growth rate for
Indigenous and Non-Indigenous residents
Confidence intervals derived using Fay-Feuer
method assuming a poisson distribution
Uptake of PBS Incentive in Sentinel Sites
and Rest of Australia
Ambulatory Care-Sensitive Hospitalizations among
Indigenous and Non-Indigenous Australians in Sentinel Sites
Uptake of PBS Incentive Across Sentinel Sites
High-Uptake Sites (Uptake)
Low-Uptake Sites (Uptake)
Logan Woodridge, QL (69%)
North Lakes, QL (20%)
Dubbo, NSW (54%)
Campbelltown, NSW (19%)
Grafton, NSW (53%)
Newcastle, NSW (19%)
Bairnsdale, VIC (52%)
Brisbane, QL (18%)
Geraldton, WA (51%)
Dandenong, VIC (11%)
Swan Hill/Mildura, VIC (39%)
Kalgoorlie, WA (11%)
Cairns, QL (26%)
East Pilbara, WA (9%)
Tamworth, NSW (26%)
Derby, WA (1.5%)
2009 Population
2009 Population
317K (17K Indigenous)
1.4 million (24K Indigenous)
Ambulatory Care-Sensitive Hospitalizations among Indigenous
Australians in High and Low-Uptake Sentinel Sites
Ambulatory Care-Sensitive Hospital Days among
Indigenous Australians in High and Low-Uptake Sentinel
Sites
Limitations
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Not causal
Limited to 3 year time window
Area-level analysis
Lack of individual data
Few covariates
Other policy changes
Conclusions
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Large disparities in rates of ACS hospitalizations
Substantial reduction in chronic ACS
hospitalization rates (~45%) among indigenous
patients following PBS copayment incentive
Variations in uptake across regions in Australia
Reductions exclusively observed in areas with
high-uptake of the incentive
Implications
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Australia has implemented innovative approaches to
increase access to medications for Indigenous populations
Increased access to prescription drugs may reduce risk of
hospitalization among Indigenous Australians
Hospital reductions are plausible given prior literature,
magnitude of uptake, and types of medications filled
Acknowledgments
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Margaret Kelaher, PhD
Centre for Health Policy, Program and
Economics, University of Melbourne
Jane Hall, PhD
Australian Department of Health
Commonwealth Fund
Hospital Offsets from Enhanced
Drug Coverage
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Systematic review of 8 prior studies published by
US Congressional Budget Office
Most studies found evidence that increased use
of prescription drugs offset spending on
hospitalizations
1% increase in drug utilization associated with a
0.2% decline in non-drug medical spending
Offset occurs nearly immediately
Principal Diagnoses of Hospitalizations
Most Common Medications Filled Under
PBS Copayment Incentive
Atorvastatin
 Metformin
 Salbutamol
 Perindopril
 Codeine
Most common conditions: cardiovascular, mental
disorders, diabetes, chronic respiratory
conditions, pain relief
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Ambulatory Care-Sensitive Hospital Days among Indigenous
and Non-Indigenous Australians in Sentinel Sites
Trends in Age-Adjusted Ambulatory Care-Sensitive Hospital
Days among Indigenous and Non-Indigenous Australians