Public health expert questions prescription charge move

The Government’s announcement that it will increase the co-payment for a prescription from $3 to $5 per item, for up to a maximum of 20 items per year, represents a questionable trade-off, says a University of Otago public health researcher.

Professor Tony Blakely, Director of the Burden of Disease Equity and Cost Effectiveness (BODE3) programme at the University of Otago, Wellington, says the trade-off is that activities such as care coordination in cancer services and IT systems to support delivery of care will be increased.

“First, will increasing funding on care coordination – things like patient navigators – increase survival among cancer patients? Yes – and probably reduce inequalities too.

“Second, will increasing prescription part charges worsen health? Yes – and definitely widen inequalities in health by impacting more on the disadvantaged.

“Third; is the trade-off between these two policies worth it? Probably not – other trade-offs and prioritisation decisions could have been considered with a better net outcome.”

Care coordination services include dedicated nurses – sometimes called patient navigators – who work alongside the patient and clinical teams to get the patient to and through care in the most timely and effective way possible.

“In New Zealand the research so far on this is limited, but there are a few, yet growing, international research findings which strongly suggest that time to treatment, quality of life, and survival are all likely to be improved.

“For example, studies among cancer patients have found care coordinators can substantially decrease time to surgery and chemotherapy – in some instances by more than 50%. In turn, other studies suggest that, for example, receiving chemotherapy for stage III colon cancer a month earlier will reduce your risk of dying by an impressive 14%,” says Professor Blakely.

“Because care coordinators can free up time of others (such as surgeons and GPs), the intervention may even be cost saving.”

Professor Blakely is leading research at the moment to work out the health, health inequality impacts, and cost effectiveness, of care coordination. He says that early signs are the evaluation will be positive, but with considerable uncertainty about the exact magnitude of gain.

The Health Inequalities Research Programme, also directed by Professor Blakely, published research on the impact of patient co-payments in 2010.

“It found that about 6% of 18,000 adult New Zealanders had deferred getting a prescription in the previous 12 months because of the part charge. And Māori and Pacific people were about twice as likely to defer.

“Good access to primary care – and community-level treatments such as prescriptions – is the bedrock of any health care system, and probably one of the most cost effective ways of improving health, reducing health inequalities, and saving spill-over costs to the hospital services.”

Professor Blakely says the Government has painted its decision making as sensible reprioritisation. However, the trade-off presented is far from the only trade-off possible.

“There has been a large increase in funding to primary health care in the last decade or so, and far from all of that has gone to ‘front-line services’ – much of it has gone to the business owners. Reprioritisation within primary care might be a better option,” he says.

“Also, it is likely that care coordinators may actually be cost saving within cancer services. Thus, with careful management and implementation there may not have been a need to increase prescription part charges to pay for care coordination.”

Rising part charges could be done with less impact on sick poor people by reducing the maximum number of prescriptions attracting a co-payment per year from 20 to 15, meaning that the worst case-scenario per year for a low-income person is an increase from $60 per year to $75 per year – not $100 per year. This would still be revenue-raising.

“The Government is making clear trade-offs elsewhere, for example by continuing with tax cuts for the wealthy, not increasing the age of eligibility for superannuation and not considering capital gains taxes. There are other ways of redistribution resources than using part charges,” says Professor Blakely.