title: Impact of a cost-sharing drug insurance plan on drug utilization among older people.
abstract: OBJECTIVE
  In August 1996, the Régie de l'assurance-maladie du QuEbec (RAMQ), the government body responsible for medical insurance in the Canadian province of Quebec, introduced a cost-sharing drug insurance plan. Before this plan, individuals age 65 years and older had to pay Canadian (CDN)$2 per prescription, with the remaining cost paid by the RAMQ. With the new plan, beneficiaries may have to pay an amount between CDN$200 and CDN$925 per year, depending on their income. Concerned that this financial constraint imposed on older people might have an impact on the use of medications, we investigated whether the consumption of four classes of medications, antihypertensive agents, anticoagulants, nitrates, and benzodiazepines, was affected by the drug plan implementation.
  
  
  METHODS
  Time series models with pre/post comparison group.
  
  
  METHODS
  Administrative computerized databases of the RAMQ.
  
  
  METHODS
  Random sample of Quebec residents age 65 years and older registered in the provincial drug plan between August 1992 and June 1997: 54,771 users of nitrates, 133,146 users of antihypertensive agents, 45,534 users of anti-coagulants, and 26,165 users of benzodiazepines.
  
  
  METHODS
  We modeled the monthly consumption of the medications under study between August 1992 and June 1996. Monthly drug consumptions predicted from the models were compared with those observed for the 13 months (August 1996 to August 1997) following the implementation of the new drug plan using 95% confidence intervals. The number of prescriptions dispensed served as an indicator for drug consumption.
  
  
  RESULTS
  During the study period we observed a nonstatistically significant decrease in number of prescriptions of 5.1% for nitrates, 1.1% for antihypertensive agents, and 0.8% for benzodiazepines, and a nonstatistically significant increase of 1.6% for anticoagulants.
  
  
  CONCLUSIONS
  Residents of Quebec age 65 years and older were not found to have reduced significantly their consumption of nitrates, antihypertensive agents, anticoagulants, and benzodiazepines during the 13 months that followed the implementation of a cost-sharing drug insurance plan.
authors.affiliation: Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Quebec, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Blais
authors.forename: J M
authors.initials: JM
authors.lastname: Boucher
authors.forename: J
authors.initials: J
authors.lastname: Couture
authors.forename: E
authors.initials: E
authors.lastname: Rahme
authors.forename: J
authors.initials: J
authors.lastname: LeLorier
mesh_terms: D000368:Aged; D017047:Cost Sharing / Q000191:economics*; D004363:Drug Utilization / Q000639:trends*; D005260:Female; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000191:economics*; D008297:Male; D011792:Quebec