title: Abolition of prescription copayments in Wales: an observational study on dispensing rates.
abstract: OBJECTIVE
  To assess effects of abolition of prescription copayments in Wales on rates of dispensing.
  
  
  METHODS
  General practice-level monthly dispensing data were compared before/after abolition between Wales and North East (NE) England where the charge was retained. Data for 14 medicines that had most items dispensed subject to charge before abolition were similarly compared with NE England. For those with over-the-counter substitutes, wholesale sales to pharmacies were examined. A survey examined local initiatives, which might differentially affect dispensing between the two areas.
  
  
  RESULTS
  Total dispensing rates (items/1000 patients) increased significantly in both areas but significantly less so in Wales (difference = -19.7, P = 0.024, 95% confidence interval [CI] = -36.7 to -2.6). For the 14 selected medicines, combined dispensing rates increased significantly in both areas but significantly more in Wales (difference = 27.51, P < 0.0001, 95% CI = 23.66-31.35). There was much variation for individual drugs, but categories tended to show this same trend except for antibiotics, where rates increased in Wales but decreased in NE England. The survey revealed few local initiatives that could explain these differences. Sales of over-the-counter substitutes did not explain the changes in dispensing.
  
  
  CONCLUSIONS
  The Welsh policy was associated with a modest increase in dispensing rates relative to NE England for the 14 medicines with the highest number of items dispensed subject to charge before abolition. Although factors besides the copayment may have influenced these observations, the smaller relative increase in total dispensing rates in Wales suggests that the overall impact of abolition was minimal.
authors.affiliation: Health Economics and Policy Research Unit, Faculty of Health, Sport and Science, University of Glamorgan, Pontypridd, UK. dcohen@glam.ac.uk
authors.forename: David
authors.initials: D
authors.lastname: Cohen
authors.forename: M Fasihul
authors.initials: MF
authors.lastname: Alam
authors.forename: Frank D J
authors.initials: FD
authors.lastname: Dunstan
authors.forename: Susan
authors.initials: S
authors.lastname: Myles
authors.forename: Dyfrig A
authors.initials: DA
authors.lastname: Hughes
authors.forename: Philip A
authors.initials: PA
authors.lastname: Routledge
mesh_terms: D016001:Confidence Intervals; D004739:England; D006291:Health Policy / Q000191:economics*; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000191:economics* / Q000706:statistics & numerical data; D010594:Pharmacies / Q000191:economics* / Q000706:statistics & numerical data; D010602:Pharmacopoeias as Topic; D055553:Prescription Drugs / Q000191:economics*; D011795:Surveys and Questionnaires; D014852:Wales
chemical_list: D055553:Prescription Drugs