title: Impact of prescription charges on people living in poverty: A qualitative study.
abstract: Prescription charges or copayments have been shown to reduce consumption of medicines. For people living in poverty, prescription charges can prevent them from getting the medicines they need, and this can result in poorer health status. Prescription charges are low in New Zealand compared to many other countries, but those living in poverty are not exempt from fees.
  
  
  
  The aim of this study was to explore the lived experience of people who struggle to pay prescription charges and to propose a model for how being unable to afford prescription charges might affect health.
  
  
  
  Participants were recruited through organizations that provide services entirely or predominantly to low income persons. Semi-structured interviews were carried out with 29 people who had been identified as having problems paying for prescriptions. Approximately half of the sample population was Māori (indigenous New Zealanders). Ethical approval was obtained from the University of Otago.
  
  
  
  Participants reported having to make difficult decisions when picking up their prescription medicines. These included choosing some medicines and leaving others, such as choosing medicines for mental health rather than physical health; cutting food consumption or eating less healthy food so as to pay for medicines; or picking up medicines for children while leaving those for adults. Participants also reported strategies like reducing doses to make prescriptions last longer; and delaying picking up medicines. These led to sub-optimal dosing or interrupted treatment.
  
  
  
  Even low financial barriers can have a significant impact on low income people's access to medicines and reduce the effectiveness of treatment. Not being able to afford prescription medicines may impact negatively on people's health directly by preventing access to medicines, through reducing expenditure on other items need for health, and by potentiating stigma.
authors.affiliation: School of Pharmacy, University of Otago, P.O. Box 56, Dunedin, New Zealand. Electronic address: pauline.norris@otago.ac.nz.
authors.forename: Pauline
authors.initials: P
authors.lastname: Norris
authors.affiliation: School of Pharmacy, University of Otago, P.O. Box 56, Dunedin, New Zealand.
authors.forename: June
authors.initials: J
authors.lastname: Tordoff
authors.affiliation: School of Pharmacy, University of Otago, P.O. Box 56, Dunedin, New Zealand.
authors.forename: Brendon
authors.initials: B
authors.lastname: McIntosh
authors.affiliation: School of Pharmacy, University of Otago, P.O. Box 56, Dunedin, New Zealand.
authors.forename: Kunal
authors.initials: K
authors.lastname: Laxman
authors.affiliation: School of Pharmacy, University of Otago, P.O. Box 56, Dunedin, New Zealand.
authors.forename: Shih Yen
authors.initials: SY
authors.lastname: Chang
authors.affiliation: Māori Pharmacists Association, New Zealand.
authors.forename: Leanne
authors.initials: L
authors.lastname: Te Karu
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009520:New Zealand; D011203:Poverty; D055553:Prescription Drugs / Q000191:economics*; D012959:Socioeconomic Factors; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D055553:Prescription Drugs
keywords: Patient experiences; Poverty; Prescription charges; Prescription copayments