title: Cost-Sharing Rates Increase During Deep Recession: Preliminary Data From Greece.
abstract: BACKGROUND
  Measures taken over the past four years in Greece to reduce pharmaceutical expenditure have led to significant price reductions for medicines, but have also changed patient cost-sharing rates for prescription drugs. This study attempts to capture the resulting increase in patients' out-of-pocket (OOP) expenses for prescription drugs during the 2011-2014 period.
  
  
  METHODS
  The authors conducted a retrospective review of financial data derived from 39 883 prescriptions, dispensed at three randomly chosen pharmacies located in Lamia, central Greece.
  
  
  RESULTS
  The study recorded an average contribution rate per prescription as follows: 11.28% for 2011 (95% CI: 10.76-11.80), 14.10% for 2012, 19.97% for 2013, and 29.08% for 2014. Correspondingly, the mean patient charge per prescription for 2011 was €6.58 (95% CI: 6.22-6.94), €8.28 for 2012, €8.35 for 2013, and €10.87 for 2014. During the 2011-2014 period, mean percentage rate of patient contribution increased by 157.75%, while average patient charge per prescription in current prices increased by 65.22%. The use of a newly introduced internal reference price (IRP) system increased the level of prescription charge at a rate of 2.41% for 2012 (100% surcharge on patients), 26.24% for 2013 (49.95% on patients and 50.04% on the appropriate health insurance funds), and 47.72% for 2014 (85.06% on patients and 14.94% on funds).
  
  
  CONCLUSIONS
  Increased cost-sharing rates for prescription drugs can reduce public pharmaceutical expenditure, but international experience shows that rising OOP expenses can compromise patients' ability to pay, particularly when it comes to chronic diseases and vulnerable populations. Various suggestions could be effective in refining the cost-sharing approach by giving greater consideration to chronic patients, and to the poor and elderly.
authors.affiliation: Pharmaceutical Association of Fthiotida Prefecture, Lamia, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Gouvalas
authors.affiliation: Technological Educational Institute of Western Greece, Faculty of Nursing, Patra, Greece.
authors.forename: Michael
authors.initials: M
authors.lastname: Igoumenidis
authors.affiliation: Open University of Cyprus, Latsia, Cyprus.
authors.forename: Mamas
authors.initials: M
authors.lastname: Theodorou
authors.affiliation: National School of Public Health, Open University of Cyprus, Latsia, Cyprus.
authors.forename: Kostas
authors.initials: K
authors.lastname: Athanasakis
mesh_terms: D003132:Commerce; D017047:Cost Sharing; D016527:Drug Costs; D057172:Economic Recession; D005382:Financing, Personal; D006115:Greece; D005102:Health Expenditures; D006801:Humans; D007356:Insurance, Pharmaceutical Services; D010594:Pharmacies; D055553:Prescription Drugs / Q000191:economics*; D012189:Retrospective Studies
chemical_list: D055553:Prescription Drugs
keywords: Cost-Sharing; Out-of-Pocket (OOP) Expenses; Patient Participation; Prescription Drugs