Copayment e spesa in farmaci delle famiglie italiane: il complesso legame tra disuguaglianze sociali, politiche regionali e crisi economica

In recent years Italian citizens have increasingly been asked to share pharmaceutical cost but at the same time households’ medicines expenditures has decreased. Cost-sharing policies have to be assessed not just in terms of limitation of moral hazard and revenue to the State, but also for equal opportunities for citizen users accessing health services. The aim of this paper is to analyze how Italian copayment policies (‘ticket’) on medicines may affect pharmaceutical expenditure of households, considering territorial (Regions) and social groups (differentiated on the basis of deciles of equivalent consumption) variation. We use cross-sectional data from ISTAT Italian household consumptions survey and OSMED on revenue from ‘tickets’ on medicines in the Italian Regions. We applied two regression models (Tobit and OLS) to estimate coefficients between the consumption deciles and the expenditure on medicines. Across the period 2001-2010 we found that the overall per capita private spending on medicines remained substantially stable, although medicine expenditure decreases whereas the ‘ticket’ increases. When cost-sharing raises, out of pocket spending on medicines by poorer families seems to remain unchanged, however poorer families seem to reduce their pharmaceutical expenditure. Our analysis suggests that applying copayment in Italy is partly successful, in terms of greater revenue to the health system, but in the last few years cost-sharing increases would seem to have rebounded negatively on more vulnerable families, due to the economic crisis.