Household Out-of-Pocket Spending on Medicines in Poland: Modest and Unequal Effects of the Medicines 75+ Program

Tambor, Marzena; Pavlova, Milena; García-Ramírez, Jorge Alejandro

Household Out-of-Pocket Spending on Medicines in Poland: Modest and Unequal Effects of the Medicines 75+ Program

Articles in Press

Document Type : Original Article

Authors

Marzena Tambor ¹

Milena Pavlova ²

Jorge Alejandro García-Ramírez ³

¹ Department of Health Economics and Social Security, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland

² Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands

³ WHO Barcelona Office for Health Systems Financing, Barcelona, Spain

Abstract

Background
Out-of-pocket payments for medicines are the main driver of financial hardship for households in most countries in Europe, particularly in Central and Eastern Europe (CEE). The aim of this study was to analyze household spending on medicines in Poland and assess the effects of the Medicines 75+ program, implemented to improve access to medicines for older people.

Methods
We utilized 2013-2021 data from household budget surveys conducted on a representative sample of Poland’s population. A two-part model was employed to identify factors associated with paying for and amount spent on medicines. We evaluated the effect of the Medicines 75+ program using a difference-in-differences (DID) analysis for cross-sectional data covering the years 2013-2019 (pre-pandemic years). Our treatment group included households headed by people aged 75-85, which was compared to the control group, ie, households headed by individuals aged 65-74.

Results
The results show that out-of-pocket expenditure on medicines increased over the analyzed years and remains the primary driver of household health spending. Ability to pay and age are strong predictors of the likelihood of paying for medicines and expenditure levels, with their effects being cumulative. The average annual per capita spending in the treatment group decreased from PLN 1282 in the pre-intervention period (2013-2016) to PLN 1221 in the postintervention years (2017-2019), while the control group’s spending increased from PLN 930 to PLN 969. The DID analysis showed that the program of free medicines reduced the annual out-of-pocket spending by an average of PLN 71 (2019 US $18), which is relatively modest given the high expenditure in this age group. The decrease was also not observed across all consumption quintiles, with no significant improvement among the poorest households.

Conclusion
Poland should reconsider its policies for equitable access to medicines, placing greater emphasis on lowincome groups and addressing both prescription and over-the-counter (OTC) medicines.

Keywords

Out-of-Pocket Payments

Medicines

Policy Evaluation

Quasi-experimental Study

Poland

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