1. ENDEP : A virtual network to provide evidence on pharmaceutical policies Patient charges in Europe and patients and physicians’ decision making process Dr C Huttin Coordinator ENDEP network, EIASM Presentation for Gastein meeting, september 2002 Website: www.eiasm/internationalprojects/endep

2. HISTORY OF ENDEP CREATION in 1994 of a virtual think tank, to provide scientific evidence to European decision-makers on the impact of pharmaceutical policies DEVELOPMENT STAGE supported by the Human capital and mobility program: sharing knowledge and building trust Pilot study: comparing what a European consumer has to pay out of pocket in different national health systems BIOMED: an integrated project with standardisation of methodologies. CENTRALISATION OF DATA

3. Patient charges in Europe and patients and physicians’ decision making process To examine whether and how cost to the patient through different reimbursement systems in Europe influence physicians treatment choices and patient behaviours To cosntruct new indicators on cost to the patient,cost to the providers and societal costs. To bring evidence useful for policy circles at EU level,using international comparisons (in particular in the context of the agenda of monitoring of health systems (Sanco, e.g. Echi)

4. These costs correspond to different prescription charge arrangements in European countries CountriesType of charge and level of charge Deductible and ceiling on patient AUSTRIAFixed3.15 per pack FINLANDGraduated above a fixed cost deductible 0;25;50% above deductible FranceGraduated0;35;65% of drug cost ITALYFixed charge GERMANYFixed charge 1.56;2.60;3.64 depending on pack size UKFixed charge

5. Patient charges and patients and physicians’decision making process (Methods on the physician side) The conceptual basis: an adaptation of the Lens model (Brunswick, 52; Cooksey, 90), Hammond,95:theoretical background of probability functionalism) Patient cues Economic cues True StateJudged State Corrected weights Clinical cues Judged weights

6. Patient charges and cost sensitivity analysis of GPs in various European countries 2. Final design for the research on cost sensitivity of GPs jointly agreed between the ENDEP/EIASM consortium and the commercial Skim partner using conjoint analysis Given a patient profile: Q1: How would you treat this patient ? Q2: To what extent did you take patient cost into account when you decided how to treat this Patient ? (scale 1-7) Patient characteristics: patient affordability,patient requestfor cheaper treatment, severity of disease (hay fever) or risk factors (hypertension), patients’expenses On other diseases

7. PATIENT CHARGE AND PHYSICIANS’COST SENSITIVITY MAIN RESULTS

8. Results France: average utility values

9. Results the UK : average utility values

10. Results Finland : average utility values

11. Results Italy : average utility values

12. LINKING COST SENSITIVTY INDEX FOR EACH INDIVIDUAL PHYSICIAN WITH PRESCRIBING INTENTION SHIFTS

13. PRESCRIBING INTENTION SHIFTS FOR HYPERTENSION IN FRANCE

14. PRESCRIBING INTENTION SHIFTS FOR HYPERTENSION IN THE UK

15. PRESCRIBING INTENTION SHIFTS FOR HAY FEVER IN FRANCE

16. PRESCRIBING INTENTION SHIFTS FOR HAY FEVER IN THE UK

17. Patient charges and patients decision making process main hypotheses for EU policy making  H1 : Cost conscious patients have poorer health status  H2 : Cost conscious patients are higher users of prescribed drugs and GP visits  H3 : Cost conscious patients are higher users of cost reduction strategies  H4 : Non exempt patients are higher users of cost reduction strategies  H5 : Lower household income groups are more cost conscious  H6 : Lower household income groups are higher users of cost reduction strategies

26. POLICY IMPLICATIONS ROLE OF SCIENCE AND EVIDENCE IN EUROPEAN POLICY MORE CONVERGENCE OF HEALTH INSURANCE SYSTEMS ? GENERATION OF PRIMARY DATA FOR THE DEVELOPMENT OF HEALTH MONITORING SYSTEMS