The use of prescription charges.

This paper makes a contribution concerning the effectiveness of the direct payment for drugs by the patient through a review of the most important empirical US and UK contributions. It confirms that the demand for prescription drugs, and even the demand for OTC to a lesser extent, is reduced by a direct contribution from the patient. The price elasticities which measure the scope of the decrease of drug consumption, range however at low levels from -0.1/or -0.2 to -0.6 [1]. In order to be able to draw some policy conclusions from these studies, the health analyst will also want to have clinical or quality assessments of the changes of consumption or the health conditions of the patient. Some of the works reviewed offer some preliminary answers, but on a limited share of the population (the Medicaid population in the USA). Applied to some non-essential medications, however, this type of work highlights the phenomena of substitution between drugs, lack of change in overall drug use and uncertain changes in the quality of prescribing. This review paper will allow the policy makers to discuss some areas of change for various types of direct payments of the patient, and the use of unique versus selective schemes.