Participation in pharmaceutical costs and seniors' access to medicines in the Czech Republic.

OBJECTIVES: Analysis of participation in drug costs by seniors in the Czech Republic in connection with seniors' access to pharmacotherapy.
MATERIALS AND METHODS: Quota-sampled guided interview with 450 respondents visiting pharmacy; ratio of men and women approximately 1:2; age over 60 years; 3 regions of the Czech Republic.
RESULTS: Respondent's income was retirement pension in 80%. More than 55% of respondents did not reach the official state average. Respondents used altogether 1,650 medicines on physician's prescription in the last four weeks. Overall co-payment for medicines was 38,778 CZK, i.e. 86 CZK per patient. Only 27% of respondents used fully reimbursed products. Respondents used together 273 OTC drugs (over-the-counter drugs, e.g. non prescription drugs) in value of 16,540 CZK, i.e. 37 CZK per patient. Average respondent spent on medicines 123 CZK in the last four weeks, i.e. 1.5% of the official state average income. There were respondents, about 10%, searching for the level of co-payment in several pharmacies and more than 8% of respondents had to refuse dispensation of medicines due to co-payment.
CONCLUSIONS: Our study demonstrates that there are patients who may fail to gain access to medication due to co-payment in the Czech Republic. The financial participation in health care costs is generally low in the Czech Republic (8.8% of total health expenditures) but there were differences in co-payment levels in patients ranging from 1 CZK to thousands CZK. In our opinion problem might be in the absence of any instrument limiting the highest individual participation as it is for example in 12-month period in Sweden. In our study co-payments were lower in smaller communities that may be due to better communication between physicians and patients or physicians and pharmacists. We found a critical ethical problem in different levels of co-payment of concrete product.