Gary L O'Brien1, Sarah-Jo Sinnott2, Bridget O' Flynn3, Valerie Walshe4, Mark Mulcahy5, Stephen Byrne3. 1. Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, College Road, Cork, Ireland. Electronic address: gary_obrien@umail.ucc.ie. 2. Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, WC1E7HT, UK. 3. Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, College Road, Cork, Ireland. 4. National Finance Division, Health Service Executive, Model Business Park, Model Farm Road, Cork, Ireland. 5. Department of Accounting, Finance and Information Systems, Cork University Business School, University College Cork, Cork, Ireland.
Abstract
BACKGROUND: Mandatory co-payments attached to prescription medicines on the Irish public health insurance [General Medical Services (GMS)] scheme have undergone multiple iterations since their introduction in October 2010. To date, whilst patients' opinions on said co-payments have been evaluated, the perspectives of community pharmacists and general practitioners (GPs) have not. OBJECTIVE: To explore the involvement and perceptions of community pharmacists and GPs on this pharmaceutical policy change. METHODS: A qualitative study using purposive sampling alongside snowballing recruitment was used. Nineteen interviews were conducted in a Southern region of Ireland. Data were analysed using the Framework Approach. RESULTS: Three major themes emerged: 1) the withered tax-collecting pharmacist; 2) concerns and prescribing patterns of physicians; and 3) the co-payment system - impact and sustainability. Both community pharmacists and GPs accepted the theoretical concept of a co-payment on the GMS scheme as it prevents moral hazard. However, there were multiple references to the burden that the current method of co-payment collection places on community pharmacists in terms of direct financial loss and reductions in workplace productivity. GPs independently suggested that a co-payment system may inhibit moral hazard by GMS patients in the utilisation of GP services. It was unclear to participants what evidence is guiding the GMS co-payment fee changes. CONCLUSION: Interviewees accepted the rationale for the co-payment system, but reform is warranted.
BACKGROUND: Mandatory co-payments attached to prescription medicines on the Irish public health insurance [General Medical Services (GMS)] scheme have undergone multiple iterations since their introduction in October 2010. To date, whilst patients' opinions on said co-payments have been evaluated, the perspectives of community pharmacists and general practitioners (GPs) have not. OBJECTIVE: To explore the involvement and perceptions of community pharmacists and GPs on this pharmaceutical policy change. METHODS: A qualitative study using purposive sampling alongside snowballing recruitment was used. Nineteen interviews were conducted in a Southern region of Ireland. Data were analysed using the Framework Approach. RESULTS: Three major themes emerged: 1) the withered tax-collecting pharmacist; 2) concerns and prescribing patterns of physicians; and 3) the co-payment system - impact and sustainability. Both community pharmacists and GPs accepted the theoretical concept of a co-payment on the GMS scheme as it prevents moral hazard. However, there were multiple references to the burden that the current method of co-payment collection places on community pharmacists in terms of direct financial loss and reductions in workplace productivity. GPs independently suggested that a co-payment system may inhibit moral hazard by GMSpatients in the utilisation of GP services. It was unclear to participants what evidence is guiding the GMS co-payment fee changes. CONCLUSION: Interviewees accepted the rationale for the co-payment system, but reform is warranted.