Barriers to access and use of high cost medicines: A review

Philip Wahlster, Shane Scahill, Christine Y. Lu, Zaheer Ud Din Babar

Research output: Contribution to journalReview article

11 Citations (Scopus)

Abstract

Background: The objective of this literature review was to identify barriers to access and use of high cost medicines (HCMs). Method: A literature review was performed in common electronic databases (Medline, PubMed, Springer Link, Embase, Science Direct, and Google Scholar). We identified original studies published between 1999 and 2011 relating to access to and use of HCMs. Three hundred and seventy four relevant articles were found. Forty-three original articles matched inclusion criteria. Results: We categorized access barriers into three levels: health system, regional/hospital, and patient levels. Barriers to access included the affordability of the healthcare system, the decision-making process for funding HCMs and eligibility criteria for access, geographic variation in funding and access, communication between physicians and patients, and patient out of pocket costs. Conclusion: Barriers to access HCMs are inter-related. These barriers are also relevant for other medicines but are escalated in the case of HCMs. Overall, healthcare systems are facing barriers related to high out-of-pocket cost for patients and/or barriers regarding the decision-making process and the effects of reimbursement decisions (i.e., restricted, delayed or denied access, particularly the latter for socialized systems with a universal coverage scheme). Inadequate access to HCMs may lead to subsequent use of unnecessary medical treatments. Barriers to access HCMs can also lead to treatment disparities between patients who can overcome these barriers and those who cannot. Improvements in the decision-making process can increase acceptance of the need to prioritize access to HCMs.

LanguageEnglish
Pages191-214
Number of pages24
JournalHealth Policy and Technology
Volume4
Issue number3
Early online date1 May 2015
DOIs
Publication statusPublished - 3 Sep 2015
Externally publishedYes

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Medicine
Costs and Cost Analysis
Costs
Decision Making
Health Expenditures
Decision making
Universal Coverage
Delivery of Health Care
PubMed
Health Status
Communication
Databases
Physicians
Health
Therapeutics

Cite this

Wahlster, Philip ; Scahill, Shane ; Lu, Christine Y. ; Babar, Zaheer Ud Din. / Barriers to access and use of high cost medicines : A review. In: Health Policy and Technology. 2015 ; Vol. 4, No. 3. pp. 191-214.
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Barriers to access and use of high cost medicines : A review. / Wahlster, Philip; Scahill, Shane; Lu, Christine Y.; Babar, Zaheer Ud Din.

In: Health Policy and Technology, Vol. 4, No. 3, 03.09.2015, p. 191-214.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Barriers to access and use of high cost medicines

T2 - Health Policy and Technology

AU - Wahlster, Philip

AU - Scahill, Shane

AU - Lu, Christine Y.

AU - Babar, Zaheer Ud Din

PY - 2015/9/3

Y1 - 2015/9/3

N2 - Background: The objective of this literature review was to identify barriers to access and use of high cost medicines (HCMs). Method: A literature review was performed in common electronic databases (Medline, PubMed, Springer Link, Embase, Science Direct, and Google Scholar). We identified original studies published between 1999 and 2011 relating to access to and use of HCMs. Three hundred and seventy four relevant articles were found. Forty-three original articles matched inclusion criteria. Results: We categorized access barriers into three levels: health system, regional/hospital, and patient levels. Barriers to access included the affordability of the healthcare system, the decision-making process for funding HCMs and eligibility criteria for access, geographic variation in funding and access, communication between physicians and patients, and patient out of pocket costs. Conclusion: Barriers to access HCMs are inter-related. These barriers are also relevant for other medicines but are escalated in the case of HCMs. Overall, healthcare systems are facing barriers related to high out-of-pocket cost for patients and/or barriers regarding the decision-making process and the effects of reimbursement decisions (i.e., restricted, delayed or denied access, particularly the latter for socialized systems with a universal coverage scheme). Inadequate access to HCMs may lead to subsequent use of unnecessary medical treatments. Barriers to access HCMs can also lead to treatment disparities between patients who can overcome these barriers and those who cannot. Improvements in the decision-making process can increase acceptance of the need to prioritize access to HCMs.

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KW - Decision-making

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KW - Stakeholder perspective

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