ArticleRole of Health Insurance Coverage in Women’s Access to Prescription Medicines
Introduction
Advances in pharmaceuticals have transformed health care over the last several decades. Today, prescription drugs are an integral component of the health care delivery system and millions of women rely on prescription drugs for a wide range of needs from contraception to treatment of chronic health problems. As drugs have become ever more tightly interwoven in the fabric of the health care system, their costs have risen at unprecedented rates. Between 2000 and 2005, spending on prescription medicines rose between 5% and 15% annually (Catlin et al., 2007). The impact of this is particularly relevant for women, because they are more likely than men to take prescription medications on a regular basis (Salganicoff, Ranji, & Wyn, 2005). A host of factors may account for the greater use among women, including women’s higher rates of chronic illness, longer life spans, and reproductive health needs. Despite their greater reliance on prescription drugs, women have fewer resources than men to pay for out-of-pocket costs for medicines and other health care services because they have lower earnings throughout their lives.
Prescription drug costs and coverage have received much attention in recent years with the implementation of the Medicare Part D program, which provides outpatient prescription drug coverage for the first time in the program’s history. Several surveys have reported that seniors utilize a variety of strategies to cope with drug expenses, including not filling prescriptions, skipping or splitting doses, stopping existing medications, not starting new medications, spending less on other basic needs such as food or electricity, or obtaining lower cost versions from other countries (Safran et al 2005, Steinman et al 2001, Kitchman et al 2002, Tseng et al 2004).
However, affordability problems are not limited to seniors alone (Kennedy et al 2004, Reed and Hargraves 2003). Younger women are also at risk for facing cost barriers, either because they cannot afford cost sharing or because they are uninsured, as is the case for nearly 1 in 5 women ages 18–64 (Kaiser Family Foundation, 2007). Given the importance of prescription drugs for addressing non-elderly women’s unique reproductive health issues, such as family planning and menopause, as well as for the management of chronic diseases, it is important to understand the factors that affect their accessibility. Cost barriers to medications have been found to be associated with subsequent declines in health status and higher rates of problems among those with chronic illnesses (Heisler et al 2004, Piette et al 2004, Soumerai et al 1991).
The vital protection that health coverage offers from health care costs and its important role in expanding access to health services is well established (Institute of Medicine, 2002). The impact of coverage on access to prescription drugs is less well understood. This study presents new data on non-elderly women’s use of and access to prescription medicines using a nationally representative sample. It is based on the conceptual model of individual health care access originally developed by Andersen (1968), which examines predisposing, enabling, and need variables that influence access. The study examines the extent to which women forgo or reduce medication use because of cost and compares differences in access barriers among subgroups of women. Of particular interest in this study are the enabling factors of health insurance and income and their role in financial access to prescribed medications.
Section snippets
Data Source
This study is based on data from the Kaiser Women’s Health Survey 2004, a telephone survey of a nationally representative sample of 2,766 adult women (≥18 years old) living in the continental United States. Survey interviews were conducted in either English or Spanish, according to the preference of the respondent.
The questionnaire was designed by researchers at the Kaiser Family Foundation, University of California Los Angeles, and Princeton Survey Research Associates International. The
Descriptive Findings
Over half (54%) of non-elderly women reported they took ≥1 prescription medicine on a regular basis in the prior year (Table 1). The share of women using prescription drugs increased with age, with 7 in 10 (71%) women ages 45–64 reporting they used a prescription medicine regularly, compared with fewer than half (43%) of their younger counterparts. White women were most likely and Latina women the least likely to take a prescription medicine regularly. Three-quarters (75%) of women in the
Discussion
In this study, a sizable share of women reported having to forgo, skip, or split medications because they could not afford the medication. Although costs affected many subpopulations of women, the effects were strongest among women who did not have insurance coverage, regardless of income. Uninsured women were more than twice as likely as women with private or public coverage to experience cost barriers that resulted in forgoing medications. Additionally, women who were low income or in poorer
References (23)
- et al.
Drug affordability and prescription noncompliance in the United States: 1997–2002
Clinical Therapeutics
(2004) A behavioral model of families’ use of health services
(1968)- et al.
Regression diagnostics
(1980) - et al.
National health spending in 2005: The slowdown continues
Health Affairs
(2007) Affording prescription drugs: Not just a problem for the elderly
(2002)Medicaid cost containment and access to prescription drugs
Health Affairs
(2005)- et al.
Individual insurance: How much financial protection does it provide?
Health Affairs
(2002) - et al.
The health effects of restricting prescription medication use because of cost
Medical Care
(2004) Care without coverage: Too little, too late
(2002)Employer health benefits annual survey
(2006)
Women’s health insurance coverage
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Funding for this research was provided by the Henry J. Kaiser Family Foundation.
- 1
Usha Ranji, MS, is a Senior Policy Analyst at the Kaiser Family Foundations. Her work addresses issues related to women’s health coverage and access to care, with an emphasis on low-income populations.
- 2
Roberta Wyn, PhD, is an associate director at the UCLA Center for Health Policy Research. She conducts research in several health care policy areas with a particular focus on access to health insurance coverage and health care for women, ethnic populations, and low-income groups.
- 3
Alina Salganicoff, PhD, is Vice President and Director of Women’s Health Policy at the Kaiser Family Foundation. Her work focuses on health policy issues of importance to women, with an emphasis on health coverage, financing, and access to care for underserved women.
- 4
Hongjian Yu, PhD, is the director for statistical support at the UCLA Center for Health Policy Research. His research in statistics has involved mixed generalized linear models, hierarchical models, survey design, and small-area estimation.