The economy has its scales and we know that a small individual contribution can add up a lot if re are many who pay it. This is logic with which in April 2012 sanitary co-payment was imposed for pensioners. The idea was to stop escalation of pharmaceutical bill by way of raising a small amount for each recipe depending on income and at same time discourage unnecessary consumption. But such decisions often have adverse social effects. In addition to gross amount collected or savings achieved, it is necessary to assess impact that measure has on those affected by it. And in case of health co-payment, re is already evidence that its effects, in addition to being unfair, can have a high cost.
Six years after implementation of co-payment, new Minister of Health, Carmen Heap, has announced its intention to revise this measure. It does not need much more data than it already managed to decide suppression of copay for pensioners with less resources in Valencian Community. The Government of Ximo Puig decided to release from co-payment those who received pensions lower than 1,000 euros and those who have recognized a disability above 65%. In total, 986,000 Valencian people were exempted from co-payment by means of subsidizing ir obligation, a strategy agreed to prevent government of Mariano Rajoy from challenging decision as it had done with or social improvements agreed by autonomy.
Several studies point out that adverse effects of co-payment are concentrated on lower-income people. One of m, published in Heart British Medical Journal, alerted that 7% of people who had undergone a first stroke stopped taking, for economic reasons, medication prescribed to avoid a second attack. It may appear that 8.23 euros per month paid by pensioners with income less than 18,000 euros per year, or 18.52 who pay those who exceed that amount, is very little. But for those who can not put heating, turn off light to not spend and buy fruit by pieces, is a lot of money. Shortly after subsidizing co-payment, in Valencia a reduction in rate of rapeutic abandonment was observed.
The same was observed in relation to euro by recipe implemented by Government of Artur Mas in Catalonia in 2012. It was applied to all patients, except for beneficiaries of minimum insertion income, with a limit of 62 euros per year. The measure was in effect only six months, because Constitutional Court cancelled it. At that time, 45.7 million euros were raised and ir "deterrent effect" allowed to save 110 million. But a later study found that a significant part of that savings fell to poorest pensioners, who stopped taking necessary treatments, such as drugs for hypertension or diabetes.
It has not been determined how much complications of se pathologies cost if y are ill-treated, but it is always more expensive to have an income, an amputation or a heart attack than to finance treatment without co-payment. In fact, savings have already been absorbed. The Spanish pharmaceutical bill has returned to previous levels. Instead, adverse social effects are maintained and unfair because y affect poorest and most vulnerable.
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