Is Access Sufficient? An Examination of the Effects of the MedShare Program to Expand Access to Prescription Drugs for Indigent Populations

Abstract

We conduct an evaluation of MedShare, a program designed to enhance access to prescription drugs for indigent patients in the Greater Cincinnati area. The program expands access to drugs by providing subsidies to reduce the costs paid by patients for their prescriptions. The assumption is that by expanding access to prescription drugs, participant health outcomes as measured by quality of life improve. Although the program appears outwardly successful, we found little difference between program participants and comparison groups. We feel that these findings point to a major flaw with existing health policy: access alone is not sufficient to improve health outcomes. Too often programs are created and, provided they show outwards signs of success (e.g., enrollment and utilization), are assumed to be improving the health of the community. Our findings indicate that one must look beyond just expanding access to ensure that programs are indeed achieving their overall objectives.

Keywords

health prescriptions evaluation policy access

Get full access to this article

View all access options for this article.

References

Anderson, R. (1995). Revisiting the behavioral model and access to care: Does it matter? Journal of Health and Social Behavior , 36, 1-10.

Bingham, R.D. , & Felbinger, C.L. (2002). Evaluation in practice (2nd ed.). New York: Seven Bridges Press.

Bowling, A. (1997). Measuring health, a review of quality of life measurement scales. Philadelphia: Open University Press.

D' Agostino, R.B. (1998). Tutorial in biostatistics, propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Statistics in Medicine, 17, 2265-2281.

Ensor, T. , & Cooper, S. (2004). Overcoming barriers to health service access: Influencing the demand side. Health Policy and Planning, 19, 69-79.

Freiman, M.P. (1998). The demand for health care among racial/ethnic subpopulations. Health Services Research, 34 (1, Part II), 215-227.

Hamilton, L.C. (1992). Regression with graphics. Belmont, CA: Doxbury Press.

Hardy, M. (1993). Regression with dummy variables. Thousand Oaks, CA: Sage.

Institute of Medicine. (2001). Coverage matters, insurance and health care. Washington, DC: National Academies Press.

10.

Institute of Medicine. (2002). Unequal treatment: Confronting racial and ethnic disparities in health. Washington, DC: National Academies Press.

11.

Parsons, L.S. (2000). Using SAS software to perform a case-control match on propensity score in an observational study. Poster 225-25 presented at the SAS Users Group International Conference in Indianapolis, IN.

12.

Robert, S. (1999). Socioeconomic position and health: The independent contribution of community socioeconomic context. Annual Review of Sociology, 25, 489-516.

13.

Schlenk, E.A. , Erlen, J.A. , Dunbar-Jacob, J. , McDowell, J. , Engberg, S. , Sereika, S.M. , et al. (1997). Health-related quality of life in chronic disorders: A comparison across studies using the MOS SF-36. Quality of Life Research, 7, 57-65.

14.

Shi, L. , & Singh, D.A. (2004). Delivering health care in America, a systems approach . Sudbury, MA: Jones and Bartlett Publishers.

15.

Spector, P. (1981). Research designs. Thousand Oaks, CA: Sage.