How the reimbursement system may influence patients’ decisions: Results from focus groups interviews on hypertension,hay-fever and hormone replacement therapy

Abstract

This paper analyzes how patients’ treatment choices are influenced by cost to the patient for three different diseases in France: mild hypertension, hay fever and hormone replacement therapy. Five focus groups of patients were conducted in May/June 1999. We found that cost conscious behaviors were very dependent on patients’ health insurance status, mainly in relation with supplemental insurance. Major shifts of drug treatment decisions differ according to the type of conditions. For hypertensive patients, differences are mainly observed in relation with the timing of prescriptions, the number of packs and the payment method for drugs. For patients with hay fever, main decision shifts are observed in the choice among professionals and the more or less extensive search for different types of therapies. For HRT patients, main differences in decisions concern the number of packs purchased, how often prescriptions are renewed and which drug categories are prescribed. Overall, cost to the patient was a much more important issue for non-drug treatment costs such as the surveillance costs in the case of HRT patients or for costs of exams and referrals in the case of hypertensive patients. Cost minimization strategies in some ways are dependent on the type of anticipations in the long run that patients may have.