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Reduced user fees for antibiotics under age 5 in Hungary: Effect on antibiotic use and imbalances in the
1Health and Population "Momentum" Research Group at the Institute of Economics, Centre for Economic and Regional Studies of the Hungarian Academy of Sciences, Budapest, Hungary.
Insights
Hungary
Area of Science:
- Health Economics
- Pharmaceutical Policy
- Pediatric Prescribing Practices
Background:
- New prescription guidelines were implemented in Hungary in August 2016 to reduce antibiotic co-payments for children aged 0-4.
- The policy aimed to improve affordability and access to antibiotics for young children.
Purpose of the Study:
- To analyze the implementation and spatial variation of the new antibiotic prescription guidelines in Hungary.
- To assess the impact of reduced co-payments on antibiotic consumption among children.
Main Methods:
- Utilized administrative prescription data from January 2010 to February 2018 for the Hungarian population aged 0-7.
- Employed spatial autocorrelation indices and settlement-level regression models to analyze spatial variations.
- Applied a difference-in-differences model comparing children aged 0-4 (treatment) with those aged 5-7 (control).
Main Results:
- Guideline adoption was higher in wealthier areas with lower unemployment and showed spatial clustering.
- A 10-15% decrease in out-of-pocket antibiotic costs correlated with a 5% increase in consumption (95% CI: 2.63%-7.55%).
Conclusions:
- Selective adoption of guidelines, possibly influenced by physician networks, occurred without strong enforcement, undermining affordability goals for disadvantaged children.
- Antibiotic use in young children is sensitive to price subsidies, indicating policy effectiveness but highlighting implementation challenges.
Objectives:
In August 2016, new prescription guidelines were introduced in Hungary to reduce the co-payments for antibiotics among children aged 0-4. This study aims at analysing the implementation of this policy and its effect on the use of antibiotics.
Methods:
The analysis is based on administrative prescription records between January 2010-February 2018, covering the entire population of Hungary aged 0-7. Spatial autocorrelation indices are calculated and settlement level regression models are estimated to analyse the spatial variation in the application of the new guidelines. The effect of reduced co-payments on antibiotic use is estimated with a difference-in-differences type model: the treatment and control groups are children aged 0-4 and 5-7, respectively; the treatment and control periods are August 2016-February 2018 and January 2010-July 2016, respectively.
Results:
The new prescription guidelines are more widely applied in settlements with higher per capita income and lower unemployment rate. Adherence to the new guidelines is spatially clustered. A 10-15% decrease in the out-of-pocket costs of antibiotics is estimated to increase the consumption of antibiotics by about 5% (95% CI: 2.63%-7.55%).
Conclusions:
In the absence of clear enforcement mechanisms, the adoption of the new prescription guidelines is selective, contradicting the aims of the policy of making antibiotics affordable for the poor children. The results point to the possible role of physicians' information networks in the application of prescription guidelines. The use of antibiotics among children aged 0-4 is responsive to the price subsidy of antibiotics.
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