Cochrane · systematic review · CD007017
Pharmaceutical policies: effects of cap and co‐payment on rational use of medicines
Luiza, VL, Chaves, LA, Silva, RM, et al. · Cochrane Database of Systematic Reviews · 2015 · Cochrane Library
Effective Practice and Organisation of CareAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
78
current version
GRADE rated
30
No studies
48
Included studies
NR
No studies 48 · 61.5%Ungraded 0 · 0%Very low 8 · 10.3%Low 20 · 25.6%Moderate 2 · 2.6%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Caps
Population: vulnerable and general populations
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Medicine use | no estimate extracted | NR | No studies |
Overall use of medicines | no estimate extracted | NR | Low Downgraded: imprecision, publication bias |
Use of medicines for symptomatic conditions | no estimate extracted | NR | Low Downgraded: imprecision, publication bias |
Use of medicines for asymptomatic conditions | no estimate extracted | NR | No studies |
Cost | no estimate extracted | NR | No studies |
Patient perspective | no estimate extracted | NR | No studies |
Insurer perspective (expenditures on medicines) | no estimate extracted | NR | Low Downgraded: imprecision, publication bias |
Insurer perspective (expenditures on health care) | no estimate extracted | NR | No studies |
Healthcare utilisation | no estimate extracted | NR | No studies |
Overall healthcare utilisation | no estimate extracted | NR | No studies |
Emergency department and hospitalisation | no estimate extracted | NR | Very low Downgraded: imprecision, publication bias |
Outpatient care | no estimate extracted | NR | Very low Downgraded: imprecision, publication bias |
Health outcomes | no estimate extracted | NR | No studies |
Caps with co‐insurance and ceiling
Population: vulnerable population: senior 65 years of age or older
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Medicine use | no estimate extracted | NR | No studies |
Overall use of medicines | no estimate extracted | NR | Low |
Use of medicines for symptomatic conditions | no estimate extracted | NR | Low |
Use of medicines for asymptomatic conditions | no estimate extracted | NR | Low |
Cost | no estimate extracted | NR | No studies |
Patient perspective | no estimate extracted | NR | Low |
Insurer perspective (expenditures on medicines) | no estimate extracted | NR | No studies |
Insurer perspective (expenditures on health care) | no estimate extracted | NR | No studies |
Healthcare utilisation | no estimate extracted | NR | No studies |
Overall healthcare utilisation | no estimate extracted | NR | No studies |
Emergency department and hospitalisation | no estimate extracted | NR | No studies |
Outpatient care | no estimate extracted | NR | No studies |
Health outcomes | no estimate extracted | NR | No studies |
Fixed co‐payment
Population: seniors and general population
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Medicine use | no estimate extracted | NR | No studies |
Overall use of medicines | no estimate extracted | NR | Very low Downgraded: risk of bias |
Use of medicines for symptomatic conditions | no estimate extracted | NR | Low Downgraded: risk of bias |
Use of medicines for asymptomatic conditions | no estimate extracted | NR | Low Downgraded: risk of bias |
Cost | no estimate extracted | NR | No studies |
Patient perspective | no estimate extracted | NR | No studies |
Insurer perspective (expenditures on medicines) | no estimate extracted | NR | Low Downgraded: risk of bias |
Insurer perspective (expenditures on health care) | no estimate extracted | NR | No studies |
Healthcare utilisation | no estimate extracted | NR | No studies |
Overall healthcare utilisation | no estimate extracted | NR | No studies |
Emergency department and hospitalisation | no estimate extracted | NR | No studies |
Outpatient care | no estimate extracted | NR | No studies |
Health outcome | no estimate extracted | NR | No studies |
Tier with fixed co‐payment
Population: vulnerable population (retirees and low income)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Medicine use | no estimate extracted | NR | No studies |
Overall use of medicines | no estimate extracted | NR | Low Downgraded: imprecision, inconsistency |
Use of medicines for symptomatic conditions | no estimate extracted | NR | Low Downgraded: imprecision, inconsistency |
Use of medicines for asymptomatic conditions | no estimate extracted | NR | Low Downgraded: imprecision, inconsistency |
Cost | no estimate extracted | NR | No studies |
Patient perspective | no estimate extracted | NR | No studies |
Insurer perspective (expenditures on medicines) | no estimate extracted | NR | No studies |
Insurer perspective (expenditures on health care) | no estimate extracted | NR | No studies |
Healthcare utilisation | no estimate extracted | NR | No studies |
Overall healthcare utilisation | no estimate extracted | NR | No studies |
Emergency department and hospitalisation | no estimate extracted | NR | Very low Downgraded: imprecision, inconsistency |
Outpatient care | no estimate extracted | NR | Very low Downgraded: imprecision, inconsistency |
Health outcomes | no estimate extracted | NR | No studies |
Ceiling with fixed co‐payment
Population: low‐income/general population
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Medicine use | no estimate extracted | NR | No studies |
Overall use of medicines | no estimate extracted | NR | Low Downgraded: risk of bias |
Use of medicines for symptomatic conditions | no estimate extracted | NR | Low Downgraded: risk of bias |
Use of medicines for asymptomatic conditions | no estimate extracted | NR | Low Downgraded: risk of bias |
Cost | no estimate extracted | NR | No studies |
Patient perspective | no estimate extracted | NR | No studies |
Insurer perspective (expenditures on medicines) | no estimate extracted | NR | Very low Downgraded: risk of bias |
Insurer perspective (expenditures on health care) | no estimate extracted | NR | No studies |
Healthcare utilisation | no estimate extracted | NR | No studies |
Overall healthcare utilisation | no estimate extracted | NR | No studies |
Emergency department and hospitalisation | no estimate extracted | NR | Low Downgraded: risk of bias |
Outpatient care | no estimate extracted | NR | Low Downgraded: risk of bias |
Health outcomes | no estimate extracted | NR | No studies |
Ceiling with co‐insurance
Population: general population
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Medicine use | no estimate extracted | NR | No studies |
Overall use of medicines | no estimate extracted | NR | Moderate Downgraded: risk of bias, imprecision, indirectness |
Use of medicines for symptomatic conditions | no estimate extracted | NR | Low Downgraded: risk of bias, imprecision, indirectness |
Use of medicines for asymptomatic conditions | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, indirectness |
Cost | no estimate extracted | NR | No studies |
Patient perspective | no estimate extracted | NR | No studies |
Insurer perspective (expenditures on medicines) | no estimate extracted | NR | Moderate Downgraded: risk of bias, imprecision, indirectness |
Insurer perspective (expenditures on health care) | no estimate extracted | NR | No studies |
Healthcare utilisation | no estimate extracted | NR | No studies |
Overall healthcare utilisation | no estimate extracted | NR | No studies |
Emergency department and hospitalisation | no estimate extracted | NR | Low Downgraded: risk of bias, imprecision, indirectness |
Outpatient care | no estimate extracted | NR | Very low Downgraded: risk of bias, imprecision, indirectness |
Health outcomes | no estimate extracted | NR | No studies |