THE IMPACT OF COST-SHARING CHANGES ON PRESCRIPTION ANTIBIOTIC FILL RATES IN CHILDREN WITH OTITIS MEDIA
Bibliographic record
Abstract
From 1975, when the SPDP was initiated, until June 30, 1987, those with STD benefits paid a flat copayment per prescription, with the balance paid by the Province, directly to the pharmacy. On July 1, 1987 the cost-sharing scheme was changed to a deductible plus coinsurance in a nonassignment format. The assignment format returned on January 1, 1989. Children receiving SAP benefits retained first dollar coverage. The objective of the present study was to determine the impact of these changes on prescription antibiotic fill rates for children aged 0 to 14 years, with an otitis media diagnosis in the physician claims data base. Children receiving SAP benefits served as the nonequivalent control group. The hypotheses were: • the changes to STD benefits would have no impact on prescription antibiotic utilization rates in either group, and • stratification of the time series on selected variables would not reveal a statistically significant impact when comparing pre- and post-intervention periods in either population. The study was population-based and quasi-experimental, multiple time series by design. Data were gathered by record linkage of three Saskatchewan Health data bases: MCIB, PDSB, and the HIRF. Analysis included descriptive and interrupted time series analyses. Each population demonstrated a statistically significant decrease (p <0.05) in prescription antibiotic fill rates following the SPDP changes in STD benefits. However, the decrease experienced by the STD population was larger than seen in the SAP population by 2.569 prescriptions per 100 OM episodes. The second set of null hypotheses was rejected in all cases except both levels of Parent type in the SAP group, Specialist level of MD type in the SAP group, and the South level of Location in both SAP and STD groups. Interpopulation differences were found on all categories except Location-South. The STD population consistently demonstrated a decrease, while the SAP population demonstrated no changes or increases in fill rates. Overall the increased cost sharing for the SPDP STD beneficiaries negatively affected the fill rates of a necessary prescribed medication. Those considering increasing the patient cost share of a prescription drug program are cautioned that this may negatively affect the acquisition of necessary medications. This may worsen health outcome, and short-term savings may be offset by long-term expenses. Public program changes should include an evaluation component to facilitate such assessment.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.020 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".