Out of pocket or out of control: A qualitative analysis of healthcare professional stakeholder involvement in pharmaceutical policy change in Ireland

O'Brien, Gary L.; Sinnott, Sarah-Jo; O'Flynn, Bridget; Walshe, Valerie; Mulcahy, Mark; Byrne, Stephen

Out of pocket or out of control: A qualitative analysis of healthcare professional stakeholder involvement in pharmaceutical policy change in Ireland

dc.contributor.author	O'Brien, Gary L.
dc.contributor.author	Sinnott, Sarah-Jo
dc.contributor.author	O'Flynn, Bridget
dc.contributor.author	Walshe, Valerie
dc.contributor.author	Mulcahy, Mark
dc.contributor.author	Byrne, Stephen
dc.contributor.funder	Irish Research Council	en
dc.date.accessioned	2020-03-05T12:07:37Z
dc.date.available	2020-03-05T12:07:37Z
dc.date.issued	2020-02-28
dc.date.updated	2020-03-05T11:59:29Z
dc.description.abstract	Background: Mandatory co-payments attached to prescription medicines on the Irish public health insurance [General Medical Services (GMS)] scheme have undergone multiple iterations since their introduction in October 2010. To date, whilst patients’ opinions on said co-payments have been evaluated, the perspectives of community pharmacists and general practitioners (GPs) have not. Objective: To explore the involvement and perceptions of community pharmacists and GPs on this pharmaceutical policy change. Methods: A qualitative study using purposive sampling alongside snowballing recruitment was used. Nineteen interviews were conducted in a Southern region of Ireland. Data were analysed using the Framework Approach. Results: Three major themes emerged: 1) the withered tax-collecting pharmacist; 2) concerns and prescribing patterns of physicians; and 3) the co-payment system – impact and sustainability. Both community pharmacists and GPs accepted the theoretical concept of a co-payment on the GMS scheme as it prevents moral hazard. However, there were multiple references to the burden that the current method of co-payment collection places on community pharmacists in terms of direct financial loss and reductions in workplace productivity. GPs independently suggested that a co-payment system may inhibit moral hazard by GMS patients in the utilisation of GP services. It was unclear to participants what evidence is guiding the GMS co-payment fee changes. Conclusion: Interviewees accepted the rationale for the co-payment system, but reform is warranted.	en
dc.description.sponsorship	Irish Research Council (GOIPG/2016/635)	en
dc.description.status	Peer reviewed	en
dc.description.version	Accepted Version	en
dc.format.mimetype	application/pdf	en
dc.identifier.citation	O'Brien, G. L., Sinnott, S.-J., O'Flynn, B., Walshe, V., Mulcahy, M. and Byrne, S. (2020) 'Out of pocket or out of control: A qualitative analysis of healthcare professional stakeholder involvement in pharmaceutical policy change in Ireland', Health Policy. doi: 10.1016/j.healthpol.2020.02.011	en
dc.identifier.doi	10.1016/j.healthpol.2020.02.011	en
dc.identifier.issn	0168-8510
dc.identifier.journaltitle	Health Policy	en
dc.identifier.uri	https://hdl.handle.net/10468/9724
dc.language.iso	en	en
dc.publisher	Elsevier B.V.	en
dc.relation.uri	http://www.sciencedirect.com/science/article/pii/S0168851020300464
dc.rights	© 2020, Elsevier B.V. All rights reserved. This manuscript version is made available under the CC BY-NC-ND 4.0 license.	en
dc.rights.uri	https://creativecommons.org/licenses/by-nc-nd/4.0/	en
dc.subject	General medical services	en
dc.subject	Co-payment	en
dc.subject	Framework analysis	en
dc.subject	Health policy	en
dc.subject	Community pharmacy	en
dc.subject	Primary care	en
dc.title	Out of pocket or out of control: A qualitative analysis of healthcare professional stakeholder involvement in pharmaceutical policy change in Ireland	en
dc.type	Article (peer-reviewed)	en