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Cost-related non-adherence to prescribed medicines among older adults: a cross-sectional analysis of a survey in 11 developed countries
  1. Steven G Morgan,
  2. Augustine Lee
  1. School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Steven Morgan; steve.morgan{at}


Objectives To assess the effects of costs on access to medicines in 11 developed countries offering different levels of prescription drug coverage for their populations.

Design Cross-sectional study of data from the Commonwealth Fund 2014 International Health Policy Survey of Older Adults.

Setting Telephone survey conducted in 11 high-income countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK and the USA.

Participants 22 532 adults aged 55 and older and living in the community in studied countries.

Primary outcome measure Self-reported cost-related non-adherence (CRNA) in the form of either not filling a prescription or skipping doses within the last 12 months because of out-of-pocket costs.

Results Estimated prevalence of CRNA among all older adults varied from <3% in the France, Norway, Sweden, Switzerland and the UK to 16.8% in the USA. Canada had the second highest national prevalence of CRNA (8.3%), followed by Australia (6.8%). Older adults in the USA were approximately six times more likely to report CRNA than older adults in the UK (adjusted OR=6.09; 95% CI 3.60 to 10.20). Older adults in Australia and Canada were also statistically significantly more likely to report CRNA than older adults in the UK. Across most countries, the prevalence of CRNA was higher among lower income residents and lower among residents over age 65.

Conclusions Observed differences in national prevalence of CRNA appear to follow lines of availability of prescription drug coverage and the extent of direct patient charges for prescriptions under available drug plans.

  • Access to Health Care
  • Drug coverage
  • Health Care Surveys
  • National Health Programs
  • Prescription drugs

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  • Contributors SGM is responsible for study concept and design, interpretation of results and preparation of manuscript. AL assisted with study design, analysis of data, interpretation of results and editing of manuscript for important intellectual content.

  • Funding This work was supported in part by a research grant from the Canadian Institutes of Health Research, Institute of Gender and Health (CIHR DCO150GP), and by the Commonwealth Fund (20160646), a national, private foundation based in New York City.

  • Disclaimer The views presented here are those of the author and not necessarily those of The Commonwealth Fund, its directors, officers, or staff. The funding agency had no role in study design, analysis, or preparation of the paper.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Survey data are available from the Commonwealth Fund. Regression results not reported in the paper are available from the authors.

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