Points of View Public awareness of and interest in the price and system of pharmaceuticals -Report on the Results of the Survey on Public Awareness of Prices, Institutions and Value of Pharmaceuticals, Part 1

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Akiko Yoshida, Senior Researcher, Pharmaceutical Industry Policy Institute

1. Introduction

The public is both the recipient of the value of pharmaceuticals and the supporter of the medical insurance system in Japan, which is based on a universal health insurance system. In order to achieve both "sustainability of universal health insurance" and "promotion of innovation," the "people's viewpoint" is indispensable when examining the price, system, and value of pharmaceuticals.

Although several surveys have been ^{conducted1-5)} on sei-katsu-sha and patients' attitudes toward medical care and pharmaceuticals, it is our recognition that these surveys have yet to analyze the price, system (medical care at the time of consultation, drug prices related to pharmaceuticals, medical insurance system, etc.), and value of pharmaceuticals by distinctive attributes.

Therefore, a web-based questionnaire survey was conducted with the aim of understanding the actual status of the public's awareness and interest in the price, system, and value of pharmaceuticals by various attributes.

This paper presents the results of the survey, which revealed the public's awareness and interest in the price and system of pharmaceuticals, as well as the characteristics of the segments of the population with high awareness and interest.

Survey Methodology

The web-based survey was conducted in the following manner. It should be presented in advance that there are limitations in the characteristics of the survey, such as the fact that the respondents are limited to those who have access to the Internet.

3. respondent demographics 4. survey results (by question)

The main information related to the respondents' attributes is appended at the end of this section.

4. survey results (results of responses to each question)

In this section, a summary of the results shown in Figure 1 will be described for each question.

Cost of receiving prescribed medicine at the pharmacy": "Includes costs other than the cost of the medicine" by 70% of the respondents

First, in order to unravel the respondents' awareness of the price of pharmaceuticals, we asked what their awareness of the cost breakdown was, using the example of when paying at a dispensing pharmacy. The results showed that the highest percentage of respondents (70.6%) answered that the amount they pay when they visit a medical institution and pick up their prescription drugs at a pharmacy "includes costs other than drug costs," followed by "drug costs only" (15.0%) and "don't know" (14.4%). Approximately 70% of respondents indicated that the amount they pay is not only the cost of the medication, suggesting a high awareness of the cost breakdown.

Checking the payment statement": "Always" and "Sometimes" were selected by about 80% of the respondents.

This question also asked about the status of checking payment statements, using the example of payment at a dispensing pharmacy. Payment slips, which list the categories of technical fees, drug fees, etc., and the names of drugs along with their unit prices and quantities, are fully ^mandatory6) for insurance pharmacies to issue. The results of the survey showed that 44.0% of the respondents "always check" the statement of payment when receiving prescribed drugs at the pharmacy after visiting a medical institution, and together with 34.4% who "sometimes check" the statement of payment, approximately 80% (78.4%) of the respondents were highly conscious of the cost breakdown.

Comparing the awareness of drug costs between the groups with high and low awareness of cost breakdown, it was found that the group with high awareness of cost breakdown had a higher percentage of respondents who checked the payment statement, indicating a higher awareness of drug costs. (Figure 2)

Reasons why about 80% of respondents check payment statements (multiple answers)

Next, approximately 80% of respondents were asked why they check payment statements. In descending order of percentage, 59.2% responded, "To get a breakdown of what I am paying for," 44.4% responded, "To understand the type of drug (name, brand name, generic) and quantity," 32.6% responded, "To check the difference in payment amount from the previous (or previous) visit," 13.8% responded, "I am not interested, but I look through it somehow," and 13.8% responded, "To check the cost of the drug. 13.8% of the respondents chose "to check the amount" and 1.8% chose "because I was asked to do so.

Reasons why about 20% of respondents do not check their payment statements (multiple responses)

Next, about 20% of respondents (21.7% who answered either "have not checked (have checked)" or "have never checked") were asked why they do not check their payment statements. In descending order of percentage, 34.9% responded, "I thought it was incomprehensible even if I looked at it (I did not understand what was written)," 28.1% responded, "It does not affect me and I feel it is not necessary to look at it," 20.5% responded, "I do not feel the need to check it because the price is always the same," and "I check the name and amount of the medicine in my medicine notebook, so I do not feel the need to check it otherwise. 20.5% said "I don't feel the need to check it because it is always the same price," 20.5% said "I don't feel the need to check it because it is always the same price," and 5.0% said "I don't want to look at it because the text is too small and difficult to read.

The reason why respondents check their payment slips more often: "When there is a change in my prescriptions" (more than 50% of respondents)

Next, when all respondents were asked, "What would make you more likely to check your payment slip than now?" the highest response was "When there is a change in your prescription (occasion, type, amount of medication received, or amount paid)" at 53.4%, followed by "When the contents of the payment slip and how to view it are The next highest response was "When there is a change in the way your prescription is written (easier to understand, larger, etc.)" at 33.5%, followed by "When there is an explanation of the contents or how to read the payment slip" at 33.5%, "When there is a change in the way the payment slip is written (easier to understand, larger, etc.)" at 32.8%, and "No increase from now" at 16.4%.

Awareness that medical expenses are covered by medical insurance premiums and taxes: More than 70% of the respondents were "well informed" or "fairly well informed.

Next, in order to unravel attitudes toward the price of pharmaceuticals from the perspective of the medical insurance system, we asked respondents about their attitudes toward costs other than payment at the dispensing pharmacy counter. The results showed that the highest percentage of respondents (50.3%) were "fairly familiar" with the fact that "costs other than the amount you pay at the pharmacy (co-payment) are covered by medical insurance premiums (health insurance system, national health insurance system, etc.) and taxes," followed by "familiarity" (23.9%) and "awareness" (74%). The results showed that more than 70% (74.2%) of the respondents were aware of the medical insurance system, followed by 23.9% who were "familiar with it".

Interest in costs other than over-the-counter co-payments: "Very much" and "Fairly much" at about 80%.

When asked if they would like to know more about the contents of the previous question (how costs other than the amount you pay (co-pay) are covered when you visit a medical institution or receive medicine prescribed by a medical institution at a pharmacy), 64.7% of the respondents answered "somewhat interested" and 12.7% answered "very interested. When asked if they would like to know more about the cost of medical insurance, 64.7% responded "somewhat interested," followed by 12.7% who responded "very interested," indicating that a total of approximately 80% (77.4%) are interested in the costs other than the co-payment at the hospital counter.

In addition, a higher percentage (84.8%) of the group with higher awareness of the medical insurance system were interested in costs other than co-payments, suggesting that higher awareness also means higher interest. (Figure 3)

Awareness of the level of medical insurance premiums": More than 50% "know much" and "know fairly well".

This question asked about the extent to which you yourself pay medical insurance premiums (i.e., how much (percentage or amount) you pay for medical insurance premiums relative to your or your family's salary). The highest percentage of 43.3% were "fairly aware," and together with 11.3% who were "well aware," more than 50% (54.6%) were aware of the amount of medical insurance premiums they pay out-of-pocket.

Awareness of the new drug access mechanism": "Did not know" at 70%.

Next, in order to unravel their awareness of drug prices and the system, we asked what their awareness of the drug pricing system is. The highest percentage of 61.9% of respondents said that they "did not know but think it is a good system" that almost all approved new drugs become available for use with insurance at an early stage in Japan, followed by 24.9% who "knew but think it is a good system," 7.7% who "did not know but do not see the need for it as a system," and 7.7% of respondents answered "Did not know, but do not see the need for it as a mechanism," and 5.5% answered "Knew, but do not see the need for it as a mechanism. Approximately 70% (69.6%) of respondents were not aware of the new drug access mechanism.

Awareness of the fact that NHI prices are fixed prices": 60% of respondents "did not know.

This question asked about the fact that in Japan, drug prices are "official prices and are determined by the government, not by individual companies." The results showed that 60.5% of the respondents were not aware of this and 39.5% were aware of it. It was found that approximately 60% of respondents were unaware that NHI prices are officially fixed prices. This result is not significantly different from the result of a survey conducted by the Pharmaceutical Manufacturers Association of ^Japan7) (68.2% of respondents answered "did not know").

Reasons why about 40% of respondents knew "NHI prices are fixed prices" (multiple answers)

When the 40% of respondents who knew that "official drug prices are fixed prices" were asked why, 48.2% said they "saw it on TV or in books," 16.0% said they "don't remember where I learned about it," 15.1% said they "had heard about it from others," 14.4% said they "had an opportunity to learn about it at school or other places," and 13.2% said they "looked it up on my own. (Figure 4). (Figure 4) In the free response column, many respondents answered that they learned about it through their work experience as clerks at medical institutions and dispensing pharmacies.

Interest in how NHI drug prices are determined": 70% of respondents were "very interested" or "somewhat interested.

The survey asked respondents about their interest in how NHI drug prices are determined, how the value of new drugs is reflected, how NHI drug prices are revised, and how prices of generics are determined. The results are presented in the order of the questions.

Interest in the way NHI prices are determined for new drugs": "Very much" and "Fairly much" (70%)

The "Fairly interested" response was the most common (57.8%), and together with the "Very interested" response (10%), approximately 70% (67.8%) were interested in the "method of determining the NHI price of new drugs.

Interest in how the value of new drugs is reflected

The "Fairly interested" response was the highest at 58.7%, and together with the "Fairly interested" response (10.9%), approximately 70% (69.6%) were interested in how the value of new drugs is reflected.

The results also showed that those who "knew" that NHI prices are "official prices and are determined by the government, not by individual companies" were more interested in the way NHI prices are determined. Figure 5 shows an example of "how the value of new drugs is reflected," but the same trend was observed for "how NHI prices of new drugs are determined," "how NHI prices are revised," and "how NHI prices of generics are determined.

Interest in how NHI drug prices are revised

The "Fairly interested" response was the highest at 55.7%, and together with the "Fairly interested" response of 10%, approximately 70% (65.7%) of the respondents were interested in the "NHI drug price revision process.

Interest in how NHI prices for generics are determined

The "Fairly interested" response was the highest at 57.2%, and together with the "Fairly interested" response of 15.8%, over 70% (73.0%) of the respondents were interested in "how NHI prices for generics are determined.

More than 70% of respondents wanted to know more about how NHI drug prices are determined (multiple responses).

Next, when asked if they would like to know more about how NHI drug prices are determined, over 70% of the respondents who answered "yes" (74.2% in total for "very much" and "fairly much") were asked why they would like to know more. In descending order of percentage of responses, 41.6% responded "Because I want to know if the national burden (co-payments, etc.) is being reduced," 37.6% "Because I am simply interested in how the value of drugs is evaluated," and 37.6% "Because the price of drugs is covered by universal health insurance, and as a member of the public I think it should be my business in terms of the sustainability of universal health insurance. 37.4% "Because I think it should be my own matter as a citizen from the viewpoint of the sustainability of universal health insurance", 36.3% "Because I think I can receive medical care more voluntarily if I know how it is decided", 31.1% "Because I want to know if the system encourages the creation of new drugs (original drugs) that contribute to people's life and health", and 37.4% "Because I have more chances to take medicines/will have more chances to take medicines". I want to know because my chances of taking medicines have increased/will increase" at 29.5%, and "because I have become more aware of the importance of medical care and medicines due to the Corona epidemic" at 22.0%.

Reasons why slightly less than 30% of respondents do not want to know more about how NHI drug prices are determined (multiple responses)

Next, we asked the more than 30% of respondents who did not want to know more about how drug prices are determined ("Not very much" and "Not at all," a total of 25.8%) why they did not want to know more. In descending order of percentage of responses, 40.6% said, "Even if I know how the decision is made, I don't think it will reflect my opinion," 24.5% said, "I don't know much about drugs in the first place," 24.3% said, "Since drugs are prescribed by doctors, I don't think it will benefit me if I know how the decision is made," and "I don't think it would be better if the government decides, like now. 24.5% answered "Because I don't know much about medicines in the first place," 24.5% answered "Because I don't think it would be beneficial for me to know how to determine the price of medicines since doctors prescribe them," 24.3% answered "Because I think the government should determine the price," 21.2% answered "Because I want to obtain general knowledge and correct information about medicines first," 18.3% answered "Because I am not interested in medicines themselves," and 13.7% answered "Because I rarely receive a prescription for medicines or have opportunities to take medicines. The "Because I am not interested in the medicine itself" was selected by 18.3% of the respondents.

5) Characteristics of Attributes of the Highly Conscious and Interested Groups

In the previous section, we overviewed the respondents' awareness of and interest in the price and system of drugs. In this section, we will analyze the characteristics of the attributes of the respondents with high awareness and interest. The respondents who answered the questions shown in Table 2 were classified as the group with high awareness and interest in the price of pharmaceuticals or in the system.

The percentage of each category for each attribute (Table 3) was calculated for each of these groups with high awareness and interest, and if the percentage was 3% higher than the overall attribute, the group with high awareness was considered to have a characteristic in that attribute category. However, if the percentage was not 3% higher than the overall percentage, but was still higher, and if the percentage of the group with low awareness and interest was more than 3% lower than the overall percentage, the attribute was considered to be characteristic of that group. The results are shown in Table 4.

The groups with higher awareness of the cost breakdown and drug costs were those who responded "high medical burden," "high sense of medical cost burden," and "high level of perceived health" at higher percentages than the overall group. The percentage of respondents who were interested in the medical insurance system and costs other than their own and who were aware of the amount of out-of-pocket costs for medical insurance premiums was higher than the total among those who answered "high age," "large medical cost burden," and "high subjective health," respectively. The percentages of respondents who expressed interest in the way drug prices are determined were higher than the total for the groups of "older age," "unemployed," "have family members in need of care," "receive medical care or have a disease," "have a large medical cost burden," "have a large medical cost burden," and "have a high level of subjective health. The percentages were higher than the total among respondents in the "older age," "receiving medical examinations/illnesses," and "high medical cost burden" groups for the mechanisms for access to new drugs and awareness that drug prices are fixed at official prices. In addition, a higher percentage than the overall respondents answered that they had a "high level of final education" for many of the questions.

As described above, the attributes of the group with high awareness of prices and systems were commonly characterized by the following attribute categories: "older age," "unemployed," "highest level of final education," "have family members in need of care," "have medical examinations and diseases," "have high medical cost burden," "have high awareness of medical cost burden," and "have high subjective health level.

The robustness of the results for the analysis by attribute for the high awareness and interest group was confirmed by multiple regression analysis using a linear probability model (taking 1 for high awareness and interest and 0 for low awareness and interest) (Table 5). The characteristics of the attributes that were statistically significant are shown in Table 5, which confirms that the results are generally consistent with those in Table 4. Consistent results are highlighted in orange. Many of the "high age" attributes that were frequently mentioned as characteristics of attributes in Table 4 were not statistically significant in Table 5. This may be due to the fact that the confounding factors between "age" and attitudes and interests, such as "see a doctor or have a disease," "have a high medical cost burden," and "have a high sense of medical cost burden," were taken into account in the multiple regression analysis, which may have reduced the influence of "age. The VarianceInflation Factor (VIF) in the regression analysis was well below 10, confirming that multicollinearity is a low concern.

The "perceived health" is the health status of the respondents, regardless of whether or not they had received a medical examination. We explored which attribute categories of "high subjective health," which was mentioned as a common attribute characteristic, were more common in other attributes. Using the total population (2,018 cases) as the population, we conducted a crosstabulation among the attributes, extracted the attribute categories that were 3% higher than the overall percentage, and inferred a trend in characteristics for each attribute category. In addition, as before, multiple regression analysis using a linear probability model was used to confirm the robustness of the results. The characteristics of the attributes that were statistically significant as a result are also shown in Table 6. In addition to the characteristics of "no medical visits or diseases" and "small medical cost burden" (Figure 6), which were indicated by attribute categories that were 3% higher than the overall percentage, the results also showed the characteristics of "high final education level," "high annual household income," and "small medical cost burden.

Finally, a characteristic analysis of attribute categories with high perceived health and high awareness and interest was conducted. Table 7 shows the characteristics of the attributes that were statistically significant through multiple regression analysis using a linear probability model. A higher percentage of respondents in the "female" and "small medical cost burden" groups had a higher awareness of the cost breakdown and drug costs than the overall group. A higher percentage of respondents in the "highest last level of education" group than the total respondents were interested in the medical insurance system and costs other than co-payments, were aware of the amount of co-payments for medical insurance premiums, and were interested in the way drug prices are determined.

The above results indicate that the attribute categories with high levels of health awareness and interest tend to be "women" and "those with the highest level of education".

6. summary

From the results of the "Survey on the Price, System, and Value of Pharmaceuticals," we have examined the characteristics of the segments with high awareness of and interest in the price and system of pharmaceuticals. Although awareness of the fact that drug prices are fixed prices is not sufficient, the level of awareness and interest is generally high, at 70%.

The characteristics of the attributes of the group with high awareness and interest include "older age," "unemployed," "higher final education level," "have family members in need of care," "have a current medical consultation or disease," "have a high medical cost burden," "have a high sense of medical cost burden," and "have a high level of perceived health. However, many of the "high age" attributes that were frequently cited as characteristics of attributes were not confirmed to be statistically significant. Age may be a confounding factor for other factors, such as "receiving medical examinations and having diseases," "high medical cost burden," and "high sense of medical cost burden. Thus, rather than "older age," the following factors were more likely to explain the group's high awareness of and interest in pharmaceutical prices and systems: "having medical examinations and diseases," "high medical cost burden," "high awareness of medical cost burden," "unemployed," "having family members in need of care," "high final education level," "having family members in need of care," and "high subjective health level, The importance of these factors was inferred. The "High last level of education" segment has a longer period of education and may have a greater desire for knowledge, but there is room for further investigation as to which segment it belongs to.

In addition to "high last level of education," which is common to the characteristics of the attributes of the group with high level of awareness and interest, "high annual household income," "no medical examinations or diseases," "small medical cost burden," and "small sense of medical cost burden" were identified as characteristics of the attributes of the group with high level of self-rated health. While the group with high self-rated health was cited as a group with high awareness and interest, this group was characterized by "no medical examinations or diseases" and "small medical cost burden" and low direct involvement in medical care. It can also be inferred that there is a segment with low "awareness of medical cost burden" and high "household income. It was also suggested that the group with high level of subjective health is not completely identical to the group with high awareness and interest (Figure 7)

Characteristic analysis of the attribute segments with high subjective health and high awareness and interest indicated that the segments with high awareness and interest and high subjective health tended to be "female" and "highest level of final education". It can be inferred that segments with high awareness and interest as well as high subjective health may have high health literacy, and further segment identification and characteristics analysis are needed.

From the reasons for checking payment statements, it was found that most of the respondents checked them to understand the cost breakdown, the type of drug (name, difference between brand-name and generic drugs), and the quantity, indicating their interest in the cost breakdown and other information. On the other hand, inability to understand the contents of the statement is sometimes the reason for not checking the payment statement, indicating that if they could understand the explanation and contents, it would trigger them to check the payment statement and may increase their awareness. The importance of promoting explanations and understanding based on those explanations was highlighted, including for those who do not voluntarily want to check the statements (i.e., they are not interested in them, but are looking through them somehow, or they were told to check them). In addition, the largest percentage of respondents were more likely to be triggered to check payment statements when there was a change in their own prescriptions (occasion, type, and amount of medication received and paid for), indicating that increased involvement in health care may increase awareness and interest even among those who are currently less involved in health care, primarily in younger age groups. It can be said that one of the starting points for increased awareness and interest is a deepening of one's own "understanding" and an increase in "involvement in medical care.

As shown in Figures 2, 3, and 5, those with higher awareness of the cost breakdown had higher awareness of drug costs, those with higher awareness of the medical insurance system were more interested in costs other than co-pays, and those who knew that drug prices were officially set prices were more interested in how drug prices were determined. In other words, since those with higher awareness and interest in prices and the system were more interested in wanting to know more, etc., it was hoped that increasing knowledge, awareness, etc., of prices and the system might increase awareness.

Conclusion

Health literacy is generally defined as the ability to find and understand health-related information, use it in decision-making, and take appropriate health ^actions8). It is known that people with high health literacy are more likely to take appropriate health actions, and as a result, are less likely to suffer from diseases, or if they do suffer from diseases, they are less likely to become seriously ill. In addition, the effects of improving health literacy are expected to lead to the maintenance of health and prevention of disease. Increasing health literacy may be important in advancing discussions regarding the price of drugs, the system (e.g., medical care at the point of care, drug prices and medical insurance systems related to drugs, etc.), and value.

Acknowledgments

The authors would like to express their deepest gratitude to Director Nagaoka for his appropriate advice and careful guidance in the preparation of this paper. I am grateful to Visiting Researcher Nishimura, Supervisory Research Fellow Iida, Supervisory Research Fellow Ito, Senior Research Fellow Okada, and Senior Research Fellow Miura for their detailed advice in conducting the research and analysis. We would like to express our gratitude to them.

In addition, we thank Mr. Tone of Intage Healthcare, Inc. for his cooperation in the survey. 3.

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