Search results

Over the last two to three decades, European welfare states have witnessed fundamental changes in both family and labour market structures with many more women being in the paid labour market. While this was seen to address previous problems linked to women’s disadvantage, it has also been argued to give rise to new risk and social inequalities, including falling fertility rates and increasing childlessness. Research has identified the lack of affordable childcare as a key factor in childlessness leading to a strong EU focus on early childhood education and care. Since 2000, the EU has played a more proactive role in policies and initiatives aimed to address decreasing fertility rates with greater pressure for convergence among member states. However, there has continued to be a large degree of variation between countries. This chapter thus examines the case of Germany which has one of the highest levels of childlessness in Europe. It focuses on the intersection between childlessness and childcare provision in Germany and analyses the existing childcare arrangements with a view to understand how they influence childlessness. Particular attention is given to the role of the German government as the main actor in the process to explore ideology-related explanations of German policy-makers which led to contradictory policies. Relying on an extensive review of the related literature and policy documents, together with the personal interviews with policy-makers, academics and women’s organisations, this chapter concludes that the relatively conservative outlook of the German government which prioritises the motherhood and caregiver role, and the dominance of the corporate welfare system, has limited developments to improve access to childcare resulting in ‘a culture of childlessness’ in Germany (Kreyenfeld & Konietzka, 2017).

Purpose – The purpose of this study is to estimate the own- and cross-price elasticity of brand-name outpatient prescription drug cost-sharing for maintenance medications and to estimate the effects of changes in the price differential between generic and brand-name prescription drugs.

Methodology/approach – We first review the literature on the effects of an increase in brand-name drug patient cost-sharing. In addition, we analyze two examples of utilization patterns in filling behavior associated with an increase in brand-name cost-sharing for patients in employer-sponsored health plans with chronic illness.

Findings – We found that the own-price elasticity of demand for brand-name prescription drugs was inelastic. However, the cross-price elasticity was not consistent in sign, and utilization patterns for generic prescription fills did not always increase after a rise in brand-name cost-sharing.

Research limitations – The empirical examples are limited to the experience of patients with employer-sponsored health insurance.

Practical implications – The common practice of increasing brand-name prescription drug patient cost-sharing to increase consumption of generic drugs may not always result in higher generic medication use. Higher brand-name drug cost-sharing levels may result in discontinuation of chronic therapies, instead of therapeutic switching.

Originality/value of chapter – The value of this chapter is its singular focus on the effects of higher brand-name drug cost-sharing through a synthesis of the literature examining the own- and cross-price elasticity of demand for brand-name medications and two empirical examples of the effects of changes in brand-name cost-sharing.

Purpose – The authors focus on understanding the relationship between costs and cost sharing on medication adherence for individuals who initiated a disease-modifying therapy (DMT) for the treatment of multiple sclerosis (MS). DMTs reduce the risk of relapse and are an essential component of MS treatment. Furthermore, the authors compare monthly payment levels for copayments versus coinsurance and estimate the effects on adherence.

Methods – Using the MarketScan Commercial Claims and Encounters database evidence from July 1 2005 to March 31 2008, the authors employ a multivariate two-stage least-squares model (2SLS) to examine the impact of copayments or coinsurance on the medication possession ratio (MPR).

Findings – Descriptive results show that the mean out-of-pocket (OOP) costs of DMT per month were higher for patients with coinsurance than for patients with copayments. For the cohort of patients with copayment there was little difference in monthly copayments across adherence thresholds. Regression analysis shows that an increase in cost sharing reduces adherence overall, but this effect was small and insignificant in the copayment cohort. In contrast, in the coinsurance cohort increased cost sharing was significantly associated with decreased adherence to DMT medication; with a 10% increase in cost sharing leading to an 8.6% decline in adherence.

Implications – Employers increasingly rely on coinsurance, despite evidence that reliance on coinsurance results in lower adherence. Our research findings suggest that coinsurance appears to be a greater obstacle to compliance, confirming predictions found in the theoretical literature.

Originality – This research converted counts of injectable treatments into a continuous adherence measure. Previous literature on cost sharing did not examine MS.