This paper studies whether geographic barriers can influence nonadherence to prescription drugs and its effect on patients' health. We used a multivariate probit model estimated by maximum simulated likelihood that considers individual unobserved heterogeneity, which may characterize the relationship between adherence, medical care utilization, and health outcome. We used administrative data from Liguria, Italy, the region with the highest rate of individuals over the age of 65 in Europe. Our sample included older individuals affected by cardiovascular diseases, which remain one of the leading causes of death in most OECD countries. Our results showed that geographic barriers to pharmacies negatively influence patients' adherence. According to our results, patients' nonadherence to pharmacological therapy is responsible for an increased probability of patients' mortality and the overuse of other medical services, namely, hospitalizations and emergency department visits. Nonadherence may thus represent a potential source of waste for the health care system.

译文

本文研究了地理障碍是否会影响对处方药的不依从性及其对患者健康的影响。我们使用了由最大模拟似然估计的多元概率模型,该模型考虑了个体未观察到的异质性,这可能表征了依从性,医疗保健利用率和健康结果之间的关系。我们使用了意大利利古里亚 (Liguria) 的行政数据,该地区是欧洲65岁以上人口比例最高的地区。我们的样本包括受心血管疾病影响的老年人,在大多数经合组织国家,心血管疾病仍然是主要的死亡原因之一。我们的结果表明,药房的地理障碍会对患者的依从性产生负面影响。根据我们的结果,患者不坚持药物治疗是导致患者死亡和过度使用其他医疗服务 (即住院和急诊就诊) 的可能性增加的原因。因此,不遵守可能是医疗保健系统浪费的潜在来源。

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