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Why Do Drug Prescribing Rates Differ Across Irish Regions?

Abstract

Martin Kenneally and Brenda Lynch*

In Ireland 68.3 m drug items were prescribed in 2010, a national average prescribing rate (APR) of 14.9 items per person. Regional APRs ranged from 13.2 items in the East to 17.1 items in the South-East region. We construct a model of regional prescribing rates in Ireland that embeds the effects of the national prescribing rates under each of Ireland’s three main community drug schemes, the regional coverage rates of those schemes and each region’s health status. Drawing on the CPS Composite Health Index to measure regional health status and the Primary Care Reimbursement Service database for all other variable, we estimate the model by Ordinary Least Squares (OLS). We find that variations in regional prescribing rates were mainly due to the different regional coverage rates of Ireland’s community drug schemes, especially its GMS (General Medical Services) community drug scheme and, to a lesser extent, to differences in each region’s health status. We simulate the estimated model and find that a percentage point reduction in each region’s GMS coverage rate would reduce the number of items prescribed nationally twice as much as a percentage point gain in each region’s health status. We find that regional prescribing rates respond most to changes in national prescribing rates in low-income regions that have high GMS coverage rates and poor health status. At the height of Ireland’s public debt crisis in 2010, government policy pressured GMS national prescribing rates down by around 2% in an effort to contain public drug costs. That reduced regional prescribing rates most in low-income regions that had high GMS coverage rates and poor health status.