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Background: In recent years, healthcare spending has outpaced economic growth in developed countries, with pharmaceutical expenditures being a key driver of this trend. While a significant number of studies investigating the effect of healthcare resource productivity on health status have been done, only a few have disaggregated pharmaceutical expenditures from total healthcare expenditures., Objective: To assess the independent association between pharmaceutical expenditures and health outcomes in 14 industrialized countries., Methods: We used data from the Organisation for Economic Co-operation and Development to construct a panel data set covering the years from 1985 to 2001. These data contain information on pharmaceutical expenditures, other healthcare expenditures, environmental health determinants, lifestyle health determinants, potential years of life lost, and life expectancy at ages 65 and 80 years across 14 industrialized nations. We estimated the relationship between pharmaceutical expenditures and potential years of life lost and life expectancy at ages 65 and 80 years for both males and females, using nonlinear fixed-effects regression models that corrected for serial correlation. All explanatory variables were lagged by 5 years to account for their cumulative effect on population health outcomes., Results: Pharmaceutical expenditures proved to be a robust correlate of health outcomes from 1985 to 2001 in this sample of nations, when controlling for the effects of other variables likely to impact population health outcomes. Our estimates imply that a 10% increase in pharmaceutical expenditures during these years was associated with a 0.3% (95% CI 0.1% to 0.5%; approximately 21 days) increase in female life expectancy at age 65 years (p < 0.05), while a similar increase was associated with a 0.4% (95% CI 0.1 to 0.7; approximately 24 days) increase in male life expectancy at age 65 years (p < 0.05) and a 0.5% increase (95% CI 0.03 to 1.0; approximately 14 days) at age 80 years (p < 0.05)., Conclusions: Our results suggest that significant, but small, marginal gains in population health outcomes were associated with increased pharmaceutical expenditures in developed nations during the period studied.

Background: Health insurance instability (ie, temporal gaps in health insurance coverage) is a prevalent phenomenon in the United States. To date, most studies have focused on the factors that affect the intermittent lack of health insurance coverage. However, no studies known to the authors have examined the factors associated with prescription drug insurance instability (ie, temporal gaps in drug insurance coverage) among working-age adults. Developing an accurate profile of persons with unstable drug insurance is essential to formulate rational policy to address this problem., Objectives: The objectives of this study were to (1) document the prevalence of prescription insurance instability among working-age adults and (2) describe the association between prescription drug insurance instability and demographic, socioeconomic status, and employment characteristics., Methods: The data source used in this study was the 2000 Medical Expenditure Panel Survey. This study used a cross-sectional design using data provided by respondents at each of the 3 interviews conducted during the year 2000. Chi-square and hierarchical multinomial logistic regression analyses were used to describe the associations among (1) demographics, (2) socioeconomic status, and (3) employment characteristics and drug insurance status (classified as continuous, absent, or unstable)., Results: During the year 2000, 12.5% (21.1 million) of the working-age adults in the United States had unstable prescription drug coverage. Persons aged 35-54 years had lower rates of drug insurance instability compared with those aged 18-24 [adjusted odds ratio 0.66 (95% confidence interval 0.54-0.80)]. The least educated (12 or fewer years of education) were more likely than those with more education (13-16 years) to experience at least one period without drug coverage (62% vs 32%, P<0.01). The poorest respondents (those at less than 200% of the federal poverty level) were more likely than the wealthiest respondents (those at more than 400% of the poverty level) to report at least some time without drug coverage (37% vs 28%, P<0.01). Those experiencing a divorce or death of a spouse were more than twice as likely as stably married persons to experience at least one period without drug insurance [adjusted odds ratio 2.23 (95% confidence interval 1.68-2.96)]. Adults who were unstably employed during the year and/or who worked for small firms generally experienced higher rates of drug insurance instability., Conclusions: Prescription drug insurance instability is a prevalent phenomenon among working-age adults in the United States, with approximately 1 in 8 experiencing this problem during 2000. Our results suggest that demographics, socioeconomic status, and employment characteristics all play important roles in predicting prescription drug insurance status, with the least educated and poorest being particularly vulnerable to interruptions in drug coverage. Premium assistance programs providing subsidies to small firms' low-income employees and permitting small firms to form insurance pools may help to decrease the number of drug coverage uninsurance spells in this population.