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Why it is a bad idea to implement copayments in the Unified Health System: harmful effects on access to care and people's health

ABSTRACT

In times of economic recession, copayments are one measure put forward to control demand and reducing public expenditures. The article aims to review the research on the effects of copayments. The results show prominent adverse effects: reduced access to health promotion and prevention services, impaired medication adherence, waiving or postponing health services utilization, particularly reducing access for elderly and chronically ill, additional administrative expenditures and increasing social inequalities in financing and access. Evidence of the assumed efficiency gains is lacking; increasing healthcare costs rather tend to prevent patients from taking out needed services at all or in time.

KEYWORDS:
Healthcare financing; Health services accessibility; Health care reform

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