In 2016, Poland introduced a nationwide programme that eliminated all out-of-pocket payments for prescription medicines prescribed by healthcare professionals to individuals aged 75 and older. This reform represented a major expansion of public pharmaceutical coverage. It was intended to improve both access to essential medicines and financial security among older adults, a group that typically faces high healthcare needs and limited income growth. A new study published in Health Economics finds that the policy led to a 23% reduction in average out-of-pocket spending on medications and a 62% decline in catastrophic drug expenses, demonstrating that the programme offered substantial protection against large and unexpected health-related financial shocks.

Despite these overall gains, the financial benefits were unevenly distributed across the older population. The evidence suggests that higher-income households and those living in urban areas experienced larger reductions in medication costs. This pattern raises concerns that the policy may have unintentionally widened existing financial disparities among older adults. Structural factors such as better access to healthcare providers, greater awareness of eligibility, and fewer logistical barriers in urban settings have allowed certain groups to benefit more fully from the reform. At the same time, more disadvantaged individuals captured fewer of its advantages.

Beyond financial outcomes, the study also documents notable behavioural responses to the reduction in prescription drug costs. With lower immediate expenses and greater insurance against future health shocks, some older adults adjusted their spending behaviour in other areas of consumption. In particular, the researchers observed increased expenditure on goods such as unhealthy food, alcohol, and cigarettes. These changes suggest that improved financial security in one domain can spill over into lifestyle choices that may not necessarily support better long-term health outcomes.

Such behavioural shifts highlight the complexity of public health and social insurance policies. While reducing financial stress and improving access to medicines are important achievements, changes in perceived risk and security can alter decision-making in ways that policymakers may not anticipate. Increased spending on unhealthy goods could partially offset the health benefits expected from improved medication adherence, especially if these behaviours contribute to the development or worsening of chronic conditions.

“The programme clearly eased financial pressure for many older adults, which is encouraging,” said the study’s corresponding author. “However, when people feel more protected from health-related costs, they may adjust other aspects of their consumption in ways that can partially dilute the overall benefits of the policy.” Taken together, the findings suggest that while universal, free prescription drug programmes can deliver meaningful financial protection, their broader distributional and behavioural effects deserve careful consideration when designing policies aimed at improving both economic wellbeing and population health among older adults.

More information: Gosia Majewska et al, The Financial and Behavioral Effects of Free Prescription Drugs: Evidence From a Policy Discontinuity in Poland, Health Economics. DOI: 10.1002/hec.70083

Journal information: Health Economics Provided by Wiley