Open Access Open Badges Research article

Is 50 cent the price of the optimal copayment? - a qualitative study of patient opinions and attitudes in response to a 50 cent charge on prescription drugs in a publicly funded health system in Ireland

Sarah-Jo Sinnott1*, Marie Guinane2, Helen Whelton3 and Stephen Byrne2

Author affiliations

1 Department of Epidemiology and Public Health, University College Cork, Cork, Ireland

2 Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland

3 Oral Health Services Research Centre, University Dental School, Wilton, Cork, Ireland

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Citation and License

BMC Health Services Research 2013, 13:16  doi:10.1186/1472-6963-13-16

Published: 10 January 2013



A 50 cent prescription levy was introduced in 2010 on the General Medical Services (GMS) scheme (Irish public health insurance). This study sought to examine patient attitudes and opinions surrounding the 50 cent copayment. Given the small momentary value of the prescription fee, these results are of interest to policymakers internationally who wish to reduce copayments rather than abolish them.


A qualitative research design was used; semi structured interviews were carried out. Twenty four GMS eligible participants were interviewed in 23 interviews. Fifteen females and 9 males took part. Ages varied from 31- >70 years. Patients were invited to be interviewed in both independent and chain community pharmacies in three types of setting; 1) a socially deprived urban area, 2) a suburban affluent area and 3) a rural area. The Framework method was used for data management and analysis using QSR International’s NVivo 9.2 qualitative data analysis software. The “Francis method” was used to test for data saturation.


Results are of interest to the Irish context and also at a broader international level. Patients were mostly accepting of the prescription levy with some reservations concerning an increased price and the way in which generated revenue would be used by government. Participants identified waste of prescription drugs at the hand of patients (moral hazard), but there was discordant opinion on whether the 50 cent copayment would halt this moral hazard. Interviewees felt the levy was affordable, albeit some may suffer a financial impact more than others.


This qualitative study gives important insights into the experiences of GMS patients with regard to the prescription levy. Information regarding the appropriateness of a 50 cent copayment as a symbolic copayment needs to be confirmed by quantitative analysis. Further insight is required from a younger population.

Qualitative research; Copayment; Health policy; Adherence; Ireland