170 VOLUME 7 • NUMBER 2 • JUNE 2015 J OURNAL OF PRIMARY HEALTH CARE VIEWPOINT 1 School of Pharmacy, University of Otago, Dunedin, New Zealand 2 Ma¯ori Pharmacists’ Association (Nga¯ Kaitiaki o Te Puna Rongoa¯ o Aotearoa), New Zealand CORRESPONDENCE TO: Pauline Norris School of Pharmacy, University of Otago, PO Box 56, Dunedin, New Zealand pauline. norris@otago.ac.nz J PRIM HEALTH CARE 2015;7(2):170–171. Poverty, medicines and health care: It’s the little things… Pauline Norris BA, MA, PhD; 1 Brendon McIntosh BSc (Neuro), BPharm; 1 June Tordoff BPharm (Hons), MPharm, PhD, RegPharmNZ; 1 Leanne Te Karu MHsc, PGCertPrescribing, PGDipClinPharm, PGCert Herbal Meds, DipPharm, CertHauoraMa¯ori (IV), FPS, MCAPA, RegPharmNZ; 2 Shih Yen Chang BA (Hons), MA 1 ABSTRACT Small patient charges and policies and events that may seem minor to health care professionals can have a big impact on the wellbeing of people living in poverty. Despite good intentions, policies can have unin- tended consequences for those who are struggling to access health care. As Trinity Roots sing in their 2001 song, some- times it’s the little things that really matter. For people living in poverty (10.3% of the New Zea- land population according to the OECD), 1 small charges for health care matter, and small indica- tions of the awareness and empathy of health professionals about their situation matter. Small events and policies can make a big impact both on a person’s health and their sense that the health system cares about them and is ‘on their side’. Little things that make a significant difference In our recent study of people who struggle to pay prescription charges, 2 we uncovered a range of ‘little things’ that made a significant difference to participants. The way the $5 prescription charge is levied The New Zealand $5 prescription charge is levied on each item on a prescription that is dispensed. This means that a medication dose change can potentially double the cost of a medicine. One woman in our study changed from a 10 mg dose to a 12.5 mg dose of an antipsychotic drug, and therefore had to pay two $5 charges because no 12.5 mg tablet is available. She pays $5 for her 10 mg tablet, and $5 for her 2.5 mg tablet. Alter- natively, the pharmacist could dispense 5 x 2.5 mg tablets, although this is clumsy and likely to lead to patients making mistakes. Surely it is not the intent of the prescription charges to dictate what dose of medicine patients should be taking, or how many tablets a person takes, although this is the effect if the patient can only afford $5. Giving a prescription is not the same as giving a medicine To health professionals and administrators, giving a prescription might be seen as equivalent to giv- ing medicines. To the participants in our study, these were not equivalent. One woman said that, in the past, the hospital had given her medi- cines on her discharge, but now they gave her a prescription, which she couldn’t always afford to get dispensed. Loss of personal medicines during a hospital stay Despite good procedures within hospitals, sometimes a medicine a patient brings with them to hospital gets ‘lost’ between admission and discharge. This can be very significant for the patients who may not be able to afford to replace them. Compulsory treatment and provision of medicines When patients with serious mental health problems are placed under the Mental Health (Compulsory Assessment and Treatment) Act, they are legally obliged to comply with treat- ment, including taking their medicines. However, they might still be charged for these, so be in a