Catastrophic out of pocket medicine expenditure: A case for monitoring performance of primary providers on national health insurance scheme
https://doi.org/10.51412/psnnjp.2023.33
Keywords:
Essential medicines, Health insurance, Impoverishment, Out of stock, Stock outsAbstract
Background: One of the critical components of national health insurance scheme is the financial protection it provides to patients by reducing out of pocket (OOP) healthcare expenditure.Among low income patients even a little OOP payments due to medicine unavailability of medicines can be financially catastrophic for households. The lack of medicines is not a new phenomenon, however it was expected that funding from health insurance will improve availability and significantly reduce or eliminate OOP for medicines. The effect of OOP medicines payments on impoverishment among insured patients remain largely unexplored in the country. This study therefore aim to determine OOP medicine payments and its impoverishing effect on patients living on national minimum wage.
Methods: This was a retrospective study using prescription records at the national health insurance pharmacy unit of the University of Maiduguri teaching hospital. A total of 2036 were selected by simple random method and reviewed for evidence of medicine unavailability (January 2022 – December 2022). Medicines for which “not available” (N/A) and “out of stock” (O/S) were indicated was considered to be unavailable at the time of filling the prescription. The cost for one month supply of drugs for non-communicable diseases (NCDs) and ten day supply for other drug classes was computed using average private and public sector prices for analysis. The data was analyzed using descriptive statistics and national minimum wage of N30,000/month ($40) at the exchange rate of $1 = N750.
Results: The profile of unavailable medicines indicated that all class of drug were affected (47 – 100%). The estimated OOPpayments due to medicine stock out resulted in catastrophic expenditure of 12 – 232.5% of minimum wage and impoverishment rate of 12 – 132%. The protecting effect of health insurance was erased by the OOP payments leaving patients with impoverishment and inability to afford medicines.
Conclusion: There is need to regularly review of provider performance with respect to medicine availability, so as to protect the most vulnerable from catastrophic OOPmedicine expenditure.
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