Out of Pocket Payment and Affordability of Medication for  Geriatric Patients in Tehran, Iran

Zarif-Yeganeh, Morvarid; Kargar, Mona; Rashidian, Arash; Kohneloo, Aarefeh Jafarzadeh; Gholami, Kheirollah

doi:10.18502/ijph.v48i6.2924

Cited by 14 publications

(20 citation statements)

References 17 publications

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“…This retrospective cross sectional study, conducted from January to March 2014, was part of a project that evaluated different aspects of pharmacotherapy for outpatient geriatrics (18,19). Data of 1512 insurance prescriptions of patients aged ≥ 65 years were collected from 5 pharmacies (Amini, Booali, Isar, Taleghani and Abedini) affiliated to the Faculty of Pharmacy, Tehran University of Medical Sciences (TUMS).…”

Section: Methodsmentioning

confidence: 99%

Prescribing for geriatrics in Tehran; is it appropriate and rational?

Kargar

Atrianfar

Rashidian

et al. 2019

Med. J. Islam. Republ. Iran

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Potentially inappropriate medications (PIMs) can predispose geriatrics to adverse drug events. Additionally, WHO prescribing indices can help to determine the rationality of administrations. Using the prescriptions, rather than the insurance claim data, can provide a more precise picture that can help to identify the prescribing problems and target the interventions more effectively. →What this article adds: Almost one-third of the patients received at least 1 PIM based on the Beers Criteria in Tehran, and general practitioners prescribed PIMs more frequently. On average, patients received 3.57 medications per prescription. Only 76.77% of all drugs were prescribed by generic names. Vitamins and corticosteroids were among the top injectable medications in this study.

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Section: Methodsmentioning

confidence: 99%

Prescribing for geriatrics in Tehran; is it appropriate and rational?

Kargar

Atrianfar

Rashidian

et al. 2019

Med. J. Islam. Republ. Iran

Self Cite

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“…High OOP is a marker of health system performance. 19 Previous research has shown that OOP is prevalent among insured populations, especially in low and middle-income countries; for instance, in the population with health insurance in Indonesia, 18% of patients experienced catastrophic medical costs. 20 This was also true in the population of India with National Health Insurance in that 66.0% of the beneficiaries incurred OOP.…”

Section: Introductionmentioning

confidence: 99%

Determinants of Out-of-Network Utilization of Care Among Insured Clients Under the National Health Insurance Fund of Sudan

Elhadi¹,

Zaghloul²,

Dabbah³

2022

RMHP

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Purpose Knowledge of insured clients' utilization behavior is essential for developing evidence-based interventions for reform activities. This study explored the magnitude and determinants of voluntary out-of-network physician visit utilization among an insured population under the National Health Insurance Fund (NHIF) of Sudan. Methods This study was a cross-sectional survey conducted at the primary healthcare centers of NHIF in Al Jazirah state in Sudan. A structured interview questionnaire was used to collect data related to socio-economic and health insurance characteristics of NHIF clients and to assess their utilization behavior. Data were collected from September to October 2021. Results Of 768 NHIF clients who were interviewed (mean age 46 years, 55.1% females), 63.2% reported using out-of-network physician visits during the last six months prior to the interview. The median out-of-pocket payment for the last out-of-network physician visit was 5000 Sudanese pounds. The regression analysis revealed that clients’ gender, marital status, self-reported health, overall rating of the quality of care, rating of the general practitioner care, and ease of referral to a specialist were the significant determinants for seeking out-of-network physician care. Conclusion A high magnitude of out-of-network physician visit utilization was found among the insured NHIF clients of Al Jazirah state in Sudan. Policymakers should address issues identified in the current study to reduce patients’ leakage to out-of-network services.

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“…Price of medicines is a concern in low- and middle-income countries where up to 90% of the population purchases medicines through out-of-pocket payments [ 14 ]. This has a huge impact on the affordability of medicines and treatment outcome of diseases [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Availability, pricing and affordability of essential medicines in Eastern Ethiopia: a comprehensive analysis using WHO/HAI methodology

Sisay

Amare

Hagos

et al. 2021

J of Pharm Policy and Pract

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Background Access to essential medicines is a universal human right and availability and affordability are the preconditions for it. In line with the sustainable development goals, World Health Organization (WHO) has outlined a framework that assists the policy makers to improve access to essential medicines for universal health coverage by 2030. However, the availability and affordability of essential medicines remains suboptimal in several low-income countries. Therefore, this study was designed to investigate the availability, pricing and affordability of essential medicines in eastern Ethiopia. Methods A cross-sectional study design was employed to conduct this study. Public and private health facilities found in Eastern Ethiopia and which fulfilled criteria set forth by WHO/Health Action International (HAI) guideline and essential medicines listed on WHO/HAI guideline and essential medicine list of Ethiopia were included. Accordingly, 60 medicine outlets were selected based on the WHO/HAI standardized sampling methodology. A standardized data collection tools developed by WHO/HAI, with necessary modifications, was employed to collect the data. Median Price Ratio (MPR) was computed as a ratio of median local buyers’ price to international buyers’ reference price. The Mann–Whitney U test was employed to compare the median buyers’ price between public and private health facilities. Kruskal–Wallis test was also run to explore the median price difference among all facilities. Treatment affordability was calculated based on the number of days of wage of the lowest-paid government employee of Ethiopia required to purchase the prescribed regimen. Results The overall percent availability of originator brand (OB) versions of essential medicines was found to be 3.6% (range: 0.0–31.7%), with the public and private sectors contributing 1.43% and 5.50%, respectively. The overall percent availability of lowest price generics (LPGs) was 46.97% (range: 1.7–93.3%) (Public: 42.5%; private: 50.8%). Only eight LPGs (16.0%) met the WHO target of 80%. The Mann–Whitney U test indicated that 64% drugs showed statistically significant median price difference between public and private settings (p < 0.05). The MPR value indicated that the median buyers’ price of drugs in private sector were more than four times the international reference price in 30% of drugs. The percentage of unaffordable medicine were 72.09 and 91.84% for public and private facilities, respectively, with 79.17% of the medicines were unaffordable when both settings were combined. Conclusion Only 16% of the surveyed medicines surpassed the WHO cut-off point of 80%. Nearly one-third of drugs in the private sector had a price of more than four times compared to the international reference prices. Moreover, four out of five drugs were found unaffordable when both settings were combined, demanded several days of wage of lowest paid government employee. This finding calls a prompt action from stakeholders to devise a strategy that help promote the access of essential medicines and rescue the struggling healthcare system of Ethiopia.

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Out of Pocket Payment and Affordability of Medication for Geriatric Patients in Tehran, Iran

Cited by 14 publications

References 17 publications

Prescribing for geriatrics in Tehran; is it appropriate and rational?

Prescribing for geriatrics in Tehran; is it appropriate and rational?

Determinants of Out-of-Network Utilization of Care Among Insured Clients Under the National Health Insurance Fund of Sudan

Availability, pricing and affordability of essential medicines in Eastern Ethiopia: a comprehensive analysis using WHO/HAI methodology

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