E-drug: Bamako Initiative (cont'd)
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Dear Joel and e-druggers,
Whether prescribers change the number of units (tablets) per drug
item prescribed in response to cost sharing may depend upon the type
of fee system as well as the level of fees (i.e. the level of cost
sharing). In the work we did in Nepal we found that where drugs were
charged for per tablet or unit, as in shops, fewer units were prescribed
due to patients' inability or unwillingness to pay. However, where a
fee per drug item covering a full course was charged as in public
health facilities, more units were prescribed, there being no economic
disincentive to the prescribing of more units. Of course, patients had
to pay more in the shops than in the public facilities but the average
patient purchasing drugs from a shop still spent less than 50% of the
average daily household cash income.
I agree it is surprising that little research has been done with regard to
whether cost sharing affects the quality of prescribing. One study that
examined this issue a little bit was the Rand Health Insurance
experiment that was done in the USA ("Free for All?: the Rand Health
Insurance Experiment", J.Newhouse 1993). In this study they found
that with increased cost sharing, the average annual drug costs per
insured person were lower with increased cost sharing, mostly due to
a reduction in the number of visits to the doctor but also due to slight
decreases in the average drug cost per prescription. This reduction in
costs was not associated with any significant reduction in health
outcome. It was also found that the unecessary prescription of
antibiotics was greatly reduced with increased cost sharing and that
this reduction in unecessary antibiotic prescription was very significant
in terms of harmful side-effects avoided as well as in terms of
resources saved.
Kathy Holloway,
Former Drug Scheme Coordinator, BNMT.
Temporary Address: 19 Camden Mews, London NW1 9DB, UK.
Tel: 00 44 171 482 1919
email: k.a.holloway@sbu.ac.uk
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