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  1. Fulltext Qualitative exploration of the modifiable factors for medication adherence among subsidised and self-paying patients in Malaysia
    Aziz H, Hatah E, Makmor-Bakry M, Islahudin F, Ahmad Hamdi N, Mok Pok Wan I
    BMC Health Serv Res, 2018 08 06;18(1):605.
    PMID: 30081892 DOI: 10.1186/s12913-018-3417-y
    BACKGROUND: Numerous studies have evaluated the related factors of medication adherence among patients with chronic disease. However, the factors influencing medication adherence and non-adherence among subsidised patients with chronic diseases-for whom medication costs may not be a constraint-remain unexplored. Thus, this study aims to identify and compare the potential factors that may influence subsidised and non-subsidised (i.e., self-paying) patients' adherence to medication.

    METHODS: Subsidised and self-paying patients were identified at public and private healthcare institutions in three states of Malaysia. Patients were then purposively selected for semi-structured, face-to-face interviews according to their medication adherence status (including adherent and non-adherent patients), which was measured using the Medication Event Monitoring System (MEMS). Adherence was defined as having 80% or more for the percentage of days in which the dose regimen was executed as prescribed. The interview was conducted from January to August 2016 and during the interviews, patients were asked to provide reasons for their medication adherence or non-adherence. The patient interviews were audio recorded and transcribed verbatim. Data were analysed using thematic analysis with NVivo 11 software.

    RESULTS: Thirteen subsidised and 12 self-paying patients were interviewed. The themes found among subsidised and self-paying patients were similar. The factors that influenced adherence to medication include the 'perceived importance of quality of life' and 'perceived benefit or value of the medications'. A unique factor reported by patients in this study included 'perceived value of the money spent on medications'; more specifically, patients adhered to their medications because they valued the money spent to buy/receive the medications.

    CONCLUSION: Medication adherence among subsidised and self-paying patients was influenced by many factors, including a unique factor relating to their perceptions of the value of money spent on medications.

    Matched MeSH terms: Prescription Fees*
  2. Treatment of Type 2 diabetes mellitus in Chongqing of China: unaffordable care for the poor
    Long Q, He M, Tang X, Allotey P, Tang S
    Diabet Med, 2017 01;34(1):120-126.
    PMID: 27472098 DOI: 10.1111/dme.13193
    AIM: This study aims to investigate the medical expenditure of people with type 2 diabetes mellitus in Chongqing, China; to explore factors that contribute to the expenditure; and to examine the financial burden placed on households, particularly poor households.
    METHODS: A cross sectional survey was conducted with a sample of people diagnosed with Type 2 diabetes mellitus in 2014. Of the 664 people eligible, 76% were interviewed. Descriptive statistics and log-linear regression were used to examine respondents' age, sex and level education, location of residence, income and type of health insurance associated with out-of-pocket expenditure on accessing diabetes mellitus care.
    RESULTS: In a year, average out-of-pocket expenditure on the purchase of drugs from pharmacies and having outpatient care were US $333 and US $310, respectively. The average out-of-pocket expenditure on accessing inpatient care was 3.7 times (US $1159) that of accessing outpatient care. After adjusting for age and sex, out-of-pocket expenditure on diabetes care was significantly higher for people covered by the Urban Employee Basic Medical Insurance programme and those enrolled in the identified priority diseases reimbursement programme, which provided higher reimbursement rates for outpatient and (or) inpatient care. Out-of-pocket expenditures on the purchase of drugs from pharmacies, having outpatient and inpatient care, respectively, were 9.8%, 16.2% and 62.6% of annual household income in low-income group.
    CONCLUSION: Even with health insurance coverage, poor people with Type 2 diabetes mellitus suffered from significant financial hardship. This has significant implications for models of care and healthcare financing in China with the growing burden of diabetes.
    Study site: Township or community health centres, Chongqing, China
    Matched MeSH terms: Prescription Fees
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