Drug expenditure and economic impact of community pharmacy visits by poor households
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Abstract
Introduction: This research aimed to study drug expenditure and economic impact of community pharmacy visits by poor households with respect to five common symptoms, including fever/headache, joint/back/musculoskeletal pains, throat/nose symptoms, skin diseases, and gastrointestinal tract symptoms. Method: A total sample from 304 poor households was interviewed face-to-face using a structured questionnaire during May-July2009. Results: Nearly all (95.5%) were under Universal Health Care coverage (UC) scheme. The majority (61.5%)was in the agriculture sector. The median household expense per month was 6,528 Baht (interquartile range-IQR 4,945), which was higher than the median income (5,575 Baht) (IQR 6,575). Medication through pharmacist initiation was common for fever/headache (68.3%), joint/back/musculoskeletal pains (65.6%), throat/nose symptoms (64.5%), and skin diseases (63.3%); whereby self-request medication was common for gastrointestinal tract symptoms (75.4%). The median (IQR) out-of-pocket payments for drugs for each of the five symptoms were 25.0(37.0), 30.0 (20.0), 39.0 (30.5), 40.0 (30.0), and 30.0 (15.0) Baht, respectively. The median (IQR) expenditures based on standard treatments for each of these symptoms were 30.0 (50.0), 60.0 (15.0), 25.0 (37.0), 35.0 (20.0),170.0 (0.0) Baht, respectively. The median value of the maximum ability to pay for the standard treatment for every symptom was 100 Baht. Those who were not able to pay for the standard treatment mostly suffered from gastrointestinal tract events (63.6%), followed by throat/nose symptoms (25.5%), and fever/headache (13.8%). The highest gap between the ability to pay and the standard treatment was equal to 81.0 Baht (median) (IQR 51.0) for gastrointestinal tract symptoms. For those who could not afford the standard treatment, major economic coping would go to household savings (63.5%), of which 54.6% were unable to save. The second most frequent impact was on their daily consumption (35.2%), of which 32.2% had decreased in the consumption. One-fifth (21.7%) had to use some kind of coping strategy, 20.4% of which was obtained from relatives. At the level of actual payment, the majority (62.2%) had no impacts, whereas 36% had their savings reduced and 15% had an impact on daily consumption. Conclusion: Most poor households were able to pay out of pocket for the drugs received and for standard drug treatments, except for the case with gastrointestinal tract symptoms. Such payments would affect the household savings and daily consumption the most.
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