Providers’ and clients’ perception and experience on National Health Insurance Scheme medicines list in public and private pharmacies in Bantama Sub-Metro: Case study of Komfo Anokye Teaching Hospital and Nimo Pharmacy Limited in Ashanti Region.

Background: National Health Insurance Scheme is improving health care in Ghana. However, the use of the NHIS medicines list which come in their generic forms has increased significantly in recent years. Since generic drugs are available at a lower cost, they provide an opportunity for savings in drug expenditure and its usage are being encouraged especially in developing countries. This study therefore determines the perceptions and experiences of the healthcare providers and clients towards the NHIS medicines list. Methods: A descriptive cross-sectional design study was employed using both quantitative and qualitative methods for this study. The quantitative data were gathered using structured questionnaire administered to four hundred and twenty clients whereas thirty-five providers, in-charges from both facilities and a NHIS representative in the Bantama sub-metro were interviewed to gather the qualitative data. The quantitative were analysed using STATA software (version 11) and the qualitative data were analysed using thematic analysis. Statistical significance for all testing was set at 0.05. Results: Majority of the clients (77.1%) were aware of NHI medicines or generics medicines and branded medicines. However, most of them preferred NHI medicines (23.8%) to branded medicines (19.1%). The reasons provided for opting for NHI medicines were effective (80.5%), affordable (89.5%), available (76.7%), safe (96.9%) and fewer side effects (97.1%). Majority of providers disagreed to the statement, NHIS medicines or generic medicines are more effective than branded ones (68.7%) and they may substitute NHIS medicines for branded ones when NHIS medicines are out of stock (45.7%). While 48.6% of providers agreed to their uncertainty about the quality of the NHIS medicines, 34.3% of providers’ opinion were neutral about the bioequivalence of generic and branded medicines. Also, majority of providers agreed that provider’s personal preference (37.1%), clients’ preference (54.3%), confidence in the generic company (60.0%) and advertisement by generic company (31.4%) would influence their prescription pattern. There was no significant difference between clients’ perception and experience and their socio-demographic characteristics. On the other hand, with exception of gender which was statistically significant (p-value= 0.025), none of the socio-demographic characteristics of the providers was found to have any statistically significant difference between perception and experience on NHIS medicines. There was a significant difference with regards to clients opinion on availability of NHIS medicines list in terms of getting all their prescriptions for free using NHIS cards (p-value= 0.038); medicines preference if paying out-of-pocket (p-value= 0.002); insurance pays if one choose to take branded medicines (p-value= 0.001) and medicines mostly prescribed by health providers (0.001). Conclusion and recommendation: The findings of the study demonstrated that clients and providers have insufficient knowledge about NHIS medicines. Therefore, they should be better educated with respect to the medicines list to promote confidence in the NHIS as well as its sustainability for the achievement of universal coverage.

Source: KNUST