Simon-Tuval Tzahit, Triki Noa, Chodick Gabriel, Greenberg Dan
Department of Health Systems Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Medical Division, Maccabi Healthcare Services, Tel-Aviv, Israel.
Value Health Reg Issues. 2014 Sep;4:41-46. doi: 10.1016/j.vhri.2014.06.010. Epub 2014 Jul 26.
The effectiveness of value-based insurance design is based on nonadherence, which derives solely from patients' economic constraints.
Our objective was to examine the extent of cost-related nonadherence to chronic medications and to analyze its potential determinants.
We conducted a telephone survey among a representative sample of Maccabi Healthcare Services chronically ill patients aged 55 years or older (n = 522). We developed a 12-month recall questionnaire that included demographic and socioeconomic characteristics, out-of-pocket expenditure on prescribed medication, physician's provision of explanation regarding prescribed therapy, adherence, and reasons for nonadherence. Respondents were defined as nonadherent if they reported that they did not purchase prescribed medications in the previous year because of their cost. We applied the multivariable logistic regression model to examine predictors of nonadherence.
Median (interquartile range) age of the study sample was 69 (13) years (53% males). One hundred sixty-five patients (31.6%) reported not purchasing prescribed medications mainly because of medications' adverse effects and/or cost. Fifty respondents (9.6%) reported cost-related nonadherence. The multivariable logistic regression model revealed that cost-related nonadherence was associated with respondent's income lower than 4600 New Israeli shekel (odds ratio [OR] = 10.86; 95% confidence interval [CI] 1.45-81.12), unemployment (OR = 4.32; 95% CI 1.47-12.66), lack of physician explanation about the prescribed medication (OR = 2.38; 95% CI 1.18-4.78), and age (OR = 0.95; 95% CI 0.91-0.99).
Cost-related nonadherence to chronic pharmaceuticals is self-reported among nearly 10% of the chronically ill patients and is strongly affected by low socioeconomic status, even under universal health insurance coverage and with relatively low co-payments as applied in Israel. Lack of information provided by physicians regarding the therapy is associated with a higher likelihood of cost-related nonadherence.
基于价值的保险设计的有效性基于不依从性，而这种不依从性完全源于患者的经济限制。
我们的目的是研究与费用相关的慢性药物治疗不依从的程度，并分析其潜在决定因素。
我们对马卡比医疗服务公司55岁及以上慢性病患者的代表性样本（n = 522）进行了电话调查。我们编制了一份为期12个月的回顾性调查问卷，内容包括人口统计学和社会经济特征、处方药的自付费用、医生对规定治疗的解释、依从性以及不依从的原因。如果受访者报告因费用原因在过去一年未购买处方药，则被定义为不依从。我们应用多变量逻辑回归模型来研究不依从的预测因素。
研究样本的年龄中位数（四分位间距）为69（13）岁（男性占53%）。165名患者（31.6%）报告未购买处方药主要是因为药物的不良反应和/或费用。50名受访者（9.6%）报告与费用相关的不依从。多变量逻辑回归模型显示，与费用相关的不依从与受访者收入低于4600新以色列谢克尔有关（比值比[OR] = 10.86；95%置信区间[CI] 1.45 - 81.12）、失业（OR = 4.32；95% CI 1.47 - 12.66）、医生未对处方药进行解释（OR = 2.38；95% CI 1.18 - 4.78）以及年龄（OR = 0.95；95% CI 0.91 - 0.99）有关。
在近10%的慢性病患者中，自我报告存在与费用相关的慢性药物治疗不依从情况，并且即使在以色列实行全民医疗保险覆盖且共付额相对较低的情况下，社会经济地位较低也会对其产生强烈影响。医生未提供有关治疗的信息与费用相关不依从的可能性较高有关。
