School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA
Department of Family Medicine, Moi University School of Medicine, Eldoret, Kenya.
BMJ Open. 2022 Dec 6;12(12):e066814. doi: 10.1136/bmjopen-2022-066814.
To examine how drug shop clients' expenditures are affected by subsidies for malaria diagnostic testing and for malaria treatment, and also to examine how expenditures vary by clients' malaria test result and by the number of medications they purchased.
Secondary cross-sectional analysis of survey responses from a randomised controlled trial.
The study was conducted in twelve private drug shops in Western Kenya.
We surveyed 836 clients who visited the drug shops between March 2018 and October 2019 for a malaria-like illness. This included children >1 year of age if they were physically present and accompanied by a parent or legal guardian.
Subsidies for malaria diagnostic testing and for malaria treatment (conditional on a positive malaria test result).
Expenditures at the drug shop in Kenya shillings (Ksh).
Clients who were randomised to a 50% subsidy for malaria rapid diagnostic tests (RDTs) spent approximately Ksh23 less than those who were randomised to no RDT subsidy (95% CI (-34.6 to -10.7), p=0.002), which corresponds approximately to the value of the subsidy (Ksh20). However, clients randomised to receive free treatment (artemisinin combination therapies (ACTs)) if they tested positive for malaria had similar spending levels as those randomised to a 67% ACT subsidy conditional on a positive test. Expenditures were also similar by test result, however, those who tested positive for malaria bought more medications than those who tested negative for malaria while spending approximately Ksh15 less per medication (95% CI (-34.7 to 3.6), p=0.102).
Our results suggest that subsidies for diagnostic health products may result in larger household savings than subsidies on curative health products. A better understanding of how people adjust their behaviours and expenditures in response to subsidies could improve the design and implementation of subsidies for health products.
NCT03810014.
考察疟疾诊断检测和治疗补贴如何影响药店客户的支出，并考察支出如何因客户的疟疾检测结果和购买的药物数量而异。
对肯尼亚西部 12 家私人药店进行的随机对照试验的二次横断面分析。
研究于 2018 年 3 月至 2019 年 10 月期间在 836 名因疑似疟疾而前往药店就诊的客户中进行。如果孩子年满 1 岁且有父母或法定监护人陪同，也包括这些孩子。
疟疾诊断检测和治疗补贴（取决于疟疾检测阳性结果）。
肯尼亚先令（Ksh）药店支出。
随机分配到 50%疟疾快速诊断检测（RDT）补贴的客户比随机分配到无 RDT 补贴的客户花费少约 23 肯尼亚先令（95%置信区间（-34.6 至-10.7），p=0.002），这大约相当于补贴的价值（20 肯尼亚先令）。然而，随机分配到如果检测出疟疾就接受免费治疗（青蒿素联合疗法（ACTs））的客户的支出水平与随机分配到 ACT 补贴的客户相似，条件是检测结果呈阳性。测试结果也相似，但那些检测出疟疾阳性的人购买的药物比那些检测出疟疾阴性的人多，而每一种药物的花费则少约 15 肯尼亚先令（95%置信区间（-34.7 至 3.6），p=0.102）。
我们的结果表明，与治疗性健康产品补贴相比，针对诊断性健康产品的补贴可能会带来更大的家庭储蓄。更深入地了解人们如何根据补贴调整行为和支出，可能会改善健康产品补贴的设计和实施。
NCT03810014。
