Owusu Bernard Afriyie, Barnes Nana Ama, Doku David Teye
Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
Sutter Santa Rosa Family Medicine Residency Program, Santa Rosa, USA.
Health Econ Rev. 2024 Sep 16;14(1):74. doi: 10.1186/s13561-024-00531-5.
Type 1 diabetes (T1D) management exerts a considerable financial burden on patients, caregivers, and developing nations at large. In Ghana, a key governments effort to attenuate the financial burden of T1D on patients was to fashion safety-net mechanisms through financial risk pooling/sharing known as the National Health Insurance Scheme (NHIS). However, there is limited research on patients and caregivers' experiences with the cost of managing T1D within the NHIS in Ghana.
This study explored the cost of T1D management, and the impact of the NHIS policy on mitigating costs of care.
A semi-structured interview guide was developed to collect qualitative data from 28 young people living with T1D (PLWD), 12 caregivers, 6 healthcare providers, and other stakeholders in Western, Central and the Greater Accra regions. Multiple data collection techniques including mystery client and in-depth interviews were used to collect data. Thematic content analysis was performed with QSR NVivo 14.
Five key domains/themes which are: cost of T1D management supplies; cost of clinical care; cost of transportation; cost of diet; and NHIS were identified. The daily cost of blood glucose testing and insulin injection per day was between GHC 5-7 (US$ 0.6 to 1.0). The NHIS did not cover supplies such as strips, glucometers, HbA1c tests, and periodic medical tests. Even for those cost which were covered by the NHIS (mainly pre-mixed insulin), marked government delays in funds reimbursement to accredited NHIS facilities compelled providers to push the financial obligation onto patients and caregivers. Such cost obligations were fulfilled through out-of-pocket top-up or full payment of insulin of about GHC 15-25 (US$ 2-4), and GHC 25-50 (US$4-8) depending on the region and place of residence.
The cost of managing T1D was a burden for patients and their caregivers. There was a commodification of life-saving insulin on the Ghanaian market, and the NHIS did not function well to ease the cost-burden of T1D management on patients and caregivers. The findings call for the need to scale up NHIS services to include simple supplies, particularly test strips, and always ensure the availability of life-saving insulin in healthcare facilities.
1型糖尿病（T1D）的管理给患者、护理人员以及广大发展中国家带来了相当大的经济负担。在加纳，政府减轻T1D患者经济负担的一项关键举措是通过名为国家健康保险计划（NHIS）的财务风险分担机制构建安全网。然而，关于加纳NHIS框架下患者和护理人员在T1D管理成本方面的经历的研究有限。
本研究探讨了T1D管理的成本，以及NHIS政策对减轻护理成本的影响。
制定了一份半结构化访谈指南，以收集来自西部、中部和大阿克拉地区的28名T1D患者、12名护理人员、6名医疗服务提供者及其他利益相关者的定性数据。采用了包括神秘顾客调查和深度访谈在内的多种数据收集技术来收集数据。使用QSR NVivo 14进行主题内容分析。
确定了五个关键领域/主题，即：T1D管理用品成本；临床护理成本；交通成本；饮食成本；以及NHIS。每日血糖检测和胰岛素注射的成本在5至7加纳塞地（约合0.6至1.0美元）之间。NHIS不涵盖试纸、血糖仪、糖化血红蛋白检测和定期医学检测等用品。即使是NHIS覆盖的费用（主要是预混胰岛素），政府向经认可的NHIS机构报销资金的严重延迟也迫使医疗服务提供者将财务义务转嫁给患者和护理人员。这些费用义务通过自掏腰包补足或全额支付胰岛素来履行，胰岛素费用约为15至25加纳塞地（2至4美元），以及25至50加纳塞地（4至8美元），具体取决于地区和居住地点。
T1D的管理成本对患者及其护理人员来说是一项负担。加纳市场上出现了救命胰岛素商品化的现象，而且NHIS在减轻患者和护理人员T1D管理成本负担方面运作不佳。研究结果表明有必要扩大NHIS服务范围，将简单用品特别是试纸纳入其中，并始终确保医疗机构有救命胰岛素供应。
