Haakenstad Annie, Kalita Anuska, Bose Bijetri, Chakraborty Arpita, Gupta Kirti, Tsuei Sian Hsiang-Te, Woskie Liana Rosenkrantz, Yip Winnie
Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
Global Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA.
BMJ Glob Health. 2025 Feb 18;10(2):e017788. doi: 10.1136/bmjgh-2024-017788.
In India, public sector patients purchase drugs from private pharmacies instead of obtaining them for free from public pharmacies-a phenomenon we call public patient forwarding to private pharmacies. This behaviour results in substantial financial hardship. We examine whether low public drug stocks, patient preferences for private drugs or the presence of private pharmacies nearby explain this behaviour.
We collected cross-sectional data from 7567 households, 523 health facilities and 1036 private pharmacies in Odisha, India. We linked 917 outpatient visits to facilities based on patient reports and linked public facilities to the nearest private pharmacy using Global Positioning System coordinates. We used ordinary least squares regression to assess whether the behaviour of facilities and patients was associated with drug stocks and pharmacy proximity, and whether patient satisfaction was associated with private drug purchases.
Among public patients prescribed drugs, more than 70% purchased private drugs. In hospitals, for each 10% increase in drug stocks, 4.8% fewer patients purchased private drugs (p=0.047). In primary facilities, the same share of patients purchased private drugs across stock levels. Regardless of facility level, when more than 75% of drugs were in stock, 60% or more of patients still obtained drugs from the private sector. Patients were more likely to purchase private drugs when private pharmacies were near public facilities, but were not more satisfied with their visit when they obtained private drugs.
The results suggest that private pharmacies are both secondary and complementary suppliers of drugs for hospitals, but may act more like substitutes for primary facilities, consistent with evidence that private pharmacies provide advice and other services akin to primary care in Odisha. Improving public facility drug stocks alone is unlikely to fully address drug-driven financial hardship in India. Provider prescribing practices should be investigated to identify additional policy options.
在印度，公共部门的患者从私人药店购买药品，而不是从公共药店免费获取——我们将这种现象称为公共患者转向私人药店。这种行为导致了巨大的经济困难。我们研究了公共药品库存不足、患者对私人药品的偏好或附近私人药店的存在是否能解释这种行为。
我们收集了印度奥里萨邦7567户家庭、523个卫生设施和1036家私人药店的横断面数据。我们根据患者报告将917次门诊就诊与医疗机构进行了关联，并使用全球定位系统坐标将公共设施与最近的私人药店进行了关联。我们使用普通最小二乘法回归来评估医疗机构和患者的行为是否与药品库存和药店距离有关，以及患者满意度是否与购买私人药品有关。
在开了药的公共部门患者中，超过70%购买了私人药品。在医院，药品库存每增加10%，购买私人药品的患者就减少4.8%（p = 0.047）。在基层医疗机构，不同库存水平下购买私人药品的患者比例相同。无论医疗机构级别如何，当超过75%的药品有库存时，仍有60%或更多的患者从私营部门获取药品。当私人药店靠近公共设施时，患者更有可能购买私人药品，但购买私人药品时他们对就诊的满意度并没有更高。
结果表明，私人药店既是医院药品的二级供应商也是补充供应商，但对基层医疗机构而言可能更像是替代品，这与私人药店在奥里萨邦提供类似于初级保健的建议和其他服务的证据一致。仅改善公共设施的药品库存不太可能完全解决印度因药品导致的经济困难。应调查医疗服务提供者的开药做法，以确定其他政策选择。
