Co-payment Effect on Drug Rational Use and Cost Coverage at Governmental Primary Health Care in Gaza Governorates

Khalid M. Abu Saman
خالد محمد محمود ابو سمعان
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Al-Quds University
Drug expenditure represents large amount of health care spending in most countries. Large spending on drugs causes loss of resources which could be deployed to other health care services. Also, the irrational use of drugs can lead to wasting of resources and health hazards as well. This study aimed to study the effect of co-payment on patients' drugs utilization, and also to study drugs cost coverage at the governmental PHC sector in Gaza Strip. The researcher used a descriptive, analytical, cross sectional design. A retrospective multistage sample of 1620 prescriptions was taken from randomly selected 15 PHC clinics from the different geographical areas and the different PHC levels. 108 prescriptions from each selected clinic were taken. Additionally, the researcher reviewed the pharmacy registry at the targeted clinics to ascertain drug cost coverage and drugs availability. The study showed that, there are drugs exploitation particularly for the exempted patients, where the average number of drugs prescribed per prescription was 2.9 (4.5 for exempted, 2.2 for under 3 years and 2 for over 3 year); the average percent of prescriptions including antibiotics per clinic was 64% (79.1% for exempted, 66.3% for under 3 years and 47% for over 3 years). The availability of key drugs was 82.8%. The percent of attendants treated with drugs is 75.4% (88.2% for under 3 year, and 70% for over 3 year visitors). The average drug cost covered by drug co-payment was 84%, more in rural areas than urban ones and the average prescription cost per clinic was 4.9 NIS (1.4US$) more in urban than rural areas. The study concluded that the introduction or increasing co-payment will decrease the quantity of the consumed drugs; helping in drug rational use. The study recommends reviewing the current exemption and co-payment system. Additionally, interventions to increase patient and physician knowledge about economical and healthy adverse effect for irrational drug use are needed