TY - JOUR
T1 - Determinants of cost-related nonadherence to medications among chronically ill patients in maccabi healthcare services, Israel
AU - Simon-Tuval, Tzahit
AU - Triki, Noa
AU - Chodick, Gabriel
AU - Greenberg, Dan
N1 - Funding Information:
Source of financial support: These findings are the result of the study supported by the Israel National Institute for Health Policy Research (grant no. R/10/148 ).
PY - 2014/1/1
Y1 - 2014/1/1
N2 - Background: The effectiveness of value-based insurance design is based on nonadherence, which derives solely from patients' economic constraints. Objective: Our objective was to examine the extent of cost-related nonadherence to chronic medications and to analyze its potential determinants. Methods: 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. Results: 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). Conclusions: 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.
AB - Background: The effectiveness of value-based insurance design is based on nonadherence, which derives solely from patients' economic constraints. Objective: Our objective was to examine the extent of cost-related nonadherence to chronic medications and to analyze its potential determinants. Methods: 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. Results: 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). Conclusions: 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.
KW - Chronic medications
KW - Co-payment
KW - Cost
KW - Nonadherence
KW - Value-based insurance design
UR - http://www.scopus.com/inward/record.url?scp=84904904310&partnerID=8YFLogxK
U2 - 10.1016/j.vhri.2014.06.010
DO - 10.1016/j.vhri.2014.06.010
M3 - Article
AN - SCOPUS:84904904310
SN - 2212-1099
VL - 4
SP - 41
EP - 46
JO - Value in Health Regional Issues
JF - Value in Health Regional Issues
IS - 1
ER -
