Provider performance in treating poor patients - factors influencing prescribing practices in lao PDR: a cross-sectional study

Abstract

BackgroundOut-of-pocket payments make up about 80% of medical care spending at hospitals in Laos, thereby putting poor households at risk of catastrophic health expenditure. Social security schemes in the form of community-based health insurance and health equity funds have been introduced in some parts of the country. Drug and Therapeutics Committees (DTCs) have been established to ensure rational use of drugs and improve quality of care. The objective was to assess the appropriateness and expenditure for treatment for poor patients by health care providers at hospitals in three selected provinces of Laos and to explore associated factors.MethodsCross-sectional study using four tracer conditions. Structured interviews with 828 in-patients at twelve provincial and district hospitals on the subject of insurance protection, income and expenditures for treatment, including informal payment. Evaluation of each patient's medical record for appropriateness of drug use using a checklist of treatment guidelines (maximum score = 10).ResultsNo significant difference in appropriateness of care for patients at different income levels, but higher expenditures for patients with the highest income level. The score for appropriate drug use in insured patients was significantly higher than uninsured patients (5.9 vs. 4.9), and the length of stay in days significantly shorter (2.7 vs. 3.7). Insured patients paid significantly less than uninsured patients, both for medicines (USD 14.8 vs. 43.9) and diagnostic tests (USD 5.9 vs. 9.2). On the contrary the score for appropriateness of drug use in patients making informal payments was significantly lower than patients not making informal payments (3.5 vs. 5.1), and the length of stay significantly longer (6.8 vs. 3.2), while expenditures were significantly higher both for medicines (USD 124.5 vs. 28.8) and diagnostic tests (USD 14.1 vs. 7.7).ConclusionsThe lower expenditure for insured patients can help reduce the number of households experiencing catastrophic health expenditure. The positive effects of insurance schemes on expenditure and appropriate use of medicines may be associated with the long-term effects of promoting rational use of drugs, including support to active DTC work.

Informal Payments for Inpatient Services and Related Factors: A Cross-Sectional Study in Tehran, Iran

“…The most common form of informal payments was in cash, which is in line with the findings of previous studies (6,9,10,24,(31)(32)(33). In some studies, most of the informal payments have been made in the form of non-monetary gifts (28,34,35).…”

Health policy evolution in Lao People’s Democratic Republic: context, processes and agency

“…Annear and Ahmed 2012 ; Alkenbrack et al 2013 ). Further, there is evidence that insured patients had lower expenditure than that of non-insured during hospital stays, although receiving higher quality care ( Syhakhang et al 2011 ; Patcharanarumol et al 2012 ). Studies have also shown that demand-side targeted approaches, such as HEFs, work better than an exemption policy ( Tangcharoensathien et al 2011 ), and that it is more costly to purchase premiums from community health insurance than direct reimbursement from HEFs ( Annear et al 2011 ).…”

“…The project was unique in its approach through the introduction of health systems research (HSR) in 1998 as part of the institution building and capacity strengthening, in which all authors have been involved in various capacities. All authors also participated from 2005 to 2009 in a research project funded by the European Commission with researchers from 10 institutions in six countries, focusing on poverty and ill-health with the ambition to feed research evidence into health policy in Lao PDR, Cambodia and China through lessons drawn from sub-projects in the three countries ( Bloom et al 2008 ; Meessen et al 2008 ; Ir et al 2010 ; Bloom 2011 ; Syhakhang et al 2011 ). Policymakers at the highest level in the Ministry of Health were consulted during the development of the research project, and the Health Care Law was chosen as a topical case of policy implementation in one of the sub-projects.…”

“…For instance, Jönsson (2002) analysed the development of the Lao NDP, Paphassarang et al (2002b) assessed the implementation of the NDP, Tomson et al (2005) studied the usefulness of research evidence in the implementation of the NDP, Boupha et al (2005) wrote a report on exemption policy covering the time from 1975 to 2005, Annear et al (2008) studied equity in health, Patcharanarumpol et al (2009) analysed health care financing for the poor, and Ahmed et al (2013) discussed organizational and institutional challenges of universal health coverage. Other articles have focused on the functioning of health insurance ( Annear et al 2011 ; Syhakhang et al 2011 ; Alkenbrack et al 2013 ) or the health system and infectious diseases ( Mounier-Jack et al 2010 ). Hence, the authors’ first hand knowledge of the policy processes has fed into the analysis, which has enriched the case descriptions and filled some of the gaps caused by the scarcity of written sources on the topic.…”

Perceptions of asymptomatic malaria infection and their implications for malaria control and elimination in Laos

“…Based on the research question of this study, all sections except section 3 submitted as manuscript elsewhere are included. Variables in the questionnaire were designed after carefully reviewing the past studies from Laos [34–36] and elsewhere [37–41]. The questionnaire was designed in English, then translated into Laotian and back translated into English to ensure validity.…”