'The national health insurance policy provides little to no benefit to young persons living with type 1 diabetes (T1D)': a qualitative study of T1D management cost-burden in Southern Ghana.

IF 2.7 3区 经济学 Q1 ECONOMICS Health Economics Review Pub Date : 2024-09-16 DOI:10.1186/s13561-024-00531-5
Bernard Afriyie Owusu, Nana Ama Barnes, David Teye Doku
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Abstract

Background: 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.

Objective: This study explored the cost of T1D management, and the impact of the NHIS policy on mitigating costs of care.

Methods: 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.

Results: 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.

Conclusion: 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.

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国家医疗保险政策对患有 1 型糖尿病 (T1D) 的年轻人几乎没有任何好处":对加纳南部 T1D 管理成本负担的定性研究。
背景:1 型糖尿病(T1D)的治疗给患者、护理人员和整个发展中国家带来了巨大的经济负担。在加纳,政府为减轻 T1D 给患者带来的经济负担所做的一项重要工作就是通过财务风险共担/分担(即国家健康保险计划 (NHIS))建立安全网机制。然而,关于加纳患者和护理人员在国家健康保险计划内管理 T1D 的费用方面的经验的研究却很有限:本研究探讨了 T1D 的管理成本以及 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,从西部、中部和大阿克拉地区的 28 名 T1D 青少年患者(PLWD)、12 名护理人员、6 名医疗服务提供者和其他利益相关者那里收集定性数据。收集数据时使用了多种数据收集技术,包括神秘客户和深度访谈。使用 QSR NVivo 14 进行了主题内容分析: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、饮食成本和 NHIS。每天检测血糖和注射胰岛素的费用介于 5 至 7 格查尔(0.6 至 1.0 美元)之间。国家医疗保险计划不包括血糖试纸、血糖仪、HbA1c 检测和定期医疗检查等用品的费用。即使是那些由国家医疗保险计划支付的费用(主要是预混胰岛素),政府在向经认可的国家医疗保险计划机构报销资金方面的明显拖延也迫使医疗服务提供者将经济责任推给患者和护理人员。根据地区和居住地的不同,这些费用通过自费补充或全额支付胰岛素的方式来履行,金额约为 15-25 吉林吉亚(2-4 美元)和 25-50 吉林吉亚(4-8 美元):治疗 T1D 的费用是患者及其护理人员的负担。在加纳市场上,救命的胰岛素被商品化了,而国家医疗保险体系并没有很好地减轻 T1D 患者和护理人员的管理成本负担。研究结果呼吁有必要扩大国家医疗保险计划的服务范围,将简单的用品,尤其是试纸纳入其中,并始终确保医疗机构提供救命的胰岛素。
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来源期刊
CiteScore
3.90
自引率
4.20%
发文量
59
审稿时长
13 weeks
期刊介绍: Health Economics Review is an international high-quality journal covering all fields of Health Economics. A broad range of theoretical contributions, empirical studies and analyses of health policy with a health economic focus will be considered for publication. Its scope includes macro- and microeconomics of health care financing, health insurance and reimbursement as well as health economic evaluation, health services research and health policy analysis. Further research topics are the individual and institutional aspects of health care management and the growing importance of health care in developing countries.
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