A Cross-Sectional Study to Evaluate the Awareness and Attitudes of Physicians towards Reducing the Cost of Prescription Drugs, Mumbai

By Billa, Gauri; Thakkar, Karan et al. | Applied Health Economics and Health Policy, April 2014 | Go to article overview

A Cross-Sectional Study to Evaluate the Awareness and Attitudes of Physicians towards Reducing the Cost of Prescription Drugs, Mumbai


Billa, Gauri, Thakkar, Karan, Jaiswar, Sarita, Dhodi, Dinesh, Applied Health Economics and Health Policy


Published online: 4 February 2014

© Springer International Publishing Switzerland 2014

Abstract

Background In India, about half of the total health expenditure is spent on medicines. The projected increase in various diseases coupled with the skyrocketing drug prices have further compounded the drug cost burden. We conducted a study to assess the awareness, attitudes, and practices of physicians with regard to various cost containment measures and the factors affecting them.

Methods A cross-sectional, questionnaire-based, observational study was conducted over a period of 3 months among 200 physicians, after permission from the Institutional Ethics Committee, at the Grant Medical College and Sir J J Group of Hospitals, Mumbai. The STROBE (Strengthening The Reporting of OBservational studies in Epidemiology) guidelines were followed.

Results Cost considerations were important to 97 % of government doctors (GDs) and 72 % of private doctors (PDs). Eighty percent of both GDs and PDs said that safety and efficacy were more important than cost. Seventy-one percent of GDs and 65 % of PDs knew about the various cost reduction methods. Twenty-four percent of GDs and 65 % of PDs said that they graded drugs according to cost. Ninety-four percent of GDs and 73 % of PDs said that patent protection should not be extended to life-saving drugs. Sixty-four percent of GDs and 10 % of PDs, and 20 % of GDs and 10 % of PDs were in favor of the stepwise introduction of drugs and the use of generics, respectively. Factors precluding the use of cheaper alternatives were narrow therapeutic index drugs (43.5 %) and fear of substandard quality (38.5 %).

Conclusion Doctors are indeed concerned about the high cost of drugs. More awareness needs to be created about the use of cheaper generics. The government has a very important role to play in reducing the cost of prescription drugs and making healthcare affordable.

1 Introduction

An average Indian household may spend about 50 % of its total health expenditures on medicines alone. According to the National Sample Survey (NSS) for the year 1999-2000, in rural India, the share of drugs in the total out-of-pocket expenditure was estimated to be nearly 83 %, while in urban India, it was 77 % [1]. About 400 million or more of the nation's citizens live in severe poverty. In rural areas, where two thirds of the nation's people are still located, the median household income is little more than US $500 a year [2]. In such circumstances, it is not surprising that that about 20 million people in India fall below the poverty line each year because of indebtedness as a result of healthcare needs [3].

Drug prices are outstripping the prices of all commodities. An examination of the price trends of 152 drugs in India reveals antibiotics, anti-tuberculosis and anti-malarial drugs, and drugs for cardiac disorders registered price increases from 1 to 15 % per annum during 1976-2000 [4].

The steady increase in the incidence and prevalence of various diseases/disorders will further compound the problem. It is estimated that by 2015 the number of HIV/AIDS cases would be three times more than that in 2005, entailing possibly a corresponding increase in the prevalence level of tuberculosis of about 8,500,000 cases. Cardiovascular diseases and diabetes mellitus will more than double. Cancers will rise by 25 %. In the coming 5 years, there will be an enormous increase in various health disorders thereby increasing the healthcare costs geometrically [4]. This will put a huge strain on an economy already reeling under an economic crisiswith inflation touching newheights and the rupee reaching a newlow. Furthermore, higher drug costs have been shown to negatively impact patient outcomes [5, 6].

It is important to know about the physician's understanding of the various cost considerations and their implications so as to take solid measures in reducing the overall cost of healthcare [7-9]. …

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