Influence of provider’s behavior on utilization of health services by insured clients: the case of induced demand for drug prescription

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University of Dar es Salaam
The National Health Insurance (NHIF), in Tanzania, was initiated to reduce the impact of out of pocket expenditures among government employees and their dependents. Across – sectional study was conducted in NHIF accredited health facilities in Dar es Salaam, to explore providers’ prescription and consumers’ behavior associated with utilization of health services, especially of drug consumption. Study group consisted of 220 NHIF members attending outpatient care, 70 health providers in four accredited health facilities and ten NHIF staff from the headquarters. The study was conducted in two public and two private hospitals in accredited health facilities. Quantitative and observation data collection method was used to collect the data. \data was analyzed using Epi Info 6 version, where appropriate association and strength of relationship between independent and dependent variables were obtained using the appropriate statistical tests. The findings of this study show that majority (57.7%) of providers and to prescribe three to four drugs of health condition. Also, the study shows that majority of the prescribers ere prescribing generic drugs. However, some of them did not know the type of drugs that they were prescribing. About 34.7% of the NHIF members had asked the prescribers to prescribe drugs of their own choice. It was also noted that the NHIF members who had a low level of education received more drugs for one health problem. Also, the study noted that only a quarter of the prescribers followed NEDLT guidelines, and the rest did not. Therefore, the prescribers who were not aware of the NEDLIT guidelines tend to prescribe a large number of drugs for a health condition. This study shows no significance difference of the prescribing behavior among prescribers in public and private hospitals. This study noted that benefit package by the scheme had no restrictions on drug prescription, especially on the number of drugs to be prescribed per illness episode, which could be the loopholes that influence the prescribers to over- prescribe. This study recommends that there should be a proper monitoring system to curb induced demand for drug prescription in all accredited health facilities. Furthermore, more studies on drug consumption should be conducted to explore the ways to reduce inappropriate prescribing and over prescribing.
Available in print form, East Africana Collection, Dr. Wilbert Chagula Library, Class mark (THS EAF HD7104.5.K32)
Insurence, Health, Public health service, Drug prescription, need, National Heath Insurance Fund (NHIF), Tanzania
Kabanywanyi, M. (2006) Influence of provider’s behavior on utilization of health services by insured clients: the case of induced demand for drug prescription, Master dissertation, University of Dar es Salaam, Dar es Salaam