Abstract
BackgroundHigh price is a major challenge limiting access to essential medicines especially among the poorest families in developing countries. The study aims to compare the prices of medicines used in the management of pain, diabetes, and cardiovascular diseases in private pharmacies and the National Health Insurance Fund (NHIF) in Tanzania. Pharmacy prices were also compared with the prices of medicines surveyed nationally by WHO/HAI in 2012.MethodThis cross-sectional study was conducted in Dar es Salaam, Morogoro, Dodoma, and Kilimanjaro regions from February to April 2015. Data were collected from 33 private pharmacies, NHIF and, the HAI database. The study used the WHO/HAI methodology. The analysis was done using non-parametric Kruskal-Wallis and post-hoc pair-wise comparison Dunn test, while a possible change in prices between our survey and 2012 WHO/HAI national survey data was tested using a Sign test in Stata version 16.1.ResultsTwenty-eight essential medicines, of which 9 are used for management of pain, 7 for diabetes, and 12 for cardiovascular diseases were analyzed. There was a significant difference in the mean pharmacy prices of some medicines between the regions and between the pharmacies and NHIF reference prices. NHIF reference prices were higher than the pharmacy prices for 16 of the 28 medicines. There was a significant increase in the prices of 5 out of the 8 medicines that were also nationally surveyed by the WHO/HAI in 2012.ConclusionThe study found that medicine prices in private pharmacies vary a lot between the study regions, which raises equity concerns. Also, there was a significant difference between the pharmacy and the NHIF reimbursement prices, which may expose patients to fraudulent co-payments or hinder timely access to prescribed medicines. Therefore, effective price control policies and regulations for medicines are warranted in Tanzania.
Highlights
Over the past two decades, there has been a substantial epidemiological transition of diseases from communicable to non-communicable diseases (NCDs)
Effective price control policies and regulations for medicines are warranted in Tanzania
For indomethacin capsules 25 mg the National Health Insurance Fund (NHIF) price was lower than pharmacy prices in Dar es Salaam and Morogoro, while the price for paracetamol tablets 500 mg was significantly higher than the NHIF reference price in Dar es Salaam by 15.4 Tshs and Dodoma by 28.8 Tsh
Summary
Over the past two decades, there has been a substantial epidemiological transition of diseases from communicable to non-communicable diseases (NCDs). NCDs such as diabetes and cardiovascular diseases do not disable a person instantly, but progress slowly and if not managed early and effectively can lead to even more severe disabling effects in the long-term [7]. The long-term health costs required for the management of NCDs that often include lengthy and expensive treatments can quickly drain household resources in low-income settings where outof-pocket health payments are common [9]. Governments in low- and middle-income countries are increasingly implementing alternative financing strategies including health insurance in an attempt to improve access to healthcare and to protect families from impoverishing health expenditures [10,11,12]. The study aims to compare the prices of medicines used in the management of pain, diabetes, and cardiovascular diseases in private pharmacies and the National Health Insurance Fund (NHIF) in Tanzania. Pharmacy prices were compared with the prices of medicines surveyed nationally by WHO/HAI in 2012
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