Healthcare Utilization with Drug Acquisition and Expenses at the National Health Insurance Fund in Sudan

Yasir Ahmed Mohammed Elhadi; Abdelmuniem Ahmed; Ramy Mohamed Ghazy; Elhadi B Salih; Osman S Abdelhamed; Ramy Shaaban; Hammad Mohamed Hammad Mohamed; Alanood Elnaeem Mohamed; Noha Ahmed El Dabbah; Ashraf Ahmed Zaher Zaghloul

doi:10.3390/healthcare10040630

Healthcare Utilization with Drug Acquisition and Expenses at the National Health Insurance Fund in Sudan

Healthcare (Basel). 2022 Mar 27;10(4):630. doi: 10.3390/healthcare10040630.

Affiliations

¹ Department of Health Administration and Behavioral Sciences, High Institute of Public Health, Alexandria University, Alexandria 21561, Egypt.
² Department of Public Health, Medical Research Office, Sudanese Medical Research Association, P.O. Box 382, Khartoum 11111, Sudan.
³ Physiology Department, Faculty of Medicine, University of Gezira, Wad Madani 2667, Sudan.
⁴ Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria 21561, Egypt.
⁵ Federal Ministry of Health, Khartoum 11111, Sudan.
⁶ Teaching Assistant, Faculty of Medicine, Ahfad University for Women, P.O. Box 167, Omdurman 14415, Sudan.
⁷ Department of Instructional Technology and Learning Sciences, Utah State University, Logan, UT 84321, USA.
⁸ Al-Mana General Hospital, Al-Jubail 35718, Saudi Arabia.
⁹ Faculty of Pharmacy, University of Science and Technology, Khartoum 11111, Sudan.

Abstract

Background: Understanding the pattern of care use can provide valuable information for reform interventions. This study investigates the pattern of healthcare utilization and its association with drug acquisition patterns and expenses in the National Health Insurance Fund (NHIF) of Al Jazira State in Sudan. Methods: A cross-sectional survey was conducted at NHIF primary healthcare centers of Al Jazirah state in Sudan. Results: A total of 768 beneficiaries were interviewed, of which 63.2% reported using out-of-network physician care, while 36.8% receive care from the NHIF physician network only. More than half (60.8%) of NHIF-interviewed clients reported a heavy burden of medication costs. The pattern of physician utilization was significantly associated with the number and source of regular drugs, the burden of out-of-pocket payment, and monthly out-of-pocket expenditures on medications, (p < 0.001). The regression analysis revealed that gender, marital status, number of chronic diseases, and number of regular drugs were the significant predictors of the pattern of physician care utilization; these factors explained nearly 36% of the variance in respondents’ pattern of physician care utilization. Conclusions: An impressive proportion of out-of-network care was found in Al Jazirah State in Sudan. The NHIF stakeholders should consider medication subsidy as a potential strategy for decreasing patient leakage to out-of-network services.

Keywords: National Health Insurance Fund; Sudan; catastrophic health expenditure; drug acquisition; health insurance; medication costs; out-of-network utilization.