Determinants of Cost-Related Nonadherence to Medications among Chronically Ill Patients in Maccabi Healthcare Services, Israel

Tzahit Simon-Tuval; Noa Triki; Gabriel Chodick; Dan Greenberg

doi:10.1016/j.vhri.2014.06.010

Determinants of Cost-Related Nonadherence to Medications among Chronically Ill Patients in Maccabi Healthcare Services, Israel

Value Health Reg Issues. 2014 Sep:4:41-46. doi: 10.1016/j.vhri.2014.06.010. Epub 2014 Jul 26.

Authors

Tzahit Simon-Tuval¹, Noa Triki², Gabriel Chodick³, Dan Greenberg⁴

Affiliations

¹ Department of Health Systems Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. Electronic address: simont@som.bgu.ac.il.
² Medical Division, Maccabi Healthcare Services, Tel-Aviv, Israel.
³ Medical Division, Maccabi Healthcare Services, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
⁴ Department of Health Systems Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

PMID: 29702805
DOI: 10.1016/j.vhri.2014.06.010

Abstract

Background: The effectiveness of value-based insurance design is based on nonadherence, which derives solely from patients' economic constraints.

Objective: Our objective was to examine the extent of cost-related nonadherence to chronic medications and to analyze its potential determinants.

Methods: We conducted a telephone survey among a representative sample of Maccabi Healthcare Services chronically ill patients aged 55 years or older (n = 522). We developed a 12-month recall questionnaire that included demographic and socioeconomic characteristics, out-of-pocket expenditure on prescribed medication, physician's provision of explanation regarding prescribed therapy, adherence, and reasons for nonadherence. Respondents were defined as nonadherent if they reported that they did not purchase prescribed medications in the previous year because of their cost. We applied the multivariable logistic regression model to examine predictors of nonadherence.

Results: Median (interquartile range) age of the study sample was 69 (13) years (53% males). One hundred sixty-five patients (31.6%) reported not purchasing prescribed medications mainly because of medications' adverse effects and/or cost. Fifty respondents (9.6%) reported cost-related nonadherence. The multivariable logistic regression model revealed that cost-related nonadherence was associated with respondent's income lower than 4600 New Israeli shekel (odds ratio [OR] = 10.86; 95% confidence interval [CI] 1.45-81.12), unemployment (OR = 4.32; 95% CI 1.47-12.66), lack of physician explanation about the prescribed medication (OR = 2.38; 95% CI 1.18-4.78), and age (OR = 0.95; 95% CI 0.91-0.99).

Conclusions: Cost-related nonadherence to chronic pharmaceuticals is self-reported among nearly 10% of the chronically ill patients and is strongly affected by low socioeconomic status, even under universal health insurance coverage and with relatively low co-payments as applied in Israel. Lack of information provided by physicians regarding the therapy is associated with a higher likelihood of cost-related nonadherence.

Keywords: chronic medications; co-payment; cost; nonadherence; value-based insurance design.