Title: Proportionate sharing of drugs from hospital pharmacy and out-of-pocket

in patients admitted in Medical ward of Services Hospital Lahore

Presented by:
Student name:
Hafiz Muhammad Salman

Batch: C

Class roll no: 56

Tutor name: Dr.

Saeed Ahmed Khan

Mentor name: Dr.

Muhammad Tauseef

DEPARTMENT OF COMMUNITY MEDICINE

Services Institute of Medical Sciences

CERTIFICATE OF APPROVAL

It is certified that Hafiz Muhammad Salman has developed this research format/synopsis as
partial fulfillment of her fourth year MBBS Community Medicine curriculum under my
supervision. Her work in this regard is satisfactory.
Signature of the supervisor--------------------------Date-------------------------

Signature of the mentor------------------------------Date-------------------------

Signature of the HOD ---------------------------------Date--------------------------

INTRODUCTION:

The Millennium Development Goals (MDGs) have put health at the heart of the development
agenda, with three out of eight Goals directly related to improvement in health status. These
goals and targets emphasize the importance of health. [1]

In Developed countries.
In developed countries, most people have their health insurances and their Government
provided a lot of health facilities. Despite the fact people have expense a lot in term of out-of-
pocket expenses. Out-of-pocket costs are high especially when it comes to prescription drugs
in the United States. [2]
In Developing Countries.
Medicine costs continue to account for a large share of all out-of-pocket health expenses
incurred by Indians, out of all health expenditure, 72% in rural and 68% in urban areas was
for buying medicines for non-hospitalised treatment, according to the ‘Health in India’ report,
which draws data from the 71st round of the National Sample Survey conducted from
January to June 2014. [3]

In other developing countries like Pakistan, Bangladesh and Nepal expenditure on medicine
accounts for the largest component of out-of-pocket expenses in both public and private
facilities. On average, medicines represented over 57% of outpatient out-of-pocket at public
facilities and over 45% of outpatient out-of-pocket at private facilities. [4]

Trends in Pakistan.
Like the other developing countries out-of-pocket health expenditure is very high among
patients. According to the National Health accounts report of 2011-12 total out-of-pocket
health expenditure is about 315 billion in one year Punjab has the highest share (54%) of the
total out-of-pocket health spending, followed by Sindh (24%).KP (including FATA) has 16%
share while Balochistan has just 5% share of the total out-of-pocket health spending.

In Pakistan, almost 50% of the total out-of-pocket spending are incurred on

“Medicine/Vaccine”, Further analysis of out-of-pocket data with regard to provinces finds
that out-of-pocket spending on “Medicine/Vaccine” is highest in Punjab (54.47%) followed
by KP (47.64%), Balochistan (41.18%) while the lowest share is of Sindh (39.69%). [5]

Trends in Punjab.

According to the Punjab government medicine for the treatment of dengue i.e. dextran 40 in
saline is available from the hospital pharmacy of DHQs and THQs but BHU and RHC do not
have dengue medicine so patient have to buy that medicine from their own pockets.
Similarly, drugs like muscle relaxants and opiod analgesics are only available in DHQs and
THQs of Punjab Hospitals and BHUs and RHCs do not have such medicine so patients have
to buy those medications from their own pockets.

This paper examines one of the financing dimensions of health that is Out-of-pocket (OOP)
expenditure. Out-of-pocket spending is an inefficient way of financing health care. It can
have a negative impact on equity as this increases the burden on common people who cannot
afford the medical expenses. As we know that major proportion of out-of-pocket expenditure
lies in the medicine expenses so this study is conducted to find the medicine which are
provided by the pharmacy of the Government hospitals to the patients and other drugs which
patients have to purchase from their own pockets.
Objectives are:

To assess the proportionate sharing of drugs from the hospital.

To assess the out-of-pocket expenses of patient in terms of purchasing medicine.

METHODOLOGY:

STUDY DESIGN:

A Cross Sectional Study.

STUDY SETTING:

The Medical Wards of Services Hospital Lahore. A tertiary level hospital located on Jail
Road, Lahore.

STUDY POPULATION:

Patients admitted in the medical wards of Services Hospital Lahore.

STUDY DURATION:

It was conducted over a period of one month.

SAMPLE SIZE:

Sample size will be estimated using WHO s-size software by using formula of estimation of
population proportion with specified relative precision at confidence level 95% and
anticipated population proportion 65% with relative precision 10%. The minimum sample
size will be 207.

SAMPLING TECHNIQUE:

Non-probability convenience sampling technique will be used.

INCLUSION CRITERIA:

All patients form Medical ward of Services Hospital.

DATA COLLECTION TOOL:

A detailed pretested Questionnaire.

DATA COLLECTION PROCEDURE:

A detailed structure questionnaire (attached in annexure) will be used for collection of data.
Face to face interview will be conducted with questionnaire in translated form. All the data
will be collected by researcher himself. Questionnaire used will be checked on daily basis for
completeness and accuracy by researchers. All the consenting patients meeting the inclusion
criteria will be approached in medical ward and pre-tested questionnaire will be filled by
members via face to face method after proper introduction of process. Close end question will
be asked.

DATA ANALYSIS PLAN:

SPSS computer software will be used for entry, compilation and analysis of data. For
quantitative variables, mean and standard deviation will be calculated. For qualitative
variables, frequency and percentage distribution tables will be generated

OPERATIONAL DEFINITIONS:
REFERENCES:

1.Charu C Garg, Anup K Karan; Reducing out-of-pocket expenditures to reduce poverty: a

disaggregated analysis at rural-urban and state level in India. Health Policy Plan 2009; 24
(2): 116-128. doi: 10.1093/heapol/czn046

2. Hurd MD, Martorell P, Delavande A, Mullen KJ, Langa KM (2013). "Monetary costs of

dementia in the United States”.
3.Saksena P, Xu K, Elovainio R, Perrot J. Health services utilization and out-of-
pocket expenditure at public and private facilities in low-income countries.
World health report. 2010; 20:20.
4.bajwa, asif. PAKISTAN NATIONAL HEALTH ACCOUNTS 2011-12. 1st ed. 2014. Print.

CONSENT

We are conducting a research study titled as

This study is being conducted by 4th year medical students of SIMS Lahore. The purpose of
this study is to---------------------------------------------- Your participation in this study is
completely voluntarily and if you agree to take part in this study, you will be asked some
questions about your profile & ------------history. To best of our ability your data and answers
in this study will remain confidential and your data will be used only for study purposes.
There are no physical, psychological or social risk factors involved in this study.
 CONSENT STATEMENT:
I agree to take part in this project. I know what I have to do and I know that I can stop it any
time.

Signature: ----------------------- Date: ----------------------

QUESTIONNAIRE:

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