The influence of health insurance scheme on the drug prescribing pattern in a Nigerian tertiary healthcare facility

Prescription medicines constitute a significant proportion of total healthcare expenditure in many countries of the world. Nonrational prescribing by healthcare providers contributes significantly to this relatively high proportion. In many developing countries of the world, a significant proportion of the population pays "out of pocket" to access healthcare, sometimes leading to catastrophic healthcare expenditure. Healthcare insurance is a form of healthcare financing that promotes judicious use of the resources and ensuring the cost-effectiveness of interventions through the use of affordable drugs. The main objective of this study was to compare concurrently the prescribing practices in the general outpatients' clinic (noninsured patients) and the National Health Insurance Scheme (NHIS) clinic (patients with insurance coverage). A cross-sectional study was conducted in the general outpatients' and the "NHIS" clinics of the Ekiti State University Teaching Hospital, Ado-Ekiti, South-western Nigeria. The medical records of patients, who attended these two clinics between the 1(st) March and 30(th) June 2014 were retrieved and used for the study. The average number of prescribed drugs for patients attending the general outpatients' clinic was 3.9 ± 2.0 while that from the NHIS clinic was 4.1 ± 1.6 (P = 0.24). Prescribing by generic names was done in 48.2 ± 23.8% and 45.8 ± 22.9% of prescriptions from the general outpatients' and NHIS clinic, respectively. Percentage of encounters with antibiotics was 49.4% and 33.6% of patients who attended the NHIS and general outpatients' clinics, respectively. There was a trend to having more medicines prescribed and more encounters with antibiotics among patients enrolled under the health insurance scheme.