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Citation Information

Type Thesis or Dissertation - PhD Thesis
Title The impact of the Jamaican Drugs for the Elderly program on access to care and spending on prescription medications
Author(s)
Publication (Day/Month/Year) 2006
Abstract
This study assessed the impact of the Jamaica Drugs for the Elderly Program (JADEP), instituted nationally in Jamaica during the fall of 1996, from two perspectives: (1)?elders' access to medical services and prescription drugs, and (2)?as an effective model, for reducing elders' drug expenditures.

The study was based on site visits and the analysis of two sources of secondary data: (1)?Jamaica's annual household Survey of Living Conditions, containing a sample of approximately 200 elderly persons (ages 60+) in each of two years before (1995 and 1996) and after (1999 and 2000) the JADEP began; and (2)?JADEP administrative data for those years. For comparison, trends in non-elderly (ages 35-59) were studied through samples from the same years. The methodology for secondary data analysis included descriptive, bivariate, and multivariate analyses. Primary data, collected through interviews of pharmacists and other stakeholders, complemented the secondary data analysis by providing contextual information. The study framework was derived from the Health Belief and the Andersen theoretical models. Those models suggest that JADEP will reduce a financial barrier and thereby increase the likelihood that an ill person will access care (i.e., see a provider and/or buy medicines).

The research analyses showed that despite implementation challenges, JADEP succeeded in enrolling 59% of persons aged 60 and above by the year 2000, and 52% of pharmacies were participating outlets. The null hypotheses for this research (no impacts of JADEP) were rejected.

The program provided marginally significant improvement in access for elders compared to non-elderly persons. Significantly more elders bought medicines but each purchaser spent less after JADEP. Interaction effects showed that elderly males improved more than elderly females in buying medicines. Rural elders became 21 more likely to buy medicines and 17% more likely to access care than urban elders.

This study generates several policy recommendations. JADEP should: (1)?computerize drug-dispensing activities at participating pharmacies to reduce paperwork requirements; (2)?be given additional manpower to achieve publicity and registration efficiently, and conduct regular management oversight of participating pharmacies; (3)?improve outreach and ongoing publicity to targeted population segments, and (4)?offer financial incentives to private pharmacies in JADEP.

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