Assessing Supplier Induced Demand in Community Pharmacies in Nairobi (Research Proposal Sample)

ASSESSING THE SUPPLIER INDUCED DEMAND IN COMMUNITY PHARMACIES IN NAIROBI
EMMANUEL MULAA
X53/87759/2016
THE UNIVERSITY OF NAIROBI
QUANTITATIVE RESEARCH METHODS
XET 550
LECTURER: DR. DANIEL MWAI
Table of Contents TOC \o "1-3" \h \z \u ABSTRACT PAGEREF _Toc486794312 \h ivCHAPTER ONE : INTRODUCTION PAGEREF _Toc486794313 \h 11.1 BACKGROUND INFORMATION PAGEREF _Toc486794314 \h 11.2 PROBLEM STATEMENT PAGEREF _Toc486794315 \h 21.3 OBJECTIVES OF THE STUDY PAGEREF _Toc486794316 \h 31.3.1 General objectives PAGEREF _Toc486794317 \h 31.3.2 Specific objectives PAGEREF _Toc486794318 \h 31.4 JUSTIFICATION OF THE STUDY PAGEREF _Toc486794319 \h 31.5 HYPOTHESIS PAGEREF _Toc486794320 \h 3CHAPTER TWO : LITERATURE REVIEW PAGEREF _Toc486794321 \h 42.1 THEORITICAL LITERATURE REVIEW PAGEREF _Toc486794322 \h 42.1.1 The healthcare market PAGEREF _Toc486794323 \h 42.1.2 Principal-agency relationship in health care PAGEREF _Toc486794324 \h 52.1.3 Determinants of supply induced demand in healthcare PAGEREF _Toc486794325 \h 52.1.4 Limitations in the research on SID PAGEREF _Toc486794326 \h 72.2 EMPIRICAL LITERATURE REVIEW PAGEREF _Toc486794327 \h 82.3 SUMMARY OF LITERATURE REVIEW PAGEREF _Toc486794328 \h 10CHAPTER THREE : METHODOLOGY PAGEREF _Toc486794329 \h 113.1 STUDY AREA PAGEREF _Toc486794330 \h 113.2 STUDY POPULATION PAGEREF _Toc486794331 \h 113.3 STUDY DESIGN PAGEREF _Toc486794332 \h 113.4 SAMPLE SIZE DETERMINATION PAGEREF _Toc486794333 \h 113.5 SAMPLING METHODS PAGEREF _Toc486794334 \h 123.6 INCLUSION AND EXCLUSION CRITERIA PAGEREF _Toc486794335 \h 123.6.1 Inclusion criteria PAGEREF _Toc486794336 \h 123.6.2 Exclusion criteria PAGEREF _Toc486794337 \h 123.7 DATA COLLECTION, INSTRUMENTS AND TECHNIQUES PAGEREF _Toc486794338 \h 133.8 VARIABLES PAGEREF _Toc486794339 \h 133.9 DATA ANALYSIS AND PRESENTATION PAGEREF _Toc486794340 \h 143.10 RELIABILITY AND VALIDITY PAGEREF _Toc486794341 \h 143.11 PRIVACY AND CONFIDENTIALITY PAGEREF _Toc486794342 \h 143.12 BENEFITS OF STUDY PAGEREF _Toc486794343 \h 144.0 APPENDICES PAGEREF _Toc486794344 \h 164.1 DATA COLLECTION FORM PAGEREF _Toc486794345 \h 16REFERENCES PAGEREF _Toc486794346 \h 19
ABSTRACT
Costs incurred in delivering health outcomes to patients are a very vital part of any health system. Of these, medications costs form a big chunk. A factor that has been attributed to these spiraling medication costs is supplier-induced demand(SID). There exists a gap of information on this topic. Globally, research on supplier-induced demand in healthcare has focused on physician induced demand. In developing countries, including Kenya, most patients visit a community pharmacy as their first contact with a healthcare provider where they buy medications over the counter. This is where they experience the induced demand by the providers at that level. This study seeks to assess this induced demand.
This will be a qualitative research that uses a cross-sectional study design to assess SID at the level of a community pharmacy. A random sample of patients that visit selected community pharmacies will be interviewed and a questionnaire filled. Information collected by the researcher using the questionnaires will be mainly on medications purchased, information asymmetry and provider characteristics.
The objectives of this study is to determine the proportion of patients visiting community pharmacies as their first contact with health providers, average number of medications sold over- the-counter and level of information asymmetry in this agency relationship. This will test the hypothesis that there exists SID in community pharmacies in Nairobi.
The results of this study will impact on the policy makers, patients and community pharmacies. Policy makers should make informed decisions while patients are made aware of the existence of this vice. Community pharmacies on the other are encouraged to enhance sound medical decisions that are ethical and improve health outcomes.
CHAPTER ONE : INTRODUCTION
1.1 BACKGROUND INFORMATION
A community pharmacy is a retail, sometimes wholesale, outlet that sells medicines to patients over-the-counter (OTC). In Kenya, it usually run by pharmacists and other pharmacy support staff, usually the pharmaceutical technologists, and registered under The Pharmacy and Poisons Act( Cap 244) of the law. The regulatory body which does this is Pharmacy and Poisons Board(PPB). PPB is also responsible for registration of all medicines, both conventional and herbal, and regulation of the pharmacy practice in Kenya.
Globally the practice of pharmacy has undergone great transformation. Pharmacist have shifted from specialists on medicines only to pharmaceutical care providers and a core of the medical care team. This was necessitated by the fact that by their skill set and location in the medical field they have been greatly underutilized CITATION Mat04 \l 1033 (Matowe, 2004).This has also come with change in the curriculum of their training that has made it more patient-centered so as to complement effort of other healthcare providers and therefore improve patient outcomes. The developed countries, mainly in Europe and America, they have been successful in integrating pharmacists as part of the medical care team and utilized them more effectively.
In Kenya, the community pharmacy is usually the first point of contact between a patient and a healthcare provider and probably the largest proportion of those seeking health. It is sometimes the only point of contact with a health provider. This is because the pharmacists do not charge for consultation, one only pays for the cost of the medicines, unlike the other health providers that are the physicians. This therefore brings the cost of healthcare down from the patient's perspective.
This highlights two major issues of concern. First is the quality of care the patients receive. It is imperative therefore that pharmacists and other pharmacy support staff are well-trained with proper knowledge and skills and are adequate since they are the service delivery channel for healthcare for a big proportion of citizens seeking health services. According to the Economic Survey 2017, there are 3169 registered pharmacists (translating to 7 per 100,000 of population) and 8673 enrolled pharmaceutical technologists (translating to 19 per 100, 000 of population) in Kenya in 2016. This numbers are still very and need to be improved.
The other issue and the focus of this study is the agency relationship between the community pharmacy staff (herein referred to as pharmacists) as the providers and the patient seeking care. The pharmacists and pharmaceutical technologists are involved in OTC prescription and dispensing of medicines to the patients. Therefore the patient is the principal and employs the pharmacist or pharmaceutical technologist as their agent to offer them health service when they go the community pharmacy.
1.2 PROBLEM STATEMENT
This research seeks to assess the principal-agent problem between the principal (patients) and the agents (pharmacists). The agents in this case are the health care providers. The principal-agent problem in health care exists when the provider, being an imperfect agent of the patient, acts to maximize profits at the expense of the patient's interests CITATION Ngu11 \l 1033 (Nguyen, 2011).
At community pharmacy level, the pharmacist prescribes over-the-counter and dispenses more medication than is needed by the patient. The patient in paying for this medicines shifts the demand curve for health care to the right and thus the provider is able to make more than they would otherwise make under normal circumstances. This creates supplier-induced demand that significantly caused increased costs of seeking treatment.
Through this research, I intend to assess the resultant SID that will facilitate better understanding of the principal-agent relationship between and pharmacist and their patient. The research questions I seek answers to are;
* Is the principal-agent relationship in community pharmacies around Nairobi characterized by supply-induced demand?
* Does the principal-agent relationship problem of supply-induced demand occur in pharmacies around Nairobi?
* Is there any pattern that describes the supply-induced demand in community pharmacies in Nairobi.
* To what extent does the problem of supply-induced demand in community pharmacies in Nairobi occur.
1.3 OBJECTIVES OF THE STUDY
1.3.1 General objectives
To assess the supply-induced demand in community pharmacies in Nairobi
1.3.2 Specific objectives
1 To determine the number of patients around Nairobi whose first point of contact with a health professional is the community pharmacy in Nairobi.
2 To determine the average number of medications sold over-the-counter.
3 To find out the information gap between the health providers in community pharmacies vis-a-vis the patients who buy higher number of drugs against that between providers and those patients buys fewer medicines over the-the counter.
1.4 JUSTIFICATION OF THE STUDY
SID in health markets has hitherto been studied mainly from physician perspective. In developed countries, this is the perspective that accounts for a great proportion of providers exploitation of patients. However, developing countries, due to poverty a majority of the sick will first( and maybe only) visit a local community pharmacy thus the greater cases of provider induced demand will occur at the community pharmacy level. There exists a gap of information as few studies have been done to assess this provider induced demand at local pharmacies. This research...