Evidence map›Paper›PMID 39965862›Full record

ArticleBMJ global health2025

Public patient forwarding to private pharmacies: an analysis of data linking patients, facilities and pharmacies in the state of Odisha, India.

Annie Haakenstad, Anuska Kalita, Bijetri Bose, Arpita Chakraborty, Kirti Gupta, Sian Hsiang-Te Tsuei, Liana Rosenkrantz Woskie, Winnie Yip

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Article in BMJ global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Annie HaakenstadInstitute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA ahaak@uw.edu.ORCID http://orcid.org/0000-0003-1517-4639
Anuska KalitaGlobal Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA.
Bijetri BoseUniversity of California Los Angeles Jonathan and Karin Fielding School of Public Health, Los Angeles, California, USA.
Arpita ChakrabortyOxford Policy Management, 4/6 First Floor, Siri Fort Institutional Area, New Delhi, India.
Kirti GuptaOxford Policy Management, 4/6 First Floor, Siri Fort Institutional Area, New Delhi, India.
Sian Hsiang-Te TsueiThe University of British Columbia Department of Family Practice, Vancouver, British Columbia, Canada.ORCID http://orcid.org/0000-0002-9540-9399
Liana Rosenkrantz WoskieDepartment of Community Health, Tufts University, Boston, Massachusetts, USA.
Winnie YipGlobal Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionIn India, public sector patients purchase drugs from private pharmacies instead of obtaining them for free from public pharmacies-a phenomenon we call public patient forwarding to private pharmacies. This behaviour results in substantial financial hardship. We examine whether low public drug stocks, patient preferences for private drugs or the presence of private pharmacies nearby explain this behaviour.

methodsWe collected cross-sectional data from 7567 households, 523 health facilities and 1036 private pharmacies in Odisha, India. We linked 917 outpatient visits to facilities based on patient reports and linked public facilities to the nearest private pharmacy using Global Positioning System coordinates. We used ordinary least squares regression to assess whether the behaviour of facilities and patients was associated with drug stocks and pharmacy proximity, and whether patient satisfaction was associated with private drug purchases.

resultsAmong public patients prescribed drugs, more than 70% purchased private drugs. In hospitals, for each 10% increase in drug stocks, 4.8% fewer patients purchased private drugs (p=0.047). In primary facilities, the same share of patients purchased private drugs across stock levels. Regardless of facility level, when more than 75% of drugs were in stock, 60% or more of patients still obtained drugs from the private sector. Patients were more likely to purchase private drugs when private pharmacies were near public facilities, but were not more satisfied with their visit when they obtained private drugs.

conclusionThe results suggest that private pharmacies are both secondary and complementary suppliers of drugs for hospitals, but may act more like substitutes for primary facilities, consistent with evidence that private pharmacies provide advice and other services akin to primary care in Odisha. Improving public facility drug stocks alone is unlikely to fully address drug-driven financial hardship in India. Provider prescribing practices should be investigated to identify additional policy options.

Indexed as

PharmaciesPrescription DrugsPrivate SectorPublic SectorAdultCross-Sectional StudiesFemaleHumansIndiaMaleMiddle AgedPatient PreferencePatient SatisfactionPrescription DrugsCross-sectional surveyHealth policyHealth services researchHealth systemsIndia

Identifiers

PMID39965862
PMCPMC11836861

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