Financial Burden, Insurance Type, and Medication Adherence Among Community-Managed Patients with Hyperthyroidism: A Cross-Sectional Study from Nanning, China

Abstract

Background Hyperthyroidism necessitates prolonged pharmacotherapy; however, adherence is frequently inadequate in community settings. Although knowledge gaps are frequently cited, the impact of socioeconomic factors and health system fragmentation – particularly in middle-income countries undergoing health reforms – remains less understood. The present study aimed to investigate the prevalence of non-adherence and its association with socioeconomic status, out-of-pocket expenditure, and health insurance schemes among community-dwelling patients with hyperthyroidism in urban China, with a specific focus on financial and structural barriers. Methods A cross-sectional survey was conducted from June 2022 to December 2023 at Xianhu community health service centre in Nanning, China. Using convenience sampling, a total of 102 adults with confirmed hyperthyroidism (mean age 45.2±12.7 years; 62.7% female) were enrolled in the study. The following instruments were included in the validation process: the Morisky, Green, and Levine Medication Adherence Scale (MGLS), the Beliefs about Medicines Questionnaire-Specific (BMQ-Specific), the Hyperthyroidism-Related Knowledge Questionnaire, and the Medication Knowledge Questionnaire. Multivariable linear regression models were utilised to identify independent predictors of medication adherence and knowledge scores. Results The mean MG score was 2.61±1.06, with 26.5% of patients classified as having low adherence (MGLS ≥3) Participants demonstrated suboptimal medication knowledge, with a mean score of 28.15±7.82 out of 48.A clear insurance gradient was observed, with self-paid patients exhibiting the worst adherence (MG 3.30±0.82), compared to Urban Employee Basic Medical Insurance (UEBMI) beneficiaries (2.39±1.29) and New Cooperative Medical Scheme (NCMS) enrollees (2.62±0.95) (P=0.048). Multivariable analysis revealed that monthly out-of-pocket expenditure exceeding 600 RMB was significantly associated with poorer adherence in the full adjusted model (β=0.364, P=0.006). After adjustment for economic factors, neither education level nor disease knowledge remained significantly associated with adherence, suggesting that financial variables were more strongly associated with adherence than knowledge variables in this sample. Future longitudinal studies are needed to confirm these associations. Conclusion In this single-centre cross-sectional study, financial burden, rather than lack of knowledge, was associated with medication non-adherence among community-managed hyperthyroidism patients. The fragmentation of the insurance system may give rise to disparities in health outcomes. Policy interventions should consider reducing copayments for outpatient chronic medications and strengthening financial protection for self-paid patients. Plain Language Summary Why we did this study : Many people with hyperthyroidism do not take their medicine as prescribed, even though long-term treatment is needed to stay healthy. We wanted to find out what stops patients from taking their medication correctly, especially whether money problems and different types of health insurance make a difference. S2001 What we did : We studied 102 patients being treated for hyperthyroidism at a community health center in Nanning, China. We collected information about their medication adherence, monthly out-of-pocket costs, health insurance type, and disease-related knowledge. S2002 What we found : About 1 in 4 patients had poor adherence. The biggest barrier was financial burden, not lack of knowledge. Patients who paid more than 300 RMB per month and self-paid patients had much lower adherence. Better insurance coverage was linked to better adherence. S2003 What this means : High medication costs and unequal insurance benefits are major barriers to adherence. Policies should reduce out-of-pocket costs for chronic medications and strengthen financial protection for vulnerable patients. Patient education alone is not enough when cost is the main problem. S2004 plain-language-summary