The complex landscape of patient access: A 25-year journey

By Dr. Joseph Saba, CEO and Co-Founder of Axios International

5th February, 2024

Table of Contents

When Axios International started operations 25 years ago, the focus was on addressing financial barriers that stopped patients from obtaining necessary treatment. Over the course of Axios’ journey in the field of healthcare accessibility, gathered insights showed that beyond affordability, various other barriers throughout the patient journey stopped them from achieving optimal medical outcomes.  

As Axios grew and learned from experience, research, and real-world insights, the complexities beyond affordability were explored to enhance the patient's journey. Questions including: What can we learn from the Patient Access Programs we designed and managed? How can we keep improving them while looking at factors influencing the patient's journey? were asked. 

The patient journey: Beyond affordability 

While affordability remains a critical barrier, it is just one facet of the intricate patient journey. Over time, a holistic approach has emerged, and we acknowledge the need to sophisticate strategies and interventions to ensure optimal medical outcomes. The patient journey - depicted as a sequence from disease onset to treatment adherence – also encompasses various stages, such as diagnosis, prescription, compliance, and adherence, which we think is a given. Notably, the complexities intensify outside the hospital setting, particularly in chronic and long-term treatment scenarios, necessitating improvements at every step. 

Understanding influencing factors: A case study 

One pivotal realization in understanding access was that addressing affordability alone did not guarantee success. We had extremely generous programs, but even then, we did not have patients because the doctors didn’t refer them, or sometimes the patients refused to take the treatment when they were referred.  

Despite having a prescription and an affordable program for the patient, we noted that it was unsuccessful. So, what other factors blocked or sometimes facilitated the patient's outcome? Where was the hiccup? 

We conducted a multi-country, in-depth study with patients and physicians to research willingness to pay and willingness to prescribe and assess why the access programs were unsuccessful. We gave physicians different price ranges and found that at a certain price, regardless of whether you have a program or not, regardless of whether the patient is willing to pay or can afford it or not, physicians will not prescribe because they do not see the value for the patient in getting treated. -

Validating our findings, a case study on asthma patients also showed that perceived value played a crucial role in physician prescription decisions beyond affordability. The study identified a price threshold below which physicians were reluctant to prescribe because they did not perceive the value, emphasizing the necessity to address value perception or value pricing before implementing access programs. 

Stock image: Nurse assisting an old patient

Tailoring solutions to regional dynamics 

Regional disparities in patient mindset further underscored the need for tailored solutions. For example, a comparative analysis between India and Egypt for asthma treatment highlighted the influence of regional economic factors. In India, patients were unwilling to pay at higher price points even if they could afford it, whereas, in Egypt, a higher cost of asthma treatment influenced both physicians and patients positively.  

This was an eye-opener for us.  

Axios access experts learned not to rush into designing access programs without understanding the physicians' and patients' mindset for that disease. These Real-World Insights prompted a re-evaluation of the one-size-fits-all approach, emphasizing the importance of understanding regional specificities before implementing access programs. 

Financial assessment tools: Evolving precision 

Financial assessment tools like Axios’ proprietary Patient Financial Assessment Tool (PFET) are crucial to determining patients' ability to pay so they can complete the full course of treatment and get the best medical outcomes.  

Since 2006, the tool has been continuously refined as well as validated and published in journals such as Population Health Management and the Journal of Comparative Effectiveness Research. However, despite the presence of a validated tool, there was a need to understand the parameters for accurate financial assessment and what factors influence the patients. 

A study titled: Ability to pay for medication: a cluster analysis of 1404 patients with the Patient Financial Eligibility Tool, examining three countries – Thailand, the United Arab Emirates, and Mexico – was carried out to explore parameters influencing accurate financial assessments. By incorporating income, assets, and standard of living, the tool demonstrated flexibility in addressing diverse economic landscapes, especially in informal economies. It also showed that the standard of living and income are the biggest drivers. Following the outcomes of these studies, assessments were done to understand the country-specificities and improve the tool to overcome some of these barriers.  

Stock image: Financial assessment of a patient

Real World Insights: Why adherence matters 

Research done to assess the impact of access programs on patient adherence revealed significant improvements in treatment duration, demonstrating an increased patient adherence from 226 to 465 days on average. These findings emphasized the pivotal role of access programs in enhancing medical outcomes.  

Pharmacists’ Role: A critical insight 

In the pursuit of understanding healthcare providers’ roles, another study done by Axios International acknowledged the often-overlooked significance of pharmacists. The research done in Egypt on Chronic Obstructive Pulmonary Disease (COPD) treatment highlighted that contrary to physicians with a high patient load, smaller pharmacies demonstrated superior patient outcomes. The study also found that small pharmacies serving the community and dealing with fewer patients had a statistically significant better outcome in Egypt compared to pharmacies with many patients. This emphasized the importance of pharmacist-patient interaction, suggesting tailored strategies based on the scale of healthcare providers. A similar study in Lebanon on oncology treatment showed the reverse. Bigger pharmacies handling many patients had statistically significant better adherence and fewer dropouts than smaller pharmacies when it came to oncology treatment because specialized treatment required specific knowledge and expertise.  

Stock image: Pharmacist helping a patient with her prescription

Impact of economic crisis on medical outcomes 

A key barrier that must be considered while designing an access program is the economic barrier. 

To illustrate this point and as an example, the unforeseen impact of economic crises on patient outcomes was illuminated through an analysis of Lebanon’s economic downturn since 2019. Patients undergoing cancer treatment experienced a significant decline in survival rates post-crisis, indicating the interplay between economic factors and healthcare system support. While beyond direct influence, such findings underscored the importance of considering external economic factors in patient access strategies. Therefore, the impact of the economic crisis on the medical outcome is an important factor to consider because it shows that economic factors cannot be influenced. 

Quest for access: An enduring and dynamic journey 

The journey of providing access to healthcare is evolving, demanding constant improvement and adaptation. The intricate landscape of patient access is changing, emphasizing the need for comprehensive understanding, continuous questioning, and progressive research to overcome barriers. Axios International’s commitment to optimizing patient outcomes remains unwavering as the healthcare landscape develops, making the quest for access an enduring and dynamic journey.