Is Tertiary care Treatment Affordable to All? – Explore Alternative (s) for Healthcare Financing
Abstract
Background: Health indicators such as life expectancy at birth, infant mortality rate etc. are some
of the tools to measure the social development of that country. Due to advancement in technology,
disease profile etc. expenditure on health care, especially tertiary care treatment is increasing day
by day, and is beyond the reach of common people. This is one of the hindrances in the social
development. India is a developing country and approx. 35% population is below poverty line. Since
many people now are below poverty line or in a lower income group, people do not have any feeling
to save or cannot save the money for future expenditure on health; therefore the tertiary care facility
is inaccessible to a major fraction of the society.
Methods: A study was conducted at Sanjay Gandhi Postgraduate Institute of Medical Sciences
(SGPGIMS) Lucknow in the month of May-June 2007 with objectives to find out the level of awareness
about hospital care financing, analyze the mode and mechanism of Health care financing and to assess
the affordability of the tertiary care treatment by the patients undergoing treatment at this centre. A
prospective study of 154 patients by floating the structured questionnaire containing 17 questions,
covering various issues of HCF was carried out.
Results: While observing the HCF pattern of High cost treatment diseases related to ICU, kidney transplant,
cardiovascular surgery, Haematology, Surgical Gastroenterology etc. (expenditure limit more than Rupees
(Rs) 75000 so far incurred in one patient ), the study revealed that the average size of family is 6 members
with an income of approx. Rs. 10185 per month per family. Average expenditure so far incurred by one
shows that majority 115 (75%) patients bear the expenses themselves (out of pocket) It was also observed
that approx. 50% out of pocket expenditure was met by taking loan from the bank,relatives, selling of assets
and mortgaging the assets. approx. 34 (22%) reported that their expenditure will be reimbursed or got
advance payment. Only 40 patients out of pocket had received some sort of assistance from some of the
of the sources like CM, PM Fund and other types of donation. The study further highlights that average
treatment expenditure already incurred in one patient i.e. Rupees 219376/- has exceeded the per capita
expenditure on health care of individual (Rs. 1500/-), & total expenditure on whole family (Rs. 9000/-) and
even total estimated annual income of one member (Rs.20370/) and whole family (approx. 122220/-).
Only 2 (1.2%) respondents had health insurance policy.
Conclusion: The present study findings reflect that the tertiary & high cost treatment is beyond the reach of
majority and will have great impact on the economy and health profile of society.
In view of above, it is the need of the hour to strengthen the mechanism of the HCF by mass awareness
with great emphasis is to be given to meet the “out of pocket expenditure” and encourage the “health insurance”
mechanism. This may help in providing the tertiary care treatment to many people; otherwise the treatment
cost is unaffordable.
of the tools to measure the social development of that country. Due to advancement in technology,
disease profile etc. expenditure on health care, especially tertiary care treatment is increasing day
by day, and is beyond the reach of common people. This is one of the hindrances in the social
development. India is a developing country and approx. 35% population is below poverty line. Since
many people now are below poverty line or in a lower income group, people do not have any feeling
to save or cannot save the money for future expenditure on health; therefore the tertiary care facility
is inaccessible to a major fraction of the society.
Methods: A study was conducted at Sanjay Gandhi Postgraduate Institute of Medical Sciences
(SGPGIMS) Lucknow in the month of May-June 2007 with objectives to find out the level of awareness
about hospital care financing, analyze the mode and mechanism of Health care financing and to assess
the affordability of the tertiary care treatment by the patients undergoing treatment at this centre. A
prospective study of 154 patients by floating the structured questionnaire containing 17 questions,
covering various issues of HCF was carried out.
Results: While observing the HCF pattern of High cost treatment diseases related to ICU, kidney transplant,
cardiovascular surgery, Haematology, Surgical Gastroenterology etc. (expenditure limit more than Rupees
(Rs) 75000 so far incurred in one patient ), the study revealed that the average size of family is 6 members
with an income of approx. Rs. 10185 per month per family. Average expenditure so far incurred by one
shows that majority 115 (75%) patients bear the expenses themselves (out of pocket) It was also observed
that approx. 50% out of pocket expenditure was met by taking loan from the bank,relatives, selling of assets
and mortgaging the assets. approx. 34 (22%) reported that their expenditure will be reimbursed or got
advance payment. Only 40 patients out of pocket had received some sort of assistance from some of the
of the sources like CM, PM Fund and other types of donation. The study further highlights that average
treatment expenditure already incurred in one patient i.e. Rupees 219376/- has exceeded the per capita
expenditure on health care of individual (Rs. 1500/-), & total expenditure on whole family (Rs. 9000/-) and
even total estimated annual income of one member (Rs.20370/) and whole family (approx. 122220/-).
Only 2 (1.2%) respondents had health insurance policy.
Conclusion: The present study findings reflect that the tertiary & high cost treatment is beyond the reach of
majority and will have great impact on the economy and health profile of society.
In view of above, it is the need of the hour to strengthen the mechanism of the HCF by mass awareness
with great emphasis is to be given to meet the “out of pocket expenditure” and encourage the “health insurance”
mechanism. This may help in providing the tertiary care treatment to many people; otherwise the treatment
cost is unaffordable.
Chandra, H., Pahari, S., Kandulna, J., Srivastava, A., Masih, L., Jamaluddin, K., & Barthwal, C. P. (2009). Is Tertiary care Treatment Affordable to All? – Explore Alternative (s) for Healthcare Financing. International Journal of Health Sciences, 3(2). Retrieved from https://ijhs.qu.edu.sa/index.php/journal/article/view/140
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