Enhancing healthcare access for poor patients through financial waiver at point of care, the model, utilization and disease profile in an apex tertiary care public hospital in India
 
Abstract
 
Introduction
An estimated 29.5% population in India lives below poverty line. With meagre 1.2% of Gross Domestic Product government spending on health and necessary evil of user charges to fund healthcare in developing countries, out of pocket catastrophic expenditures restrict access at point of tertiary care due to non-affordability despite government schemes. This study explored the system established by hospital administration for waiver of user charges for poor indigent patients. 
 
Methods
A descriptive and ambi-spective study was done in an apex referral public hospital in India. Direct observations and interviews with key stakeholders were conducted to study exemption model. Disease profile of in-patients needing financial assistance and utilisation of surgical consumables provided free were prospectively studied for six months.
 
Results
On request from treating doctors, waiver of user charges were authorized by hospital administrators through socio-economic assessment by medical social officers (both available at all times). All requests were honoured irrespective of documentary evidence of poverty. Waiver for surgical consumables was 27100 rupees (427 dollars) per patient and 837 rupees (13 dollars) per patient per day. Most prevalent were cancers (35.92 %) and kidney diseases (24.65 %). These poor patients had longer length of stay (22.3 days). Majority belonged to Bihar and Uttar Pradesh states.
 
Conclusions
The model, which can be adopted in similar settings, demonstrated increased access as all requests were honoured. Financial expenditures revealed can help in budget projections. Disease profile and types of consumables revealed can be used as basis for strengthening healthcare delivery systems of referring states.
Keywords: Length of Stay; Health Expenditure; Poverty; User fee; Waivers
Date: 
Wednesday, March 27, 2019
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