Pyakurel Prajjwal, Tripathy Jaya Prasad, Oo Myo Minn, Acharya Bijay, Pyakurel Ujjwal, Singh Suman Bahadur, Subedi Laxmi, Yadav Kamlesh Prasad, Poudel Mukesh, Pandey Dipesh Raj, Budhathoki Shyam Sundar, Lohani Guna Raj, Jha Nilambar
School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, The Union South East Asia Office, New Delhi, India.
BMJ Open. 2018 Nov 15;8(11):e022002. doi: 10.1136/bmjopen-2018-022002.
The study aimed at estimating out-of-pocket (OOP) expenditure, catastrophic health expenditure (CHE) and distress financing due to hospitalisation and outpatient care among industrial workers in Eastern Nepal.
We conducted a cross-sectional study involving industrial workers employed in a large-scale industry in Eastern Nepal. Those who were hospitalised in the last 1 year or availed outpatient care within the last 30 days were administered a structured questionnaire to estimate the cost of illness. CHE was defined as expenditure more than 20% of annual household income. Distress financing was defined as borrowing money/loan or selling assets to cope with OOP expenditure on health.
Of 1824 workers eligible for the study, 1405 (77%) were screened, of which 85 (6%) were hospitalised last year; 223 (16%) attended outpatient department last month. The median (IQR) OOP expenditure from hospitalisation and outpatient care was US$124 (71-282) and US$36 (19-61), respectively. Among those hospitalised, the prevalence of CHE and distress financing was found to be 13% and 42%, respectively, and due to outpatient care was 0.4% and 42%, respectively. Drugs and diagnostics account for a large share of direct costs in both public and private sectors. More than 80% sought hospitalisation and outpatient care in a private sector.
Industrial workers face significant financial risks due to ill health compared with the general population. Poor utilisation and higher cost of care in public health facilities warrant strengthening of public sector through increased government spending. The labour act 2014 of Nepal should be strictly adhered.
本研究旨在估算尼泊尔东部产业工人因住院和门诊治疗产生的自付费用、灾难性卫生支出及经济困难融资情况。
我们开展了一项横断面研究，涉及尼泊尔东部一家大型产业的在职产业工人。对过去1年住院或过去30天内接受门诊治疗的工人进行结构化问卷调查，以估算疾病费用。灾难性卫生支出定义为超过家庭年收入20%的支出。经济困难融资定义为借钱/贷款或出售资产以应对卫生方面的自付费用。
在1824名符合研究条件的工人中，1405人（77%）接受了筛查，其中85人（6%）去年住院；223人（16%）上个月去过门诊部。住院和门诊治疗的自付费用中位数（四分位间距）分别为124美元（71 - 282美元）和36美元（19 - 61美元）。在住院患者中，灾难性卫生支出和经济困难融资的患病率分别为13%和42%，门诊治疗的患病率分别为0.4%和42%。药品和诊断在公共和私营部门的直接成本中占很大比例。超过80%的人在私营部门寻求住院和门诊治疗。
与普通人群相比，产业工人因健康不佳面临重大财务风险。公共卫生设施利用率低和医疗成本高，需要通过增加政府支出加强公共部门。应严格遵守尼泊尔2014年的劳动法。
