Department of Social Medicine, Maastricht University, CAPHRI, Maastricht, The Netherlands.
Int Health. 2021 Jan 14;13(1):30-38. doi: 10.1093/inthealth/ihaa016.
In countries with out-of-pocket (OOP) payment systems for healthcare, the combination of chronic disease and poverty can have damaging socio-economic and health impacts for affected households. Using a life course perspective, this article aims to explore how Nepalese people struggle with, experience and adapt to chronic disease, poverty and their consequences, and how chronic diseases and poverty reinforce each other.
In-depth semi-structured interviews were conducted with 21 chronically ill Nepalese people with one or more chronic diseases and/or their caretakers. Data were transcribed and analysed thematically.
The adaptation strategies for the consequences of the huge OOP costs make patients and their households financially disadvantaged. The impoverishment has major social impacts and often persists across generations. The situation forces people to choose between avoiding medical treatment or further impoverishing their families.
This study explored how chronically ill Nepalese people struggle with socio-economic and health consequences of OOP payments for their disease. The article sheds light on circumstances and adaptation strategies that obstruct every attempt to escape from the vicious cycle of the poverty trap. Hence poverty and health adversities accumulate across generations and contribute to greater health expenditures, worse health outcomes and severely compromised social life.
在实行医疗保健自费（OOP）支付制度的国家，慢性病和贫困的结合会对受影响的家庭产生破坏性的社会经济和健康影响。本文采用生命历程的视角，旨在探讨尼泊尔人如何应对、经历和适应慢性病、贫困及其后果，以及慢性病和贫困如何相互加强。
对 21 名患有一种或多种慢性病的尼泊尔慢性病患者及其护理人员进行了深入的半结构化访谈。对数据进行了转录和主题分析。
应对巨额自费费用后果的适应策略使患者及其家庭在经济上处于不利地位。贫困带来了重大的社会影响，并且常常会持续几代人。这种情况迫使人们在避免治疗或进一步使家庭贫困之间做出选择。
本研究探讨了尼泊尔慢性病患者如何应对自费支付疾病带来的社会经济和健康后果。本文揭示了阻碍摆脱贫困陷阱恶性循环的各种情况和适应策略。因此，贫困和健康逆境会在代际之间积累，导致更高的医疗支出、更差的健康结果和严重受损的社会生活。
