Mohanty Parimala, Satpathy Sudhir Kumar, Patnaik Sibabratta, Patnaik Lipilekha
Department of Community Medicine, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Khordha, Bhubaneswar, Odisha, India.
School of Public Health, KIIT Deemed to be University, Bhubaneswar, Odisha, India.
J Family Med Prim Care. 2021 Oct;10(10):3892-3898. doi: 10.4103/jfmpc.jfmpc_2337_20. Epub 2021 Nov 5.
Out-of-pocket (OOP) expenditure influences the access to the healthcare of the marginalized and vulnerable population including under-five children (U5C). The aim of the study is to estimate the OOP expenditure and its predictors in Bhubaneswar, a region of eastern India.
A cross-sectional study was conducted using a semi-structured interview schedule in 20 urban slums of Bhubaneswar. The survey was carried out by using the National Sample Survey Office (NSSO) health consumption schedule 25.0 in which mothers of U5C with illness (n = 530) were interviewed. For data analysis, the nonparametric Wilcoxon rank-sum test and Kruskal-Wallis test were used as tests of significance.
The study revealed that the mean OOP expenditure for outpatient department (OPD) care was ₹375.9 (₹219.48). The mean approximated expenditure was ₹1669.8 (₹1131.9) for inpatient department (IPD) care. In OPD care, doctors' fee and medicine cost constituted 65.01% and 50.46% of OOP expenditure, respectively. In IPD care, medicine cost and doctors' fee contributed to 36.62% and 30.54% of OOP expenditure, respectively. The major significant predictors that contributed to increased OOP were gender and delay in approaching the source of treatment in OPD, whereas in IPD no such predictors were observed.
This study prominently sheds light on the issue of accessibility and affordability of health services without a comprehensive health insurance scheme for U5C illness among the vulnerable urban slum dwellers to achieve universal health coverage.
自付支出会影响包括五岁以下儿童在内的边缘化和弱势群体获得医疗保健的机会。本研究的目的是估计印度东部地区布巴内斯瓦尔的自付支出及其预测因素。
采用半结构化访谈问卷，在布巴内斯瓦尔的20个城市贫民窟开展了一项横断面研究。调查使用的是国家抽样调查办公室（NSSO）的健康消费问卷25.0，对患有疾病的五岁以下儿童的母亲（n = 530）进行了访谈。数据分析采用非参数Wilcoxon秩和检验和Kruskal-Wallis检验作为显著性检验。
研究显示，门诊护理的平均自付支出为375.9卢比（219.48卢比）。住院护理的平均近似支出为1669.8卢比（1131.9卢比）。在门诊护理中，医生诊疗费和药费分别占自付支出的65.01%和50.46%。在住院护理中，药费和医生诊疗费分别占自付支出的36.62%和30.54%。导致自付支出增加的主要显著预测因素在门诊方面是性别和就医延迟，而在住院方面未观察到此类预测因素。
本研究显著揭示了在缺乏针对弱势城市贫民窟居民中五岁以下儿童疾病的全面医疗保险计划的情况下，卫生服务的可及性和可负担性问题，以实现全民健康覆盖。
