Institute of Public Health, Kalyani, West Bengal, India.
Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, West Bengal, India.
PLoS One. 2022 Feb 25;17(2):e0264314. doi: 10.1371/journal.pone.0264314. eCollection 2022.
Elevated blood pressure or hypertension is responsible for around 10 million annual deaths globally, and people residing in low and middle-income countries are disproportionately affected by it. India is no exception, where low rate of treatment seeking for hypertension coupled with widespread out-of-pocket payments (OOPs) have been a challenge. This study assessed the pattern of health care seeking behaviour and financial protection along with the associated factors among hypertensive individuals in rural West Bengal, India.
A cross-sectional study was conducted in Birbhum district of the state of West Bengal, India, during 2017-2018, where 300 individuals were recruited randomly from a list of hypertensives in a population cohort. Healthcare seeking for hypertension and related financial protection in terms of-OOPs and expenses relative to monthly per-capita family expenditure, were analysed. Findings indicated that 47% of hypertensives were not on treatment. Among those under treatment, 80% preferred non-public facilities, and 91% of them had wide-spread OOPs. Cost of medication was a major share of expenses followed by transportation cost to access public health care facility. Multivariable logistic regression analysis indicated longer duration of disease (adjusted odds ratio (aOR): 5.68, 95% Confidence Interval (CI) 1.24-25.99) and health care seeking from non-public establishment (aOR: 34.33, CI: 4.82-244.68) were associated with more incident of OOPs. Linear regression with generalized linear model revealed presence of co-morbidities (adjusted coefficient (aCoeff)10.28, CI: 4.96,15.61) and poorer economic groups (aCoeffpoorest 11.27, CI 3.82,18.71; aCoefflower-middle 7.83, CI 0.65,15.00 and aCoeffupper-middle 7.25, CI: 0.80,13.70) had higher relative expenditure.
This study suggests that individuals with hypertension had poor health care seeking behaviour, preferred non-public health facilities and had suboptimal financial protection. Economically poorer individuals had higher burden of health expenditure for treatment of hypertension, which indicated gaps in equitable health care delivery for the control of hypertension.
全球每年约有 1000 万人死于高血压或高血压，中低收入国家的居民受其影响不成比例。印度也不例外，高血压的治疗寻求率低，加上广泛的自付费用（OOPs）一直是一个挑战。本研究评估了印度西孟加拉邦农村地区高血压患者的医疗保健寻求行为和财务保护模式以及相关因素。
2017-2018 年，在印度西孟加拉邦的比尔布姆区进行了一项横断面研究，从人群队列中的高血压患者名单中随机招募了 300 名患者。分析了高血压的医疗保健寻求以及 OOPs 和相对于每月人均家庭支出的费用相关的财务保护。研究结果表明，47%的高血压患者未接受治疗。在接受治疗的患者中，80%选择非公立医疗机构，其中 91%的患者有广泛的 OOPs。药物费用是支出的主要部分，其次是获得公共医疗保健设施的交通费用。多变量逻辑回归分析表明，疾病持续时间较长（调整后的优势比（aOR）：5.68，95%置信区间（CI）：1.24-25.99）和从非公立机构寻求医疗保健（aOR：34.33，CI：4.82-244.68）与更多的 OOPs 事件相关。广义线性模型的线性回归显示存在合并症（调整系数（aCoeff）10.28，CI：4.96，15.61）和较贫穷的经济群体（最贫困的 aCoeff11.27，CI 3.82，18.71；aCoefflower-middle 7.83，CI 0.65，15.00 和 aCoeffupper-middle 7.25，CI：0.80，13.70）的相对支出较高。
本研究表明，高血压患者的医疗保健寻求行为较差，更喜欢非公立医疗机构，财务保护不理想。经济较贫困的人治疗高血压的医疗支出负担更高，这表明在提供公平的高血压控制医疗服务方面存在差距。
