Adeniran Abiodun S, Fasiku Mojirola M, Jimoh Maryam A, Adesiyun Omotayo O, Adetiloye Oniyire, Okoli Ugo, Chukwu Elizabeth, Ayoola Olusola S, Oyeniyi Samuel, Orjingene Obinna, Akande Tanimola M
Department of Obstetrics and Gynaecology, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria.
Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria.
Int J Gynaecol Obstet. 2025 Mar;168(3):1185-1190. doi: 10.1002/ijgo.15990. Epub 2024 Oct 25.
To assess the occurrence of client financial insolvency, experiences of key healthcare stakeholders, and policy gaps on handling the situation during maternity services.
A qualitative study was conducted in North-Central Nigeria. Participants were key healthcare stakeholders including healthcare workers from private, primary, secondary, and tertiary facilities, healthcare administrators/facility-heads, program managers and policy makers at local and state government levels through In-depth and Key Informant interviews. Identified themes were occurrence, experiences of stakeholders, and prevention of client financial insolvency. Data were analyzed with the Nvivo statistical package.
Participants confirmed the occurrence of client financial insolvency. Clients' inability to pay hospital bills was due to being indigent, awaiting support from relations, or clients who were uncommitted to the payment. Health facilities lack guiding policy documents; potential cases are referred from private to public or from primary to secondary/tertiary facilities. Methods of handling financial insolvency included healthcare worker-related (staff scavenging for needed consumables, fund-raising among facility staff), facility-related (revolving fund, medical social welfare, welfare committee, discharge with re-payment plan, fee-waiver), community-related (ward development committee, religious organizations/philanthropists) interventions, or hospital detention of insolvent clients. Although clients' bills did not increase during detention, many clients did not honor post-discharge re-payment agreements. Participants suggested a client-friendly billing system, early initiation of birth preparedness, partner involvement, and a rapid scale-up of health insurance for pregnant women to curb financial insolvency.
Tackling client financial insolvency requires policy documents, support to private facilities, effective debt-recovery mechanisms, and scale up of health insurance for pregnant women.
评估产妇服务期间客户财务破产的发生情况、主要医疗利益相关者的经历以及处理该情况的政策差距。
在尼日利亚中北部进行了一项定性研究。参与者是主要医疗利益相关者，包括来自私立、初级、二级和三级医疗机构的医护人员、医疗管理人员/机构负责人、项目经理以及地方和州政府层面的政策制定者，通过深入访谈和关键信息提供者访谈进行。确定的主题包括发生情况、利益相关者的经历以及预防客户财务破产。使用Nvivo统计软件包对数据进行分析。
参与者证实了客户财务破产的发生。客户无法支付医院账单的原因是贫困、等待亲属支持或不承诺付款。卫生设施缺乏指导政策文件；潜在病例从私立机构转诊至公立机构，或从初级机构转诊至二级/三级机构。处理财务破产的方法包括与医护人员相关的（工作人员自行寻找所需耗材、在机构工作人员中筹款）、与机构相关的（循环基金、医疗社会福利、福利委员会、制定还款计划后出院、费用减免）、与社区相关的（病房发展委员会、宗教组织/慈善家）干预措施，或对破产客户进行医院拘留。虽然客户被拘留期间账单没有增加，但许多客户并未履行出院后的还款协议。参与者建议建立一个方便客户的计费系统、尽早启动分娩准备工作、让伴侣参与以及迅速扩大孕妇医疗保险以遏制财务破产。
解决客户财务破产问题需要政策文件、对私立机构的支持、有效的债务追收机制以及扩大孕妇医疗保险。
