OUT OF POCKET AND HEALTH FACILITY CHARGES AMONG PATIENTS UNDERGOING DIALYSIS AT SERVICES HOSPITAL, LAHORE

Abstract

ABSTRAC
 Background:- Dialysis is the process of removing waste products and excess fluid from the body. Dialysis allows the patient with kidney failure a chance to live a productive life. Government Hospitals in Punjab providing free treatment to all Hemodialysis patients, Government introduced Sehat Sahoolat card for citizen of Pakistan for their family by providing 1 million rupees per year for every family. Most of the patients spending out of pocket expenditures to meet their medical demand and due to this burden some time they can’t continue their routine visit for Hemodialysis to sustain their daily life, the impact of this out pocket expenditure disturb the home budget as well as their treatment continuity. The purpose of this study to find out different categories of expenses and its impact on their treatment, 
 Of patients being treated with dialysis about 10% receive peritoneal dialysis and the remainders receive Hemodialysis. Pakistan is among the lower middle income countries. It is reported that the cost of dialysis per patient is approximately international $4,003.03 per year. Dialysis is exhausting for patients and fraught with morbidity and eventual mortality. While out-of-pocket expenditure remains the major source of health care financing in Pakistan (two-thirds of the total health spending), the financial burden varies enormously across diseases and by the economic wellbeing of the households.1
 Objectives: To assess out of pocket expenditures and health facility charges among patients undergoing dialysis at Services Hospital, Lahore.
 Study design: It was a descriptive Cross section study.
 Study setting: Dialysis unit of Services Hospital, Lahore.
 Sample size: The sample size was estimated by using WHO SS (Sample Size) software by using formula of estimating a population proportion with specific relative precision at confidence level of 75%, anticipated population proportion of 75% and relative precision of 10%. The maximum sample size is 130.
 Result: We audited records Mean out of pocket incurred both medical and non medical 4950/week while mean out of pocket charges on lab investigation were 10300/ during one year of dialysis, Study shows that those with co-morbidity but they lost the regularity treatment were 69.2% and having only renal dialysis 8.4% and lost the regular treatment due to out of pocket expenditures either expending from their own pocket or support from family. Highly significant with df=1 Chi squire=14.0793 P value=0.0001. 
 Reason to lost continuity of treatment from 33 cases 90.9% due to out of pocket expenditures while 9.09% says due to other reason ,their source of income was personal and from family support respectively. df=1 Chi squire= 0.0143478 P value=0.90
 Conclusion: Our research concluded that health facilities provided by the dialysis unit of Services hospital to the patients were considered to be average. Majority of patients who spent money on medicines and transport, were financially supported by their families. Government hospitals were preferred because medical facilities were affordable.
 Key words: Out of Pocket. Hemodialysis,Financial burden ,Co-Morbidity