Abstract
BackgroundSome reports indicate financial concerns as a factor affecting ED patients leaving the acute care setting against medical advice (AMA). In India, no person is supposed to be denied urgent care because of inability to pay. Since a large proportion of the Indian health care system is financed by out-of-pocket expenses, we investigate the role of financial constraints for ED patients at a private hospital in India in leaving AMA.MethodsA prospective ED-based cross-sectional survey of patients leaving AMA was conducted at a private hospital in India from 1 October 2010 to 31 December 2010. Descriptive statistics and the chi-square test were used to identify associations between financial factors and the decision to leave the hospital AMA.ResultsOverall, 55 (3.84%) ED patients left AMA, of which 46 (84%) reported leaving because of financial restrictions. Thirty-nine (71%) respondents indicated the medical bill would represent more that 25% of their annual income. Females (19/19) were more likely to leave AMA for financial reasons compared to males (27/36, p = 0.017). Among females who signed out AMA, the decision was never made by the female herself.ConclusionThe number of people leaving the ED AMA in a private Indian hospital is relatively high, with most leaving for financial reasons. In most cases, women did not decide to leave the ED AMA for themselves, whereas males did. This survey suggests that steps are needed to ensure that the inability to pay does not prevent emergent care from being provided.
Highlights
Some reports indicate financial concerns as a factor affecting ED patients leaving the acute care setting against medical advice (AMA)
The Indian health care system is a complex integration of the national public health system, private hospitals, and alternative medicine practitioners [3,4]
Among the 1,854 patients seen in the ED during the study period, 71 (3.8%) left the hospital AMA, and of the 71 patients who left AMA, a total of 55 (71.4%) completed the survey
Summary
Some reports indicate financial concerns as a factor affecting ED patients leaving the acute care setting against medical advice (AMA). Since a large proportion of the Indian health care system is financed by out-of-pocket expenses, we investigate the role of financial constraints for ED patients at a private hospital in India in leaving AMA. The total expenditure on health per capita is $132 in a country where the gross national income per capita is only $2,930 [2]. According to the World Health Organization (WHO), The Indian health care system is a complex integration of the national public health system, private hospitals, and alternative medicine practitioners [3,4]. India’s public health system constitutes only 1% of its total gross domestic product, placing it below most low-income countries and in the bottom 20% of all countries [6]. Because the public health system is perceived to be poorly equipped to provide quality care, the majority of Indians seek health care in the private system and pay out-of-pocket [3,5]
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