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Strategies for coping with the costs of inpatient care: a mixed methods study of urban and rural poor in Vadodara District Gujarat India

机译：应对住院护理费用的策略：印度古吉拉特邦瓦多达拉地区城乡贫困人口的混合方法研究

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>Background In India, coping mechanisms for inpatient care costs have been explored in rural areas, but seldom among urbanites. This study aims to explore and compare mechanisms employed by the urban and rural poor for coping with inpatient expenditures, in order to help identify formal mechanisms and policies to provide improved social protection for health care.>Methods A three-step methodology was used: (1) six focus-group discussions; (2) 800 exit survey interviews with users of public and private facilities in both urban and rural areas; and (3) 18 in-depth interviews with poor (below 30th percentile of socio-economic status) hospital users, to explore coping mechanisms in greater depth.>Results Users of public hospitals, in both urban and rural areas, were poor relative to users of private hospitals. Median expenditures per day were much higher at private than at public facilities. Most respondents using public facilities (in both urban and rural areas) were able to pay out of their savings or income; or by borrowing from friends, family or employer. Those using private facilities were more likely to report selling land or other assets as the primary source of coping (particularly in rural areas) and they were more likely to have to borrow money at interest (particularly in urban areas). Poor individuals who used private facilities cited as reasons their closer proximity and higher perceived quality of care.>Conclusions In India, national and state governments should invest in improving the quality and access of public first-referral hospitals. This should be done selectively—with a focus, for example, on rural areas and urban slum areas—in order to promote a more equitable distribution of resources. Policy makers should continue to explore and support efforts to provide financial protection through insurance mechanisms. Past experience suggests that these efforts must be carefully monitored to ensure that the poorer among the insured are able to access scheme benefits, and the quality and quantity of health care provided must be monitored and regulated.
机译：>背景在印度，农村地区已探索了应对住院医疗费用的机制，但在城市居民中很少见到。这项研究旨在探索和比较城乡贫困人口应对住院费用的机制，以帮助确定正式的机制和政策，以改善医疗保健的社会保护。>方法使用了分步方法：（1）六个焦点小组讨论； （2）对城乡公共和私人设施使用者进行800次出境调查采访； （3）对贫困（社会经济地位低于30％的人群）使用者进行18次深度访谈，以更深入地探讨应对机制。>结果城市和农村公立医院的使用者相对于私家医院的使用者而言，这些地区相对贫困。私人每天的支出中位数比公共场所的支出高得多。大多数使用公共设施（在城市和农村地区）的受访者都能够用他们的储蓄或收入来支付；或者从朋友，家人或雇主那里借钱。使用私人设施的人更有可能将出售土地或其他资产作为应对的主要来源（特别是在农村地区），他们更有可能不得不借息借钱（尤其是在城市地区）。使用私人医疗设施的贫困个人被认为是他们距离医院更近，医疗质量更高的原因。>结论为了促进更公平地分配资源，应该有选择地进行这项工作，例如重点放在农村地区和城市贫民区。决策者应继续探索并支持通过保险机制提供财务保护的努力。过去的经验表明，必须认真监控这些努力，以确保被保险人中的较贫穷者能够获得计划的利益，并且必须监控所提供的医疗保健的质量和数量。

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