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Indian Journal for the Practising Doctor

Efforts and Experiences in Accessing Health Care in Sabarkantha District (Gujarat)

Author(s): Harshvardhan Mehta, K.K.Rajguru

Vol. 3, No. 6 (2007-01 - 2007-02)

Harshvardhan Mehta, K.K.Rajguru

ISBN: 0973-516X

Dr Harshvardhan Mehta (Tutor), and Dr K K Rajguru (Associate Professor) are from the Department of Community Medicine, B. J. Medical College, Ahmedabad.

Address for correspondence: Dr. Harshvardhan Mehta, 1571, Shriramji’s Street, Opp.lakhia Street, Khadia, Ahmedabad 380 001 (Gujarat State).
Phone: (079) 22 14 59 30; Mobile: 0- 94275-22075
Email: [email protected]

Abstract:

Research question: What are the efforts and experiences of patients in accessing health care? Objectives: To measure the met and unmet needs for health care.

  1. To know the criteria considered by patients in deciding what facility to go.
  2. To know the experiences of patients while accessing health care.

Study Design: Cross-sectional descriptive study over the period of four months.
Setting: 150 patients who took “inpatient care” in various hospitals of Sabarkantha district (Gujarat) within the last one year from the date of interview.
Participants: Patients / family members/ close relatives.
Statistical Analysis: Standard error of proportion (SEP)
Study Variables: Knowledge, Distance, Reasons, Cause, Experience
Results: Overall people know about private hospitals more from friends and relatives, while Government hospitals are approached for their good image and popularity in the community. NGO- hospitals are approached more due to past experiences as well as advice by friends and relatives. People prefer private hospital after being referred by doctors, NGOs for comfortable distance and Govt hospitals for cost benefit.

Patients travel up to 5-7 km for treatment in private and NGOs hospital hospitals; in case og government hospitals the distance traveled is 10-15 km. For delivery patients prefer private hospitals where as for major systemic diseases people prefer government hospitals. Proportion of dissatisfaction was higher in private hospitaltreated patients. NGOs were highest on the satisfaction scale..

Key words: Need, Knowledge, Experience

Introduction

It is important to know how and why people choose a particular health care service from among the different available health care facilities. This knowledge is crucial to policymaking and planning of various health care delivery services and systems in a particular locality. Ours was a systematic effort to know the public attitude regarding different health care facilities in a particular district and factors affecting their relative utility. The general belief is that the costs of care in private hospitals are relatively high, and public (government) hospitals are free so there should be a strong motivation for people to go to Government hospitals1. The reasons why people avoid some hospitals sometimes are not clear. The information presented here covers various aspects of their decision-making to seek care. The data also reflects their experiences after getting the care and up to what level they were satisfied with the care they received.

Admission to a health care facility for at least 24 hours or an overnight stay in hospital in the preceding one year of the date of interview is considered for getting the views of the patient or their attendants.

Methods and Materials

Collection of baseline data

A list of the patients, who had been admitted in various hospitals for 24 hours or had at least an overnight stay during the preceding one year, was prepared. For this the first household in the area was selected randomly and subsequently the information about other previously-admitted patients in the area was sought.

Study area

The study was carried out in the three areas of Sabarkantha District.

  1. Jamla PHC area and it’s villages, Taluka Himmatnagar,
  2. Limbhoi PHC area and it’s villages, Taluka Modasa,
  3. Chitroda PHC area and it’s villages, Taluka Idar.

Study period spanned four months from December 2000 to March 2001.

Study method and materials

A pre-designed and pre-tested questionnaire was used, which included questions related to the type of health care facility they had visited, reasons for selecting that particular facility, details of indoor treatment taken, number of days of their indoor admission, subjective reactions regarding the particular health care facility, sense of satisfaction or dissatisfaction after indoor treatment etc.

Fifty respondents were identified from each of the 3 areas bringing the total to 150. The details were obtained from patients and their close relative who had stayed with the patient in the hospital during his/her indoor treatment. Patients include adults and children, both admitted in various hospitals during the last one year from the date of interview.

Data Analysis

The information thus collected, was compiled, tabulated and analysed by applying proper statistical tests. (Z test).

TABLE 1: SOURCES OF FIRST TIME KNOWLEDGE ABOUT HOSPITALS

First came to know from Private
n1=69
NGO/Trust
n2=32
Government
n3=49
Total
N=150
Read in news paper 02 (2.90%) 02 (6.25%) 03 (6.12%) 07 (4.67%)
Friends/relatives told# 40 (57.97%) 13 (40.62%) 14 (28.57%) 67 (44.67%)
Past experience 06 (8.70%) 09 (28.13%) 09 (18.37%) 24 (16%)
Good Image/popularity 07 (10.14%) 05 (15.62%) 11 (22.45%) 23 (15.33%)
Doctor introduce 12 (17.39%) 03 (9.38%) 12 (24.49%) 27 (18%)
Neighbour 02 (2.90%) 00 (0%) 00 (0%) 02 (1.33%)
Total 69 (100%) 32 (100%) 49 (100%) 150 (100%)

Results

Table 1 shows that in case of a particular private hospital 2.90% of patients knew from a newspaper, 57.97% from friends and relatives, 8.70% had past experience and 10.14% were drawn by its good image and popularity. For a particular NGOs hospital, 6.25% of patients learnt from newspapers, 40.62% from friends and relatives, 28.13% had past experience and 15.62% because of good image and popularity. In case of the government hospital 6.12% of patients came to know through a newspaper, 28.57% from friends and relatives, 18.37% by their own past experience and 22.45% by good image and popularity of the hospital; 24.49% of patients were introduced to a government hospital by their own doctors. The observed difference between private and NGOs+Govt is highly significant. (Z=3.1)

TABLE 2: REASONS FOR SELECTION OF VARIOUS HOSPITALS FOR INDOOR TREATMENT

Reason for selection Private
n1=101
NGO/Trust
n2=68
Government
n3=85
Total
N=254
Situated near residence 14 (13.86%) 22 (32.35%) 18 (21.18%) 54 (21.25%)
24 hour service 12 (11.89%) 04 (5.88%) 06 (7.06%) 22 (8.67%)
Reasonable cost# 06 (5.94%) 14 (20.59%) 24 (28.24%) 44 (17.33%)
Chosen at Random 07 (6.93%) 00 (0%) 00 (0%) 07 (2.76%)
Family members/friends 25 (24.75%) 04 (5.89%) 04 (4.71%) 33 (12.99%)
Referred by doctor 15 (14.85%) 02 (2.94%) 16 (18.82%) 33 (12.99%)
Service not available in village 01 (0.99%) 00 (0%) 00 (0%) 01 (0.39%)
Well known hospital 07 (6.93%) 02 (2.94%) 03 (3.53%) 12 (4.72%)
No option 01 (0.99%) 00 (0%) 01 (1.18%) 02 (0.79%)
Quick and good service 10 (9.90%) 08 (11.76%) 02 (2.35%) 20 (7.87%)
Experienced and qualified doctors. 00 (0%) 06 (8.82%) 10 (11.76%) 16 (6.3%)
Adequate facilities 03 (2.97%) 04 (5.89%) 01 (0.18%) 08 (3.15%)
Others (known doctor in hosp.) 00 (0%) 02 (2.94%) 00 (0%) 02 (0.79%)
Total 101 (100%) 68(100%) 85 (100%) 254 (100%)

Table 2 gives the reasons for selection of a particular hospital. A particular private hospital was preferred because it was situated near the residence by 13.88%, for reasonability of cost (5.94%), due to being referred by friends or relatives (24.75%), or because of being referred by the treating doctor in 14.85%. A particular NGOs hospital was selected because of proximity to residence (32.35%), reasonable cost (20.59%), referral by friends or relatives (5.88%). In case of a government hospital the main reasons behind the selection by the patient were proximity to the residence in 21.18%, reasonable cost in 28.24%, referral the treating doctor in 18.82%, and availability of a more qualified and experienced doctors in 11.76%. The observed difference for selection of hospital on the basis of cost is highly significant between private and government hospitals. (i.e. Z= 5.42)

TABLE 3: DISTANCE TRAVELLED BY PATIENTS FOR HOSPITAL ADMISSION

Distance from home (Km) Private
n1=69
NGO/Trust
n2=32
Government
n3=49
Total
N=150
Up to 1 01 (1.45%) 01 (3.13%) 02 (4.08%) 04 (2.7%)
2-4 06 (8.70%) 01 (3.13%) 03 (6.12%) 10 (6.66%)
5-7 19 (27.54%) 17 (53.11%) 10 (20.41%) 46 (30.66%)
8-10 05 (7.25%) 00 (0%) 02 (4.08%) 07 (4.66%)
10-15 12 (17.39%) 02 (6.25%) 11 (22.45%) 25 (16.66%)
16-20 17 (24.62%) 06 (18.75%) 07 (14.29%) 30 (20%)
21-25 04 (5.80%) 02 (6.25%) 01 (2.04%) 07 (4.66%)
26-30 05 (7.25%) 01 (3.13%) 02 (4.08%) 08 (5.33%)
>30 00 (0%) 02 (6.25%) 11 (22.45%) 13 (8.67%)
Total 69 (100%) 32 (100%) 49 (100%) 150 (100%)

Table 3 shows the distance travelled by the patient for taking indoor treatment in a particular hospital. In case of private hospitals 1.45% of patients had travelled up to 1 km, 27.54% 5-7 km, and 24.62% a distance of 16-20 km. In case of NGOs hospitals the respective proportions were 3.13% (up to 1 km), 53.13% (5-7 km), and 18.75% (16-20 km). In case of the government hospitals the respective proportions turned out to be 4.08% (up to 1 km), 20.41% (5-7 km), and 14.26% (16-20 km). For some government hospitals 22.45% of patients had travelled even a distance of more than 30 kilometres to get free of charge treatment.

4: REASON FOR ADMISSION TO HOSPITALS

Cause Private n1=69 NGO/Trust n2=32 Government n3=49 Total N=150
Accident/Injury 06 (8.70 %) 03 (9.38%) 08 (16.33%) 17 (11.33%)
Prescribed Operation 11 (15.94%) 06 (18.75%) 13 (26.53%) 30 (20%)
Delivery# 16 (23.18%) 04 (12.5%) 04 (8.16%) 24 (16%)
Minor Diseases 19 (27.54%) 09 (28.12%) 08 (16.33%) 36 (24%)
Major Diseases 17 (24.64%) 09 (28.12%) 15 (30.61%) 41 (27.33%)
Burns 00 (0%) 01 (3.13%) 00 (0%) 01 (0.67%)
Poisoning 00 (0%) 00 (0%) 01 (2.04%) 01 (0.67%)
Total 69 (100%) 32 (100%) 49 (100%) 150 (100%)
# SEP= 6.07, Z= 2.19 (P<0.05) (for calculation NGOs and Govt. are merged)

Table 4 depicts the nature of ailment for which treatment was sought. In case of private hospitals, 8.70% of patients were treated for accidents and 15.94% for a prescribed operation and 23.18% for delivery. In NGOs hospitals, the respective proportions were 9.38% (for accident and injuries), 18.75% (for prescribed operation) and 12.5% (for delivery), while 28.12% inpatients were treated for both minor and major diseases. in NGOs hospitals In government hospitals, 16.33% of patients were treated for accidents and injuries, 26.53% were admitted for elective surgery and 8.16% for delivery. Overall, 20% of the studied patients got admitted to various hospitals for prescribed operations. The observed difference in admission rates for delivery between private and NGOs + Govt. is highly significant. (Z=2.19)

TABLE 5. EXPERIENCE OF PATIENTS REGARDING THE TREATMENT RECEIVED

Experience of patients Private n1=69 NGO/Trust n2=32 Government n3=49 Total N=150
Completely satisfied# 62 (89.85%) 22 (68.75%) 41 (83.66%) 125 (83.32%)
Some what satisfied 00 (0%) 04 (12.5%) 02 (4.08%) 06 (4%)
Neither satisfied nor dissatisfied 00 (0%) 06 (18.75%) 02 (4.08%) 08 (5.33%)
Somewhat dissatisfied 02 (2.90%) 00 (0%) 00 (0 %) 02 (1.33%)
Completely dissatisfied 05 (7.25%) 00 (0%) 04 (4.08%) 09 (6%)
Total 69 (100%) 32 (100%) 49 (100%) 150 (100%)

Table 5 reflects the satisfaction level of the treated patients. In case of private hospitals, 89.85% patients were fully satisfied after treatment and 7.25% extremely dissatisfied. In case of the NGO hospitals, 68.75% patients expressed full satisfaction after treatment. In case of government hospitals 83.66% patients were fully satisfied after treatment and 4.08% were extremely dissatisfied. The difference in feeling of satisfaction for the received treatment between private and NGOs hospital patients is significant. (Z=1.98)

Discussion

More than 23% people preferred private hospitals for delivery and 27% for minor disease. For prescribed operations 16% of patients were treated in private hospitals, 19% in NGO-run hospitals and 26.53% in government hospitals. For delivery 23% patients preferred private hospitals, 12% NGOs and only 8% government hospitals. For major diseases, however, 25% of patients were treated in private hospitals, 28% in NGOs and 31% in government hospitals.

Where the hospital was 5-7 km away, 53% patients seeking indoor treatment travelled to a NGO-Charity hospital, 27% of patients to private hospital; only 20% of patients preferred a government hospital for indoor treatment in such cases.

Only 21% patients had selected a particular hospital for its proximity to their residence; 17% preferred it for its reasonable cost. Many patients (>28%) preferred Government hospitals for reasonability of cost. And it is a fact that integrated preventive, curative and promotive services being provided by Government hospitals are more economic and cost effective.5 PHC is an attempt by Government to reduce the cost of health care.1

Private hospitals were getting highest referrals (25%) by family members or relatives of patients as against an overall 13%.

Bipolar results were got regarding satisfaction or dissatisfaction of the patients after treatment in various hospitals. In the case of private hospitals about 90% of patients were fully satisfied after treatment, where as in the case of Government hospitals a lesser proportion (84%) showed full satisfaction with the received treatment. About 10% of patients receiving treatment in private hospitals were dissatisfied as against a mere 4% attending government hospitals. Thus, contrary to the expectations, dissatisfaction of patients was higher with private hospitals than with the government hospitals. In case of NGOs/Trust hospitals none of the patients receiving treatment were dissatisfied, which is a major attribute of their services.

Recommendations:

  1. Government hospitals should charge token amount for outdoor and indoor services to filter unnecessary flow of patients, to concentrate more on needy patients and to improve the quality of care.
  2. There should be a contract between the government and NGOs hospitals for specific skilled services on “no benefit, no loss” basis.

References:

  1. AIIMS. Criteria for evaluation of Quality Care and Customer, Satisfaction. The Quality aspects of Health Care Services, Page 94-97, All India Institute of Management Studies, Chennai.
  2. GOI. Krishnan Committee Report. Working Group on Primary Health Centre Services in Urban Areas. 1982; pg 181-82
  3. Health Care Delivery. Health for All through Medical Education. Indian J Pub Hlth, 1983; Vol. XXVI. No. 4.: 139.
  4. WHO (1984). Public Health Paper no. 80.
  5. Roy, Bandana. A Study on Concept of Health Education Among Various Health Personnel. Indian J Pub Hlth, 1985; Vo
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