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George TK, Peter JV, Jeyaseelan L, Yadav B, Patole S, Koshy RM, Joseph P, P B, Nair A, Zachariah A, George K, Abraham G, Venkatesh B. The impact of demonetisation on the utilisation of hospital services, patient outcomes and finances: a multicentre observational study from India. BMJ Glob Health 2020; 5:e002509. [PMID: 32938612 PMCID: PMC7493109 DOI: 10.1136/bmjgh-2020-002509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/10/2020] [Accepted: 07/18/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This study assessed trends in healthcare utilisation in relation to the implementation of an economic policy in India wherein 500 and 1000 rupee notes were demonetised. METHODS In this ambidirectional observational study of private not-for-profit hospitals, data on hospital outpatient and inpatient numbers, surgeries, emergency department (ED) visits, obstetric admissions and mortality were obtained for pre-demonetisation (September/October 2016), early (November/December 2016) and late demonetisation (January/February 2017), and post-demonetisation periods (March/April 2017) and compared with the control period (2015-2016) from 11 centres (three tertiary hospitals; eight secondary). A Bayesian regression analysis was performed to adjust for seasonal (winter) effect. Monthly financial data, including the proportion of cash versus non-cash transactions, were collected. FINDINGS Overall, at the pooled all-hospital level, Bayesian analysis showed non-significant increase in outpatients (535.4, 95% CI -7097 to 8116) and decrease in deaths (-6.3 per 1000 inpatients, 95% CI -15.45 to 2.75) and a significant decrease in inpatients (-145.6, 95% CI -286.4 to -10.63) during demonetisation. Analysis at the level of secondary and tertiary hospitals showed a variable effect. For individual hospitals, after adjusting for the seasonal effect, some hospitals observed a significant reduction in outpatient (n=2) and inpatient (n=3) numbers, ED visits (n=4) and mortality (n=2) during demonetisation, while others reported significantly increased outpatient numbers (n=3) and ED visits (n=2). Deliveries remained unchanged during demonetisation in the hospitals that provided the service. There was no significant reduction in hospital incomes during demonetisation. In tertiary hospitals, there was a significant increase in non-cash component of transactions from 35% to 60% (p=0.02) that persisted beyond the demonetisation period. CONCLUSIONS The effect of demonetisation on healthcare utilisation was variable. Some hospitals witnessed a significant reduction in utilisation in some areas, while others reported increased utilisation. There was an increase in non-cash transactions that persisted beyond the period of demonetisation.
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Affiliation(s)
- Tarun K George
- General Medicine, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - John Victor Peter
- Medical Intensive Care Unit, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | | | - Bijesh Yadav
- Biostatistics, Christian Medical College and Hospital Vellore, Vellore, India
| | - Shalom Patole
- General Medicine, Christian Hospital, Chhatarpur, Madhya Pradesh, India
| | - Roshine Mary Koshy
- General Medicine, Makunda Christian Leprosy and General Hospital, Karimganj, Assam, India
| | | | - Balasubramanian P
- Hospital Management, RUWSEC Hospital Tamil Nadu, Chengalpattu, Tamil Nadu, India
| | - Aravindan Nair
- General Surgery, Sri Narayani Hospital and Research Centre, Sripuram, Tamil Nadu, India
| | - Anand Zachariah
- General Medicine, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Krupa George
- General Medicine, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Georgi Abraham
- Nephrology, Madras Medical Mission, Chennai, Tamil Nadu, India
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Pati S, Swain S, Knottnerus JA, Metsemakers JFM, van den Akker M. Magnitude and determinants of multimorbidity and health care utilization among patients attending public versus private primary care: a cross-sectional study from Odisha, India. Int J Equity Health 2020; 19:57. [PMID: 32349770 PMCID: PMC7191801 DOI: 10.1186/s12939-020-01170-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 04/07/2020] [Indexed: 12/21/2022] Open
Abstract
Background Multimorbidity in primary care is a challenge not only for developing countries but also for low and medium income countries (LMIC). Health services in LMIC countries are being provided by both public and private health care providers. However, a critical knowledge gap exists on understanding the true extent of multimorbidity in both types of primary care settings. Methods We undertook a study to identify multimorbidity prevalence and healthcare utilization among both public and private primary care attendees in Odisha state of India. A total of 1649 patients attending 40 primary care facilities were interviewed using a structured multimorbidity assessment questionnaire collecting information on 22 chronic diseases, medication use, number of hospitalization and number of outpatient visits. Result The overall prevalence of multimorbidity was 28.3% and nearly one third of patients of public facilities and one fourth from private facilities had multimorbidity. Leading diseases among patients visiting public facilities included acid peptic diseases, arthritis and chronic back pain. No significant difference in reporting of hypertension and diabetes across the facilities was seen. Besides age, predictors of multimorbidity among patients attending public facilities were, females [AOR: 1.6; 95% CI 1.1–1.3] and non-aboriginal groups [AOR: 1.6; 95%CI 1.1–2.3] whereas, in private females [AOR: 1.6; 95%CI 1.1–2.4], better socioeconomic conditions [AOR 1.4; 95% CI 1.0–2.1] and higher educational status [primary school completed [AOR 2.6; 95%CI 1.6–4.2] and secondary schooling and above [AOR 2.0; 95%CI 1.1–3.6] with reference to no education were seen to be the determinants of multimorbidity. Increased number of hospital visits to public facilities were higher among lower educational status patients [IRR: 1.57; 95% CI 1.13–2.18] whereas, among private patients, the mean number of hospital visits was 1.70 times more in higher educational status [IRR: 1.70; 95%CI 1.01–3.69]. The mean number of medicines taken per day was higher among patients attending private hospitals. Conclusion Our findings suggest that, multimorbidity is being more reported in public primary care facilities. The pattern and health care utilization in both types of settings are different. A comprehensive care approach must be designed for private care providers.
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Affiliation(s)
- Sanghamitra Pati
- Indian Council of Medical Research, Department of Health Research, ICMR Regional Medical Research Centre, Bhubaneswar, Chandrasekharpur, Bhubaneswar, Odisha, 751023, India.
| | - Subhashisa Swain
- School of Medicine, Clinical Sciences Building, City Hospital, University of Nottingham, Nottingham, NG5 1PB, UK
| | - J André Knottnerus
- Department of Family Medicine, School Caphri, Maastricht University, Maastricht, The Netherlands
| | - Job F M Metsemakers
- Department of Family Medicine, School Caphri, Maastricht University, Maastricht, The Netherlands
| | - Marjan van den Akker
- Department of Family Medicine, School Caphri, Maastricht University, Maastricht, The Netherlands.,Academic Centre of General Practice / Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Kumar VD. The missing pieces of the big picture: Unaddressed healthcare conundrums during demonetization. J Family Med Prim Care 2019; 7:1150-1151. [PMID: 30598985 PMCID: PMC6259509 DOI: 10.4103/jfmpc.jfmpc_239_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- V Dinesh Kumar
- Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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