Indirect expenses
Loss of income due to hospitalization of the patient or a family member
who has to stay with a patient in the hospital was observed in all
income quintiles. We classified the employment status of the patients
into three categories; as those who were 1. Unemployed 2. Employed with
a daily wage or non-fixed income (daily-paid workers), 3. Employed with
a monthly salary or retired with a pension.
The worst impact of hospital admission on household economy was seen in
patients earning a daily wage or those whose mode of income was
small-scale self-employment (e.g. manual laborers, owners of small
shops, taxi drivers). The loss of income of hospitalization had a direct
impact on their households. A patient who is a manual laborer mentioned,
“I have been in the hospital for the last eight days. My household
income is totally lost, and my wife had to leave the children with our
neighbor and find daily-paid manual work. We also borrowed money from
relatives.”
The impact was also seen to be higher among the poorer people who had
minimal or no savings. This is illustrated in the following statement of
a patient who was a manual laborer, belonging to the second income
quintile: “Me and my son are the two breadwinners of the family. My
wife stays at home and our two daughters are still schooling. I have
been in the hospital for the last five days and my son has to stay with
me. My son has to pay daily to the owner of the three-wheeler, which he
drives. Thankfully he has been given a months’ time to pay his debt. My
wife’s brother is helping us.”
On the other hand, loss of income was not a problem or was only a minor
problem for patients with more stable, fixed-income occupations in
either the government or private sector. A patient’s income is not
affected if they are paid a monthly salary and the duration of hospital
admission is within the approved quota for medical leave.
Patients with long-standing diseases such as cirrhosis are likely to be
affected more by recurring out-of-pocket expenditures and disruptions to
household income. Many of these patients had multiple medical problems
requiring numerous hospital visits and admissions. As a result of their
illness, most of their household activities and functions were also
disturbed. Furthermore, there were patients whose illnesses have
rendered them unsuitable to carry out their occupations and/or for
employment.
Patients of lower income categories were less protected from these
direct and indirect costs due to lack of savings, support, compensation
or inability to find an alternative occupation. Patients from lower
economic backgrounds often used terms such as “helpless, disrupted,
lost, devastated” when describing the household impact of illness and
hospital admission. The impact on patients in middle- and higher-income
categories was less, mainly due to the availability of a monthly wage or
pension, savings and stronger family support.