Patients in a private hospital in India leave the emergency department against medical advice for financial reasons

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.

Discharge against medical advice (DAMA): Causes and predictors

“…Therefore, in this study, the distance and financial problems can be considered as the main causes of the DAMA. The results are consistent with the results of studies in Nigeria ( 21 , 28 ), India ( 25 ), and Tehran ( 27 ). The distance in addition to the cost for patients can increase their willingness for DAMA.…”

“…Several studies have been conducted to investigate the causes of DAMA. Dissatisfaction with the care received, an enhanced sense of well-being ( 16 ), financial problems ( 21 , 25 – 27 ), lack of access to skilled and qualified physicians, lack of advanced medical services due to lack of essential medical equipment, high burden of patients referral, and bustle in medical centers ( 11 ), dissatisfaction with the medical staff, dissatisfaction with the hospital environment, not achieving a satisfactory result from treatment ( 28 ), and prolonging the stay of patients ( 29 ) are of investigated reasons in the studies. In addition to the reasons stated, several variables have been examined in studies and have been confirmed as predictors of DAMA.…”

The care and transport of trauma victims by layperson emergency medical systems: a qualitative study in Delhi, India

“…Healthcare in Delhi is provided by a mix of for-profit hospitals, and relatively low-cost public hospitals 43. Patients often leave for-profit hospitals against medical advice for financial reasons 44 45. It is standard medico-legal practice across India to treat all injuries as potentially criminal cases that are registered as medico-legal cases and reported to the police.…”

What happens to patients discharged against medical advice?

“…[ 1 ] Despite the widespread nature of this problem, there has been little data evaluating incidence, reasons, and outcome of patients leaving DAMA. Studies have focused on specific patient groups such as patients admitted to the emergency department[ 7 ] or psychiatric/orthopedic patients. [ 8 ] We did not find any studies specifically evaluating this in critically ill patients in India.…”