Why Financial Constraints Drive Indian Patients to Leave Against Medical Advice: Key Findings from Recent Study

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By Gautam Debroy

A recent study reveals that financial constraints are a major reason why patients leave emergency departments against medical advice (LAMA). Conducted by a team of emergency medicine experts, the study found that alongside money issues, other reasons include patients feeling better after initial treatment, the unavailability of ICU beds, and fears of infection.

Notably, Mohan Bhagwat, chief of the RSS, commented that good healthcare is becoming harder for regular people to access. At the opening of the Madhav Srishti Arogya Kendra in Indore, he said that healthcare and education, once seen as services, are now commercialized and out of reach for many.

The study, led by Rishu Kumar, Sandeep Jain, and Anoop Purkayastha and published in The National Medical Journal of India, highlights how LAMA presents a real challenge for healthcare providers. Patients who leave early often lose the chance for follow-up care, making it hard to track their health outcomes.

“Leaving the hospital against medical advice can lead to untreated conditions that may result in readmission,” the authors noted. “While no hospital supports LAMA, patients still have the right to choose their care.”

Key Findings of the Study

The researchers categorized the reasons for LAMA into two groups: patient-related factors such as age and financial status, and healthcare-related factors like hospital policies and doctor-patient interactions. They found that low income and inadequate financial support are consistently linked to LAMA in developing countries. In India, these reasons vary: a study in the north found that 27.6% of LAMA cases were financial, while a southern study reported figures as high as 50%.

Conducted at Max Super Specialty Hospital in New Delhi, the observational study tracked 400 patients who chose to leave early between October 2021 and March 2022. Out of 7,598 emergency visitors, 400 (5.2%) opted for LAMA. Most were men, mainly in the 31-40 age group.

Here’s a breakdown of reasons for leaving:

25.8% (103 patients) left because they felt better.
20.5% (82 patients) cited unavailable bed types.
17.3% (69 patients) left due to financial issues.
14.8% (59 patients) were worried about hospital-acquired infections.

The study also pointed out that lack of health insurance and low monthly income were significant predictors of LAMA across all age categories.

Tackling the LAMA Issue

To address this problem, researchers recommend enhanced home care services, more family doctors, and increased ICU availability. They emphasize the importance of improving communication between patients and healthcare providers.

Healthcare experts note that ICU costs differ based on hospital type and location. Government hospitals often have lower costs, while private hospitals can be pricey due to advanced facilities. This disparity can lead to significant financial strain for patients paying out-of-pocket.

Dr. Tamorish Kole, a health expert and former president of the Society for Emergency Medicine, India, emphasized that LAMA stems from various clinical, logistical, and financial factors. He noted that while many leave because they feel better, systemic issues like the lack of ICU beds and high costs are critical contributors.

According to Dr. Kole, addressing financial concerns is vital. He suggests several strategies:

Offer clear and upfront cost estimates in emergency departments.
Direct patients towards health insurance options like Ayushman Bharat.
Collaborate with NGOs and philanthropic groups for financial assistance.
Provide home care to lower ICU costs.
Use medical social workers to discuss flexible payment plans.

Regarding fears of infection, Dr. Kole explained that while risks exist in ICUs, accredited hospitals follow strict protocols to minimize these dangers. “LAMA reflects gaps in healthcare access and affordability,” he said, urging coordination among hospitals, government programs, and communities to bridge these divides.