HEALTHCARE EXPENDITURE AND CARE SEEKING PATTERNS AMONG PEOPLE WITH CHRONIC CONDITIONS DURING THE PANDEMIC

ABSTRACT

Objective: Public health strategies resorted to world-wide, to reduce the transmission of COVID-19 had economic impacts which led to care seeking changes among people with pre-existing chronic diseases. We aimed to assess the household expenditure and, care seeking among people with chronic diseases due to COVID-19 pandemic in Sri Lanka. Design and Methods: An online survey was conducted in 2021 involving 449 adults living in the Western-Province of Sri Lanka. Data on participants socio-demographic and economic status, co-morbidities, healthcare utilization, and healthcare-seeking behaviours were collected using a pre-tested questionnaire. The questionnaire link was distributed through social media and by emails. Categorical data were expressed as proportions/percentages with 95% confidence intervals where relevant. Quantitative data, normally distributed, were summarized in terms of mean and standard deviation (SD) and non-normally distributed as the median and interquartile-range (IQR). Results: 449 respondents completed the survey. Majority (55%;n = 173) responded that they experienced a negative impact on their main income. Nearly 30%(n = 130) of the participants had an additional source of income before the pandemic;and of them majority (74%;n = 97) reported a negative impact on the income. Twenty six percent (n = 115) mentioned that they had a doctor-diagnosed chronic disease or a disability and of them 72% (n = 83) were on regular medication. Nearly half (n = 55;48%) mentioned that there was a delay in seeking healthcare during the pandemic and 27% (n = 30)reported not having sought treatment during the lockdown period. Of the people with delayed healthcare seeking 25% had hypertension, 16% diabetes, and 12.2% asthma. The pandemic led to changes in healthcare utilization patterns among patients. Majority had to obtain the drugs from the pharmacy 65% (n = 70) and the laboratory tests from private labs 58% (n = 62). Forty-eight percent agreed that the pandemic led to delays in healthcare seeking, mostly because they were unaware of the services rendered. The incurred high OOPE during the pandemic. Of the participants, 9% (n = 39) and 3.2% (n = 14) had incurred catastrophic healthcare expenses at 10% and 25% of their total income. Conclusions: Residents of the Western-province were severely economically affected by the COVID-19 pandemic. Participants had incurred high out-of-pocket expenditures which led to changes in care seeking patterns among people chronic conditions. Strategies to ensure continuity of care especially for chronic conditions while protecting people from financial hardships is necessary to move towards Universal Health Coverage.