In the present situation there is an urgent need to pay attention to the public health services in order to improve them. To foster such a programme, CEHAT provided research inputs for a seminar on improving public hospitals in Mumbai organised by the Medico Friend Circle (Bombay Group). As a follow up to this campaign, the Anusandhan Trust supported the above study of patient satisfaction in the L. T. M. G. Hospital (popularly known as Sion Hospital) of the Brihanmumbai Municipal Corporation in 1996. It was a collaborative effort with the Hospital and the volunteers of Sion Senior Citizens Association who collected data from 123 indoor patients (about 10% of the bed strength) using a questionnaire. We took care in the methodology to include information on the socio-economic background of the participants, their health seeking behaviour before arriving at the public hospital, the problems and expenditure incurred at the public hospital and their perceived satisfaction with the services. Along with that we also obtained data on the hospital facilities, both through observation as well as from hospital records.
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A large majority of the patients (71.4 %) were from the city's slums, chawls or streets. Clearly, the patients seeking indoor care at a public hospital like LTMG are in many ways disenfranchised members of society.
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The survey showed that 3.2 % of patients were not provided beds, 19.5 % were not provided linen and 16.3 % were not given hospital clothing. Once provided, 21.1 % of linen and 27.6 % of hospital clothes had never been changed. Less than half the respondents approved of the hospital food.
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As against 19.5 % who were provided all medicines by the hospital, a majority of the patients (68.1 %), had to buy medicines from outside pharmacies. The situation vis-à-vis diagnostic facility was found to be better; nearly two out of three were able to get all the required diagnostic tests done at the hospital.
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One of the most startling findings of the survey was the fact that as many as 41.8 % of the patients spent more on the daily expenses on hospital care, than their entire households earned in a day. The average monthly household income was RS. 2,749 per month, and patients spent an average of RS. 2,533 before and RS. 1,555 after admission. This means that, one-and-a-half times the monthly income of the entire household had already been spent, prior to the interview, on medicines, investigations and doctors' fees. by the time the interview was conducted. By the time the patient was discharged, this ratio might probably have become twice as high. Medical expenses inevitably force the poor deeper into the debt trap, with poverty leading to illness and illness leading to further poverty.
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The contribution of the private sector in increasing the misery of patients from the poorer strata was high, since half of them had first approached private practitioners who often squeeze them of money before sending them to a public hospital. Nearly three out of five patients had been ill for more than three weeks before they were admitted to the hospital.
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Regardless of all the problems they encounter at a public hospital, the study found that the overall patient satisfaction was high. They were impressed by the fact that it was a "big" hospital. In a touching display of faith, an astonishing 88.6 % said that all doctors were competent, while 91.9 % believed all nurses were competent. The dominant emotion was gratitude for the expert care they received.
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What explains these high levels of patient satisfaction? The study argues that one reason could be a very low-key, if not a totally absent, demand for better service by users. Only the poor come to public hospitals, many of them after getting exploited and neglected in the private hospitals. Besides, their daily living condition in the slums is several times worse than the conditions in the public hospitals. They are therefore grateful for whatever care comes their way.
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Since they expect so little, they fail to pressurise the institution to improve its standards. This absence of pressure for quality from users sets off a vicious circle of low demand, therefore low quality, leading to the alienation of larger strata of people, and again lower demand. A way out is to make a commitment to quality and user friendliness as part of the culture and tradition of the hospital, irrespective of whether or not users demand it.
The findings and recommendations of the study were presented in a seminar at the Sion hospital and also to the hospital's committee of doctors.
Projected Supported by: Anusandhan Trust
Team:Aditi Iyer,Amar Jesani and Santosh Karmarkar
