Open AccessVicious cycle of chronic disease and poverty: a qualitative study in present day Nepal
Author(s) -
Taranath Sapkota,
Inge Houkes,
Hans Bosma
Publication year - 2020
Publication title -
international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.743
H-Index - 31
eISSN - 1876-3413
pISSN - 1876-3405
DOI - 10.1093/inthealth/ihaa016
Subject(s) - poverty , disadvantaged , chronic poverty , disease , health care , social determinants of health , economic growth , cycle of poverty , chronic disease , development economics , payment , qualitative research , basic needs , inequality , medicine , economics , sociology , poverty reduction , social science , family medicine , pathology , finance , mathematical analysis , mathematics
Background In countries with out-of-pocket (OOP) payment systems for healthcare, the combination of chronic disease and poverty can have damaging socio-economic and health impacts for affected households. Using a life course perspective, this article aims to explore how Nepalese people struggle with, experience and adapt to chronic disease, poverty and their consequences, and how chronic diseases and poverty reinforce each other. Methods In-depth semi-structured interviews were conducted with 21 chronically ill Nepalese people with one or more chronic diseases and/or their caretakers. Data were transcribed and analysed thematically. Results The adaptation strategies for the consequences of the huge OOP costs make patients and their households financially disadvantaged. The impoverishment has major social impacts and often persists across generations. The situation forces people to choose between avoiding medical treatment or further impoverishing their families. Conclusions This study explored how chronically ill Nepalese people struggle with socio-economic and health consequences of OOP payments for their disease. The article sheds light on circumstances and adaptation strategies that obstruct every attempt to escape from the vicious cycle of the poverty trap. Hence poverty and health adversities accumulate across generations and contribute to greater health expenditures, worse health outcomes and severely compromised social life.