The economic impact of the insured patients with severe chronic and acute illnesses: a qualitative approach

Figures & data

Table 1 Qualitative research sampling strategy and sample size

No.	Hospital	Level	Number of beds	Location	Sample size
1	Margono Sukarjo Hospital	B (teaching hospital at provincial level)	507	Banyumas	13
2	Banyumas Hospital	B (teaching hospital at district level)	325	Banyumas	6
Total sample size					19

Table 2 Characteristics of study participants

	Frequency	%
Health insurance status
Askes	7	36.8
Jamsostek	5	26.4
Jamkesmas	7	36.8
Gender
Male	5	26.3
Female	14	73.7
Hospital admission
Banyumas Hospital	6	31.6
Margono Sukarjo Hospital	13	68.4
Residency
In Banyumas	9	47.4
Out of Banyumas	10	52.6
Employment status
Working
Formal and salaried	10	52.6
Not salaried	3	15.8
Not working	4	21.1
Retired	2	10.5
Household relationship
Parents	5	26.3
Spouse	8	42.1
Child	4	21.1
Others	2	10.5

Table 3 The steps of the thematic framework analysis

Code	Issue discussed	Basic/initial theme	Organizing/developed theme	Global/final theme
Cost-sharing	The amount of the cost-sharing	The amount of expenditures	OOP expenditures related to medically direct costs	Characteristic of out-of-pocket expenditures for insured patient during hospitalization
No cost-sharing	Without cost-sharing
Covered benefits	The type of covered benefits	Covered benefits scheme
Uncovered benefit cost	The amount of the negative list benefits costs	Uncovered benefits scheme
Types of uncovered benefits	The type of the negative list benefits
Chronic disease	Type of chronic disease	Severity of diseases
Acute disease	Type of acute disease
Decision to choose uncovered benefits	Provider convince insured to use branded drugs	Locus of control decision making
	Learning from past experience to control expenditures
Ward upgrade	Decision to upgrade ward class		OOP expenditures related to non-medical direct costs
Hospital LoS	The length of stay in hospital
Direct cost non-medical	Payment for patient transportation
	Upgrading facilities
Costs for accompany	The amount of cost for people who accompanied the patient		OOP expenditures for additional costs
Meals cost for family	Expenditures for family meals
Transport cost for family	Expenditures for family transportation
Using saving for bill	Using family saving for cost-sharing and uncovered benefits	Mobilizing savings	Insured households use their internal resources	Household strategy to cope with out-of-pocket expenditures due to severe illnesses
Selling valuable goods	Selling family assets to cover the bill	Sale of assets
Borrowing for bill	Decision to borrow some money for the bill	Loans
Son and daughter support	Support for hospital bill	Family supports	External supports for addressing high OOP expenditures
	Support for indirect cost
Parent supports	Financial support from parent
Relatives support	Financial support for hospital bill
	Support for daily living patient accompany
Employer support	Employer providing additional benefit plan	Other benefits plan from employer
Neighbor support	Neighbor donation	Community support
Uncertainty solution for a bill	Unclear solution for payments	Many efforts to find solution
Feel financial burden	Cost-sharing more than income	Influencing monthly income	Economic difficulty influence household income stability	Financial hardships faced by insured households due to hospitalization
	Inability without family support	Income support from family
	Additional burden
No feel financial burden	Adequate support from family
	High level of civil servant grade	Sufficient income
	Cost-sharing was less than income	Less effect to income
Having economic impact to household	Decreasing household economic stability	Household economic disruption	High OOP expenditures reduce household assets
	Affecting household assets	Decreasing household wealth
No economic impact to household	Having sufficient saving	Less effect to household wealth
	Scheme provide sufficient coverage
	Family supports
Working disruption	Leaving working time	Less working performance	Employment-related issues
	Reducing working time
	Reducing salary
	Influence work performance
	Inability to work	Employment termination
	Quit the job
Grateful for scheme	Positive impression of having scheme	Feeling pleasurable satisfaction	Insured household feel satisfied with the scheme	Positive and negative perceptions of insured households regarding health insurance schemes
	Feeling convenient with the scheme
	Protecting financial shock	Feeling adequate protection
	Sufficient benefits coverage
Past experience of using scheme	Having good experience of having scheme	Good experience using the scheme
Unhappy with the scheme	Drugs coverage	Insufficient coverage	Insured household feel less satisfied with the scheme
	Higher cost-sharing
	Quality of hospital services	Service discrimination
Another impact	Early discharged from hospital	Other reason to stop the service

Fig. 1 Classification of economic hardship.