Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan 14;13(1):30-38.
doi: 10.1093/inthealth/ihaa016.

Vicious cycle of chronic disease and poverty: a qualitative study in present day Nepal

Taranath Sapkota  1 , Inge Houkes  1 , Hans Bosma  1
Affiliations

Vicious cycle of chronic disease and poverty: a qualitative study in present day Nepal

Taranath Sapkota et al. Int Health. .

Abstract

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.

Keywords: Nepal; chronic disease; life course perspective; out-of-pocket payments; poverty trap; qualitative study.

PubMed Disclaimer

References

    1. O’Donnell O, Doorslaer EV, Rannan-Eliya R, et al. Who pays for health care in Asia? J Health Econ. 2008;27(2):460–475. - PubMed
    1. Poudel R, Upadhyaya T, Tiwari DP. People’s perspectives on access to healthcare services in a rural district of Nepal. J Nepal Med Assoc. 2012;52(1):20–24. - PubMed
    1. World Health Organization Regional Office for South-East Asia Health financing profile 2017. Nepal. Available from: https://apps.who.int/iris/bitstream/handle/10665/259643/HFP-NEP.pdf.
    1. World Health Organization Global Health Expenditure Database. Available from: https://apps.who.int/nha/database [accessed 25 January 2020].
    1. Organisation for Economic Co-operation and Development, World Health Organization Health at a glance: Asia/Pacific 2018. Measuring progress towards universal health coverage. Paris:OECD Publishing, 2018.