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Original research
The impact of demonetisation on the utilisation of hospital services, patient outcomes and finances: a multicentre observational study from India
  1. Tarun K George1,
  2. John Victor Peter2,
  3. Lakshmanan Jeyaseelan3,
  4. Bijesh Yadav3,
  5. Shalom Patole4,
  6. Roshine Mary Koshy5,
  7. Prabhu Joseph6,
  8. Balasubramanian P7,
  9. Aravindan Nair8,
  10. Anand Zachariah1,
  11. Krupa George1,
  12. Georgi Abraham9,
  13. Balasubramanian Venkatesh10
  1. 1General Medicine, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
  2. 2Medical Intensive Care Unit, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
  3. 3Biostatistics, Christian Medical College and Hospital Vellore, Vellore, India
  4. 4General Medicine, Christian Hospital, Chhatarpur, Madhya Pradesh, India
  5. 5General Medicine, Makunda Christian Leprosy and General Hospital, Karimganj, Assam, India
  6. 6Orthopedics, Duncan Hospital, Raxaul, Bihar, India
  7. 7Hospital Management, RUWSEC Hospital Tamil Nadu, Chengalpattu, Tamil Nadu, India
  8. 8General Surgery, Sri Narayani Hospital and Research Centre, Sripuram, Tamil Nadu, India
  9. 9Nephrology, Madras Medical Mission, Chennai, Tamil Nadu, India
  10. 10Division of Critical Care, George Institute for Global Health, Sydney, New South Wales, Australia
  1. Correspondence to Dr Tarun K George; tarunkg{at}gmail.com

Abstract

Background This study assessed trends in healthcare utilisation in relation to the implementation of an economic policy in India wherein 500 and 1000 rupee notes were demonetised.

Methods In this ambidirectional observational study of private not-for-profit hospitals, data on hospital outpatient and inpatient numbers, surgeries, emergency department (ED) visits, obstetric admissions and mortality were obtained for pre-demonetisation (September/October 2016), early (November/December 2016) and late demonetisation (January/February 2017), and post-demonetisation periods (March/April 2017) and compared with the control period (2015–2016) from 11 centres (three tertiary hospitals; eight secondary). A Bayesian regression analysis was performed to adjust for seasonal (winter) effect. Monthly financial data, including the proportion of cash versus non-cash transactions, were collected.

Findings Overall, at the pooled all-hospital level, Bayesian analysis showed non-significant increase in outpatients (535.4, 95% CI −7097 to 8116) and decrease in deaths (–6.3 per 1000 inpatients, 95% CI −15.45 to 2.75) and a significant decrease in inpatients (−145.6, 95% CI −286.4 to −10.63) during demonetisation. Analysis at the level of secondary and tertiary hospitals showed a variable effect. For individual hospitals, after adjusting for the seasonal effect, some hospitals observed a significant reduction in outpatient (n=2) and inpatient (n=3) numbers, ED visits (n=4) and mortality (n=2) during demonetisation, while others reported significantly increased outpatient numbers (n=3) and ED visits (n=2). Deliveries remained unchanged during demonetisation in the hospitals that provided the service. There was no significant reduction in hospital incomes during demonetisation. In tertiary hospitals, there was a significant increase in non-cash component of transactions from 35% to 60% (p=0.02) that persisted beyond the demonetisation period.

Conclusions The effect of demonetisation on healthcare utilisation was variable. Some hospitals witnessed a significant reduction in utilisation in some areas, while others reported increased utilisation. There was an increase in non-cash transactions that persisted beyond the period of demonetisation.

  • health services research
  • hospital-based study
  • health economics
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgh-2020-002509

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    Footnotes

    • Handling editor Lei Si

    • Contributors We provide the list of authors with their contribution. TKG: Literature search, data collection, study design, interpretation and writing. JVP: Literature search, study design, data interpretation, writing and review. LJ: Study design, data interpretation, writing and review. BY: Data analysis, interpretation, drafting and approval of manuscript. SP: Data collection, interpretation, drafting and approval of manuscript. RMK: Data collection, interpretation, drafting and approval of manuscript. PJ: Data collection, interpretation, drafting and approval of manuscript. BP: Data collection. interpretation, drafting and approval of manuscript. AN: Data collection, interpretation, drafting and approval of manuscript. AZ: Study design, interpretation and approval of manuscript. KG: Study design, data collection, interpretation and approval of manuscript. GA: Data collection, interpretation and approval of manuscript. BV: Literature search, study design, data interpretation, writing, approval and review of manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by the Institutional Review Board (IRB) and Ethics committee of the lead hospital (Ref No. 10 868 (OBS) dated 27.09.2017) and the ethics committee or the respective administrative authority of the participating hospitals.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon request. The deidentified data is available with the corresponding author and available on request.