N. Syed  ( PMRC Research Centre, Jinnah Postgraduate Medical Centre, Karachi. )
R. Athar  ( PMRC Research Centre, Jinnah Postgraduate Medical Centre, Karachi. )
O. F. Khan  ( PMRC Research Centre, Jinnah Postgraduate Medical Centre, Karachi. )
K. Shakoor  ( PMRC Research Centre, Jinnah Postgraduate Medical Centre, Karachi. )
H.Qureshi  ( PMRC Research Centre, Jinnah Postgraduate Medical Centre, Karachi. )
S. E. Alam  ( PMRC Research Centre, Jinnah Postgraduate Medical Centre, Karachi. )

For a medical institute to provide quality health care facilities in it's out patient's departments (OPD), it is essential to analyze it's present method of operation including the type of facilities available, their utilization and also determine the financial burden on the patients visiting for treatment.1-4
The aim of this survey was to determine the money the patients have to pay themselves for the management of their illness.

The survey was carried out by means of a questionnaire, which included the type of out-patient service visited by the patient, mode and expenditure of transport, cost of OPD token, medicine prescribed and whether provided fully or partially by the hospital or self purchased. Similar questions regarding the cost of laboratory and radiological tests,the amount of time consumed in hospital premises and the number of outpatient visits for the illness.

Table 1. Time spent by the patient in the hospital
Days per week	Medicine (%)	Surgery (%)	Gynae	Other (%)
			cology (%)
	(n=352)	(n=318)	(n=234)	(n=109)
One	63.8	56.0	54.4	67.9
Two	34.0	40.2	36.7	29.3
More than two	2.2	3.8	8.9	2.8
Hours per day
One	2.0	1.2	0	10.0
Two	14.5	6.3	9.8	26.6
Three	36.6	34.9	28.6	35.7
Four	32.1	46.2	36.3	26.6
Five and above	14.0	11.6	25.2	0.9

Out of a total of 1013 patients, 352, 318 and 234 were from medical, surgical and gynecological outpatient services, respectively. Another 109 were from other services like ENT and Neurology. The gender distribution showed more female patients (714) as compared to males (299). The

Table 2. Average number of patient visits per ailment.
Outpatient service	Average	`95% C.I.
Medicine	12	10-14
Surgery	6	5 - 7
Gynaecology	5	4 - 5
Others	7	6 - 8
Overall	8	7 - 9
Table 3. Patient expenditure on outpatient treatment*.
Expendityre on	Average	`95% C.I.
Transport
Bus/mini bis / coach	16	12 - 20
Rickshaw	60	40 - 80
Taxi/ambulance	145	125 - 165
Drugs	126	100 - 145
Laboratory test	180	80 - 280
Xray/ultrasound	50	40 - 75
Specific test	320	200 - 550
*In pakistani rupees

most common mode of transport utilized by the patients was bus, followed by minibus, coach, taxi and rickshaw.
A large number of patients were utilizing the institute's facilities for investigations, with approximately 96% using laboratory tests and 95% using radiology and ultrasound. Specific tests were done in 61% cases. Time consumed by each patient in the hospital was about 4 hours per day and on an average each patient had 8 visits per ailment. The average expenditure on transport was between Rs 16 - Rs 145. The average expenses for drugs, laboratory tests and specific tests (Thyroid profile, L.F.T, lipid profile etc) were 126, 180 and 320 rupees respectively. Complete analysis of time spent in hospital by the patients along with number of visits and their overall expenditure is shown in Tables 1, 2 and 3, respectively.

The analysis shows that Jinnah Postgraduate Medical Centre facilities are mostly being utilized for investigation purposes. Basic drugs (analgesics, antacids and multivitamins) are being provided to the patients while specific drugs like antibiotics, anti ulcers oral hypoglycemics and seizure controlling drugs etc are not provided and the patients have to purchase them on their own.
In order to improve the health delivery system, efforts should be directed to shorten the time spent by the patient in the OPD's along with reduction in the number of visits made by the patients.

1. Hyder AA. Applying WHO's Health Systems Performance Assessment in Pakistan: Critical reflections. J Coll Physicians Surg Pak 2003;13:187-91.
2. Mc Devitt, Buczko W. Medicad program characteristics: effects on health care expenditures and utilization. Health care Finance Rev. 1985;7:1-15.
3. Anderson GF. In search of value: an international comparison of costs, access and outcomes. Health Aff (Millwood) 1997;16:13-71.
4. Shi L. Health care spending, delivery and outcome in developed countries: a cross-national comparison. Am J Med Qual 1997;12:83-93.