ClinicoEconomics and Outcomes Research (Jul 2022)
Financial Burden and Catastrophic Health Expenditure Associated with COVID-19 Hospitalizations in Kerala, South India
Abstract
Ronnie Thomas,1 Quincy Mariam Jacob,1 Sharon Raj Eliza,2 Malathi Mini,1 Jobinse Jose,3 Sobha A1 1Department of Community Medicine, Government Medical College Kottayam, Kottayam, Kerala, India; 2Department of Community Medicine, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India; 3Department of Community Medicine, Kasturba Medical College, Mangalore, IndiaCorrespondence: Ronnie Thomas, Department of Community Medicine, Government Medical College Kottayam, Kottayam, Kerala, India, Tel +91 9947014747, Email [email protected]: Catastrophic health expenditure during COVID-19 hospitalization has altered the economic picture of households, especially in low resource settings with high rates of COVID-19 infection. This study aimed to estimate the out of pocket (OOP) expenditure and the proportion of households that incurred catastrophic health expenditure due to COVID-19 hospitalization in Kerala, South India.Materials and Methods: A cross-sectional study was conducted among a representative sample of 155 COVID-19 hospitalized patients in Kottayam district over four months, using a pretested interview schedule. The direct medical and non-medical costs incurred by the study participants during hospitalization and the total monthly household expenditure were obtained from the respective COVID-19 affected households. Catastrophic health expenditure was defined as direct medical expenditure exceeding 40% of the household’s capacity to pay.Results: From the study, median and mean OOP expenditure was obtained as USD 93.57 and USD 502.60 respectively. The study revealed that 49.7% of households had catastrophic health expenditure, with 32.9% having incurred distress financing. Multivariate analysis revealed being below poverty line, hospitalization in private healthcare facility, and presence of co-morbid conditions as significant determinants of catastrophic health expenditure.Conclusion: High levels of catastrophic health expenditure and distress financing revealed by the study have unveiled major unaddressed challenges in the road to universal health coverage.Keywords: COVID-19, financial burden, catastrophic health expenditure, distress financing, Kerala
