Determinants of out-of-pocket health care expenditures and financial coping strategies among beneficiaries of a state-run health insurance scheme in South India

Abstract

Background: The household spending for health care in terms of out-of-pocket expenditures (OOPEs) in India remains one of the highest in the world at around 55% of current health expenditures and 48% of total health expenditures. Hence, it becomes extremely important to explore the determinants, i.e., the factors leading to OOPE. Objectives: To explore the determinants of OOPE and the financial strategies undertaken by the households to cope up with OOPE. Methodology: A longitudinal study was conducted among chronic kidney disease (CKD) patients who availed care at a Tamil Nadu Chief Ministers Comprehensive Health Insurance Scheme empanelled health care facility. They recorded their OOPE over a period of 6 months in the hand-book provided to them. An interview schedule was administered at the end of 6 months, to explore the determinants of OOPE and coping strategies. Results: Among the sociodemographic characteristics, age and gender had an impact on OOPE. Females had higher OOPE (INR 10,100) when compared to that of males (INR 9360) and with increased age of more than 60 years, there was a dip in OOPE (60-INR 10,100). The duration of current treatment has been another important determinant, whereas borrowings were the most predominant financial strategy to cope up with OOPE. Conclusion: Despite having the health insurance coverage sponsored by government, CKD patients had OOPE pertaining to the various aspects such as age, gender, comorbidities, and number of members in the household utilizing the scheme and the coverage amount under the scheme.

Keywords

• catastrophic health expenditures
• health insurance
• out-of-pocket health expenditures