Catastrophic health expenditure due to hospitalisation for COVID-19 treatment in India: findings from a primary survey

Abstract

Objective The COVID-19 pandemic has caused widespread illness and a significant proportion of the infected required hospitalisation for treatment. People in developing countries like India were vulnerable to high hospitalisation costs. Despite its crucial importance, few primary studies are available on this aspect of the pandemic. This study was aimed at finding out the out of pocket expenditure (OOPE) and incidence of catastrophic expenditure on hospitalisation of persons infected with COVID-19. A primary survey of 492 randomly selected hospitalisations of individuals tested positive for COVID-19 in high-burden districts during August to November 2020 was carried out telephonically in Chhattisgarh state of India. Results Public hospitals accounted for 69% of the hospitalisations for COVID-19 treatment. Mean OOPE per hospitalisation was Indian Rupees (INR) 4871 in public hospitals and INR 169,504 in private hospitals. Around 3% of hospitalisations in public hospitals and 59% in private hospitals resulted in catastrophic expenditure, at a threshold of 40% of non-food annual household expenditure. Enrolment under publicly or privately funded health insurance was not effective in curtailing OOPE. Multivariate analysis showed that utilisation of private hospitals was a key determinant of incurring catastrophic expenditure.

Household Catastrophic Health Expenditure for COVID-19 during March-August 2021, in South India: A Cross-Sectional Study

“…[33] As documented in east-central India, those hospitalised in public hospitals [3.2% (1.8-5.7%)] incurred CHE more than those hospitalized in private hospitals [58.9% (50.5-66.74%)]. Overall, 20.3% (16.9-24.1%) of those hospitalised had CHE, [25] which is more comparable with our study ndings. Comorbidities and being elderly were associated with the severity of COVID-19 and the need for hospitalisation.…”

“…[25] Our analysis found that households that received insurance co-payments/reimbursement were six times more likely to experience CHE, pointing towards likely ineffectiveness of insurance copayment/reimbursement, whether public or private. Similar ndings from India [25] and other countries such as Peru and USA have reported high OOPE for COVID-19 hospitalization and the ineffectiveness of health insurance. [16, 39,40] Tamil Nadu State reports that approximately 66.5% of households are covered by the Chief Minister's Comprehensive Health Insurance Scheme (CMCHIS), implemented to provide nancial protection to the vulnerable, compared to a national average of 41% of households.…”

“…[21][22][23][24] Literature shows how the COVID-19 pandemic made families vulnerable to CHE due to health systems' growing dependence on OOPE. [25,26] Hence, there is a need to generate information on OOPE and CHE due to COVID-19 in India. In this context, we conducted this study to estimate the household OOPE for COVID-19 treatment and the proportion of households that experienced CHE in Tamil Nadu.…”

Post-COVID-19 Assessment of Physical, Psychological, and Socio-Economic Impact on a General Population of Patients From Odisha, India

“…This monthly income showed a decrease to INR 25,000 (USD 337. [24]. Another study on COVID-19 patients from Western India revealed that even after the government scheme, the median difference in the final bill and the amount reimbursed through government schemes was INR 59,560 ($ 807.75) [25].…”

Assessing the time use and payments of multipurpose community health workers for the various roles they play—a quantitative study of the Mitanin programme in India

“…In addition to the designated four roles described earlier, Mitanins were expected to carry out a number of tasks related to the COVID-19 pandemic including promoting behavioural change, door to door visits for surveillance of relevant symptoms and monitoring the cases under home isolation. The data collection was done in November 2020 and the first wave of the pandemic was in progress in Chhattisgarh in that period [ 26 ]. The sixth and the last purpose of time use was for data collection, routine reporting about their work and other paper work of administrative nature.…”