Why is the inpatient cost of dying increasing in India?

Abstract

IntroductionThere is an evidence of increasing inpatient expenditure for decedents. Estimates used to assess the economic burden of out-of-pocket (OOP) healthcare expenditure provide an underestimation for inpatient decedent cases. The aims of this paper are to study the trend and pattern of inpatient decedent expenditure and decipher the reasons behind the increasing cost in India.MethodsUsing three rounds of national level National Sample Survey (NSS) data on morbidity & healthcare conducted during 1995–2015 in India, total and component-wise cost of dying was estimated by the socio-demographic characteristics and types of diseases. Generalised linear model was employed to find the changing effect of inpatient decedents on inpatient expenditure on three-time points.ResultsMore than half among inpatient decedents were elderly. Mean inpatient expenditure for neoplasm, circulatory system-related diseases and external causes of mortality and morbidity increased substantially during these two decades. Mean decedent inpatient expenditure become double, diagnostic and bed charges increased by 243%, 323% respectively during 2004–05 to 2014–15. During 2014–15 average decedents aged 15–59 years spent ₹53599 in last twelve month of their life. Controlling all other potential factors, the inpatient expenditure among decedents increased substantially between 1995–96 and 2014–15.DiscussionOut-of-pocket inpatient health expenditure widened between survivor and decedents in between 1995–2014. Increase in the proportion of elderly, proportion of non-communicable and lifestyle-related diseases, expenses on drugs, diagnostics, bed charges largely private sector expenses were the leading reasons for increasing inpatient decedent expenditure. Age-based risk adjustment and modification of end-of-life care are strongly required, future social insurance based on the health-based value of out-of-pocket expenditure rather than their pure consumption value need to be designed to tackle the burden.

Drivers of hospital expenditure and length of stay in an academic medical centre: a retrospective cross-sectional study

“…age, SES, inpatient death) that have been studied elsewhere, our results have corroborated well with those studies. For example, our observation of less costly and less intensive care in the oldest age groups [46–49], association between lower SES with increased frequency of inpatient visits [53–56], and excessive inpatient expenditure from decedents [67] have also been reported in other studies. These give us confidence that the novel results in our studies could apply to those populations and countries as well.…”

“…Expenditure of visit which ended in death accounted for almost half of total observed expenditure of a patient on average. Although analysis was performed at patient-level, a study in India found that 2014 to 2015 inpatient expenditure for decedents was 64% higher than non-decedent [67]. This observation may be due to more intensive care rendered at the end-of-life (EOL), prior to the patient passing on in the hospital.…”

Medical intervention before death of elderly in India: An inquiry into gender‐based difference

“…The study, using the NSS data set of the 60th round (2004)(2005), finds that the cost is significantly higher for the group, who are rural residents, suffering from chronic ailments, staying in hospitals for longer duration, and utilizing private healthcare facilities. Another study by Das and Ladusingh 13 further confirms from the NSS dataset for the period 1995 to 2015 that while mean decedent inpatient expenditure doubled during 2004-2005 to 2014-2015, diagnostic and bed charges increased manifolds. Controlling all other potential factors, the inpatient expenditure among elderly decedents increased substantially between 1995-1996 and 2014-2015.…”

INDICAPS II: A Bird's Eye View of the Indian Intensive Care Landscape

“…The out-of-pocket expenses on in-patient decedents were found to be unbearable for the majority of families in the large National Sample Survey. 4 The costs of ICU care were not explored further in this study.…”