Out- of- Pocket Expenditure for Health Care Services among the Households in the Rural Field Practice Area of a Medical College in Bengaluru – A Community Based Prospective Study

Background and objectives: Health expenditure is the money spent to restore, maintain, and protect health in a country. Out-of-pocket health expenditure (OOPHE) is the direct payment made by households without insurance. In 2022, the world spent 9.8 trillion US dollars on health, about 9.9% of the global GDP. Health spending was growing slower than GDP. Although India aims for “Universal Health Coverage,” its public health spending was only 1.8% of GDP in 2021-22. Households in India pay about 62.6% of total health costs out of pocket. High out-of-pocket costs can create financial barriers for poor people and causing financial disaster or poverty in many countries. Around 100 million people worldwide fall into extreme poverty due to high out-of-pocket health costs. Therefore, this study was conducted to estimate the amount of OOPHE incurred among the rural households. Methodology: A community based prospective study. Results: Out of 300 households studied, only 4 (1.33%) had health insurance coverage. The prevalence of OOPHE was 97% (291 out of 300). There was no statistical difference in median annual OOPHE with gender, educational status, occupation of the head of the household and socioeconomic classes of the household. The median (IQR) annual OOPHE was significantly higher among the households who had more than five members in the family [Rs. 7,200 (1,800-7,800)], joint families [Rs. 6,500(2,400-17,800)], those who were seeking health care from private hospitals [Rs. 23,600(12,000-78,000)], households with both acute and chronic illness (Rs.12,000) (p<0.005). About 11.33% of households incurred catastrophic health expenditure, with more than 10% of household income spent on health conclusion: Around 97% of the households incurred Out-of-pocket health expenditure and it was significantly more among the joint families, households with both acute and chronic illness, and those who were seeking health care from private hospital. And 11.33% of households had catastrophic health expenditure.