Out-of-Pocket Expenditure for Health Care in India: A Narrative Review

Background: Out-of-Pocket Expenditure (OOPE) for health care is a clear indicator of the financial strain that households endure. In India, Catastrophic Health Expenses (CHE) have been borne by almost 18% of the households. Over millions of people are pushed into poverty each year as a result of increased cost of health care. This narrative review was undertaken to obtain the current status of OOPE in India. Methodology: A comprehensive search of major databases such as PubMed Central, Scopus, Web of Science, Cochrane Library database, Google Scholar was done using keywords relevant to the research question. Articles published in English from 2010 onwards relevant to the review were included. Results: About 16 studies were reviewed and their findings are presented. Out-of-Pocket Expenditure was incurred by 75% of the households for Outpatient care and 5% to 28% of the households experienced Catastrophic Health Expenditure. Medications contributed to the largest proportion of the expenses. Conclusion: The burden of OOPE for outpatient (OP) & inpatient (IP) care as well as medications were very high, CHE was incurred by a few households for IP care. We recommend inclusion of outpatient treatment for chronic illnesses in the current government-instituted health insurance programs and to expand the coverage. Since the scope of this review is limited, a comprehensive systematic review and meta-analysis is warranted to understand the extent of the problem and the reasons behind.