Household out-of-pocket expenditure on health care - A cross-sectional study among urban and rural households, Puducherry.

Abstract

A major proportion of health expenditure is by households as out-of-pocket expenditure (OOPE) in India. Recent estimates at district level are required for planning implementation of Universal Health Coverage. To estimate the proportion of households incurring OOPE and the average amount spent by the household for healthcare. A cross-sectional study was conducted during August 2016 in the field practice areas of a medical college in Puducherry. A random sample of 240 households (120 rural and 120 urban) with 1,029 participants (531 rural and 498 urban) were surveyed. A pretested questionnaire was used to collect information on sociodemographic details, morbidity, healthcare services utilized, and expenses incurred. Recall period of 1 month was fixed for OP/Pharmacy Services and 6 months for IP services. In total, 120 rural and 120 urban households were surveyed; out of which, majority of the households were below poverty line [rural (83.3%, <i>n</i> = 100), urban (69.2%, <i>n</i> = 83)] and belonged to other backward classes [rural (60.8%, <i>n</i> = 73), urban (83.3%, <i>n</i> = 100)]. The proportion (95% CI) of households which incurred OOPE was 68.3% (59.5%-76%) in rural and 65.8% (57%-73.7%) in urban areas. The median (inter quartile range) proportion of OOPE out of the household budget was 3.31% (0.4%-10.96%) in rural and 5.15% (0.83%-16.3%) in urban areas. Even in a resource rich setting as the selected areas of Puducherry, majority of the households (67%) reported OOPE. The study estimates are lesser than the national estimates, but the availability and accessibility of resources are higher in Puducherry compared with the other parts of country.