Hospitalisation, associated factors and out-of-pocket expenditure among patients with multimorbidity in Kerala, India: a cross-sectional study.

Abstract

To estimate the rate of hospitalisation, identify associated factors and assess out-of-pocket expenditure (OOPE) among adults with multimorbidity in Kerala, India. Community-based cross-sectional study. Two districts of Kerala, representing different geographic regions of the state. A total of 432 adults aged ≥30 years with multimorbidity were selected using multistage cluster sampling; 52.3% were women. Self-reported hospitalisation in the preceding 12 months and OOPE related to multimorbidity. Hospitalisation in the past year was reported by 26.62% of participants (n=115; 95% CI 22.5% to 31.1%). Among them, the majority (n=78, 67.83%) were admitted to government hospitals, and most hospital stays lasted <7 days (n=77, 67%). Hospitalisation was significantly higher among residents of Kollam district (adjusted prevalence ratio (APR) 1.52; 95% CI 1.09 to 2.12), participants with health insurance (APR 1.38; 95% CI 1.01 to 1.89) and those with more than two chronic conditions (APR 1.76; 95% CI 1.28 to 2.41). Among participants who incurred OOPE (90.7%), the median annual expenditure was ₹30 720 (US$353) (IQR ₹17 850-59 725). Medicines constituted the largest share of OOPE (61.7%). One in four adults with multimorbidity in Kerala reported hospitalisation. A significant proportion of OOPE was for drugs. These findings highlight the urgent need for targeted financial protection measures, equitable resource allocation and strengthening of primary care services to reduce avoidable hospitalisations and economic burden. The increase in hospitalisation among those with insurance coverage requires careful attention from policy makers. Regulation of drug prices may be required to reduce the financial burden imposed by drugs.