Economic burden and catastrophic health expenditure associated with COVID-19 hospitalisations in Kerala, South India

Abstract

Introduction - Catastrophic health expenditure during COVID-19 hospitalization has altered the economic picture of households especially in low resource settings with high rates of COVID-19 infection. This study aimed to estimate the Out of Pocket (OOP) expenditure and the proportion of households that incurred catastrophic health expenditures due to COVID-19 hospitalisation in Kerala, South India. Materials and Methods - A cross-sectional study was conducted among a representative sample of 155 COVID-19 hospitalised patients in Kottayam district over four months, using a pretested interview schedule. The direct medical and non-medical costs incurred by the study participant during hospitalisation and the total monthly household expenditure were obtained from the respective COVID-19 affected households. Catastrophic health expenditure was defined as direct medical expenditure exceeding 40% of effective household income. Results - From the study, median and mean Out of Pocket (OOP) expenditures were obtained as USD 93.57 and USD 502.60 respectively. The study revealed that 49.7% of households had Catastrophic health expenditure, with 32.9% having incurred Distress financing. Multivariate analysis revealed being Below poverty line, hospitalisation in private healthcare facility and presence of co-morbid conditions as significant determinants of Catastrophic health expenditure. Conclusion - High levels of Catastrophic health expenditure and distress financing revealed by the study unveils major unaddressed challenges in the road to Universal health coverage.

Household Catastrophic Health Expenditure for COVID-19 during March-August 2021, in South India: A Cross-Sectional Study

“…A recent study from South India found that 49.7% of households faced CHE, and 32.9% of the households incurred distress nancing due to COVID-19. [33] As documented in east-central India, those hospitalised in public hospitals [3.2% (1.8-5.7%)] incurred CHE more than those hospitalized in private hospitals [58.9% (50.5-66.74%)]. Overall, 20.3% (16.9-24.1%) of those hospitalised had CHE, [25] which is more comparable with our study ndings.…”

“…[38] The mean OOPE for COVID-19 per household in this study, at US $1,643, is different from the ndings from other parts of India. A study from Kerala reported the mean OOPE as US $502 during the second wave, [33] and in a survey from Chhattisgarh, the mean OOPE was US $2,229 for private and US $64 for government hospitals in the rst wave of the COVID-19 pandemic.…”

Catastrophic health expenditure during the COVID-19 pandemic in five countries: a time-series analysis

“…Reductions in the use of non-COVID-19 care could have offset the use of COVID-19 care. 11 Stay-at-home orders and fear of exposure to COVID-19 could have kept potential users away from health facilities, driving up rates of forgone care. 12 Shortages of health-care workers and personal protective equipment and other capacity constraints limited the ability of health systems to maintain essential services.…”

“…Other studies have looked at single countries, examined COVID-19 care spending, or only assessed OOP spending (but not CHE). 4 , 6 , 7 , 11 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 The absence of cross-country comparison of 2020 CHE limits understanding of health system resilience and the adaptation of policies to address financial hardship going forward.…”

Determinantes del gasto de bolsillo en salud en el Perú, la pandemia de Covid 19 y los seguros de salud

“…Como es de conocimiento público, estas deficiencias provocaron la muerte de más de 200 mil peruanos entre los años 2020 y 2021. Al respecto, estudios recientes en otros países encuentran que la enfermedad covid 19 puede incrementar fuertemente el gasto de salud (Thomas et al, 2021;Gang et al 2022).…”