Microeconomic Costs, Insurance, and Catastrophic Health Spending Among Patients With Acute Myocardial Infarction in India

Abstract

Key Points Question What are the costs and risks of impoverishment for patients with acute myocardial infarction and their families in Kerala, India, and how do these factors vary by health insurance status? Findings In this prespecified cross-sectional substudy of a randomized clinical trial, 2114 respondents reported $480 international dollars in out-of-pocket costs per acute myocardial infarction, with $400 international dollars in higher costs among individuals without insurance vs those with insurance. Catastrophic health spending was also higher among individuals without insurance (58.1% vs 39.9%) as was distress financing (9.7% vs 3.1%). Meaning Survivors of acute myocardial infarction in Kerala may face high costs and risk for impoverishment, and expansion of insurance access and coverage should be considered for financial risk protection.

Emerging challenges in the health systems of Kerala, India: qualitative analysis of literature reviews

“…However, the literature reveals that health financing in the state has been criticized because of the high rate of catastrophic expenditure on health and poor insurance coverage. Some surveys reported the financial status as a reason for restricting people from seeking health care [14, 59]. Recent reports based on various surveys showed that only a small percentage (less than 40%) of India's population availed themselves of any kind of health insurance protection [60–62]; Kerala is also struggling to improve its health insurance coverage [59].…”

“…Some surveys reported the financial status as a reason for restricting people from seeking health care [14, 59]. Recent reports based on various surveys showed that only a small percentage (less than 40%) of India's population availed themselves of any kind of health insurance protection [60–62]; Kerala is also struggling to improve its health insurance coverage [59]. The private health-care sector plays a significant role in Kerala's health-care system and is considered to be the highest compared to other states [31].…”

“…Despite all the efforts made by the government and private insurance facilities, socio-economic status, employment and disease profile have an adverse impact on insurance coverage in the state [46,48,65,68]. One of the futuristic approaches the state [58] Abbreviations: MCH -Medical college hospital, GHgeneral hospital, DHdistrict hospital, THtaluk hospital, *not fully functional Table 2.…”

Implications and Economic Impact of Applying International Guidelines and Recommendations to the Management of High-Risk Group of Type 2 Diabetes Mellitus Patients in India

“…We also need to look at the costs associated with the management of these adverse CV or renal outcomes in India if they do occur eventually in these high-risk T2DM patients, because this is exactly the expenditure that could be prevented by the use of SGLT-2 inhibitors (with/without DPP-IV inhibitors). In a study assessing the healthcare expenditure of patients with HF in India, it was found that the average total expenditure per patient during a two-year follow-up period was INR 133,663, out of which >60% was out-ofpocket expense [25]. Another study reported that out-of-pocket cost per acute MI was USD 480 (approximately INR 35,000), with the cost being much higher among non-insured patients (58.1%) [26].…”

Affordability Assessment from a Static to Dynamic Concept: A Scenario-Based Assessment of Cardiovascular Medicines

“…They stated that the treatment of CVDs with 21 selected lowest-price generic equivalent medicines was generally affordable, but the poorest households in Iran would be at risk of pushing under the poverty line because of the price of these CVD medicines [40,41]. Due to this fact that the CVD patients can still encounter a considerable expense, particularly with regards to multi-drug utilization [39,42], there is an interest to evaluate the impacts of health costs on households with the specific consideration of CVDs by multinational studies or single countries studies [38,[43][44][45][46][47][48][49][50][51][52][53][54].…”