Out-of-Pocket Spending on Out-Patient Care in India: Assessment and Options Based on Results from a District Level Survey

Abstract

Out-of-pocket spending at out-patient departments (OPD) by households is relatively less analyzed compared to hospitalization expenses in India. This paper provides new evidence on the levels and drivers of expenditure on out-patient care, as well as choice of providers, using household survey data from 8 districts in 3 states of India. Results indicate that the economically vulnerable spend more on OPD as a proportion of per capita consumption expenditure, out-patient care remains overwhelmingly private and switches of providers—while not very prevalent—is mostly towards private providers. A key result is that choice of public providers tend to lower OPD spending significantly. It indicates that an improvement in the overall quality and accessibility of government facilities still remain an important tool that should be considered in the context of financial protection.

Financial protection analysis in eight countries in the WHO South-East Asia Region

“…Studies reported that the poor were more likely to be deterred by the perceived high prices. 32 , 33 This is particularly worrisome as the burden of noncommunicable diseases, which are associated with higher out-of-pocket expenditure and catastrophic health expenditure 22 , 34 , is increasing fast in the Region.…”

The costs of seeking healthcare: Illness, treatment seeking and out of pocket expenditures among the urban poor in Delhi, India

“…We opine that improving access to the government healthcare services along with improved quality is much needed to address the healthcare needs of the poor and to reduce the OOPE as expressed by various scholars (Gupta, Reddy, Semwal, & Singh, ; Gupta, Chowdhury, Prinja, & Trivedi, ; Gupta & Muraleedharan, ; Rao, Selvaraju, Nagpal, & Sakthivel, ; Tripathy et al, ). Need for improving access to public sector health services and social protection policies was expressed (Brinda, Rajkumar, Enemark, Rajkumar, Enemark, Prince, & Jacob, ; Daivadanam, Thankappan, Sarma, & Harikrishnan, ; Gupta et al, ; Karan, Selvaraj, & Mahal, ). Babu and Kusuma () opined that both public and private firms who engage a great number of informal workers, mainly the internal migrants, should provide basic amenities including the healthcare as the migrants were usually excluded for accessing services.…”

“…Selvaraj and Karan (2012) could not find any beneficial effects of any health insurance on out of pocket healthcare expenditures. We opine that improving access to the government healthcare services along with improved quality is much needed to address the healthcare needs of the poor and to reduce the OOPE as expressed by various scholars (Gupta, Reddy, Semwal, & Singh, 2017;Gupta, Chowdhury, Prinja, & Trivedi, 2016;Gupta & Muraleedharan, 2014;Rao, Selvaraju, Nagpal, & Sakthivel, 2005;Tripathy et al, 2016). Need for improving access to public sector health services and social protection policies was expressed (Brinda, Rajkumar, Enemark, Rajkumar, Enemark, Prince, & Jacob, 2012;Daivadanam, Thankappan, Sarma, & Harikrishnan, 2012;Gupta et al, 2016;Karan, Selvaraj, & Mahal, 2014).…”

Tackling the primary care access challenge in South Asia

“…In India, evidence suggests that outpatient care is more impoverishing than inpatient care in urban and rural areas alike. A study done in three Indian states showed that 3.5% of the population fell below the poverty line on account of out-of-pocket expenses on healthcare, but this decreased to 0.5% if outpatient care was excluded 28. In Pakistan, 90% of out-of-pocket payment is for outpatient services 29.…”