Out-of-Pocket Expenditure Among Patients With Diabetes and Hypertension at a Public Secondary Healthcare Facility in Delhi

Abstract

Introduction: Despite national-level improvements in government health expenditure, a significant proportion of patients with chronic conditions like diabetes and hypertension still incur out-of-pocket healthcare expenses, with some facing catastrophic financial burdens. Out-of-pocket expenditure (OOPE) is the direct payments made by individuals for healthcare services at the point of use, excluding any reimbursements from insurance or government schemes. Healthcare spending that exceeds a predefined threshold of a household's income or consumption, potentially pushing families into financial hardship, is referred to as catastrophic health expenditure (CHE). Understanding the extent of OOPE and its potential to cause catastrophic health expenditure is crucial for designing effective financial risk protection measures. This study aims to assess OOPE among persons with diabetes and hypertension visiting a public secondary-level healthcare facility in Delhi.

Methods: A cross-sectional study was conducted among 390 participants using a self-developed questionnaire to collect data on healthcare expenses. The data was collected over a period of six months, from February 2024 to July 2024, with the help of Google Forms (Google Inc., Mountain View, CA, USA). A self-designed, pre-tested questionnaire was developed in English, translated to Hindi, and back-translated to English. The face validity of the questionnaire was assessed by three subject experts. Data was collected by resident doctors. Data was analysed in STATA 14.0 (StataCorp., College Station, TX, USA).

Results: The median age of participants was 58 years (49-64), with 235 (60.3%) being women. The median monthly family income was reported to be 20000 (12000-30000) Indian rupees (INR). The mean monthly OOPE was 174.9 INR, ranging from 0 to 4350 INR. OOPE was incurred by 205 (52.56%) participants. Mean direct expenditure was reported as 156.8 INR (95% CI: 120.8-192.9). Mean indirect expenditure was found to be 22.2 INR (95% CI: 12.1-32.2). Among them, 20 (5.13%) participants had faced CHE.

Conclusion: The findings of this study highlight the heterogeneous nature of OOPE among persons with diabetes and hypertension seeking care at the Rural Health Training Centre in Najafgarh, Delhi. Although many participants reported no OOPE, others experienced significant financial burden across various health service components, including medications, diagnostics, consultations, and hospitalizations. A total of 20 participants experienced CHE. This highlights the need for further research on OOPE determinants and the impact of government interventions.

Keywords: affordable healthcare; catastrophic health expenditure; cost of healthcare; direct cost; expenses; hypertension; indirect cost; non-communicable disease; out-of-pocket-expenditure; types 2 diabetes.