Patients who were admitted for at least one night in a tertiary care hospital of Chandigarh during a 1 month period from April 15, 2013, and May 15, 2013, were recruited. Data were collected for the type of injury, out-of-pocket expenditure, and mechanisms undertaken to cope up with the expenditure. Cases were followed up at 1 month, 2 months, and 12 months after discharge to collect information about out-of-pocket expenditure. Prevalence of catastrophic expenditure—ie, if it exceeded 30% of the patient's annual household income—and distress financing—ie, if borrowing (with or without interest) or selling of assets was used to cope with high out-of-pocket expenditure, were assessed among patients recruited. Assuming prevalence of catastrophic expenditure to be 22%, with a precision of 5·5% and 5% alpha error, the sample size was estimated to be 218.
227 patients were recruited, of whom 155 (68%) were followed up until 12 months. No significant differences were noted based on sociodemographic, injury, and hospitalisation characteristics between the patients who were followed up and those who were lost to follow-up. Average out-of-pocket expenditure per admission to hospital was US$388 (95% CI 332–441) and at 12 months after injury was US$1046 (871–1221). Mean out-of-pocket expenditure for road traffic injury cases at the time of hospitalisation was US$400 (95% CI 344–456) and for non-road traffic injury cases was US$369 (313–425). The prevalence of catastrophic expenditure was 30% (95% CI 26·95–33·05), which was significantly associated with lower income quartile (OR 23·3 [95% CI 5·7–93·9]; p <0·01), inpatient stay greater than 7 days (OR 8·8 [95% CI 3·8–20·6); p<0·01), major surgery (OR 4·9 [95% CI 2·2–10·8]; p<0·01), and occupation as wage labourers (OR 8·1 [95% CI 1·6–39·9]; p=0·01).
High private out-of-pocket expenditure for treatment of injury poses major economic burden on families. Measures aimed to increase public health spending for prevention of injury and to provide financial risk protection to those injured deserve urgent priority in India.
The George Institute for Global Health, India.