What is the out-of-pocket expenditure for fall injuries in India?

Out-of-Pocket Expenditure for Fall Injuries in India

The out-of-pocket expenditure for fall injuries in India is significantly high, with fall injuries being one of the major contributors to injury-related economic burden among Indian households. While specific data exclusively for fall injuries is limited, research indicates that injuries overall, including falls, result in substantial financial burden with direct out-of-pocket medical expenditure averaging INR 16,768 (USD 263) per hospitalization 1.

Financial Burden of Fall and Other Injuries

• Fall injuries, along with road traffic injuries, cause higher disease and economic burden compared to other types of injuries in India 2.
• The mean out-of-pocket expenditure (OOPE) is five times higher in private facilities than in public hospitals for injury treatment 2.
• Households seeking treatment in private facilities face three times higher risk of catastrophic expenditure compared to those using public hospitals 2.

Catastrophic Health Expenditure

• Approximately 22.2% of households experience catastrophic health expenditure (defined as spending more than 30% of consumption expenditure) due to injury-related hospitalizations 1.
• About 12.2% of households slip below the poverty line following injury-related expenses 1.
• The prevalence of catastrophic expenditure is significantly higher among:
  • The poorest income quintile 1
  • Patients admitted to tertiary care hospitals 1
  • Cases with increased duration of hospitalization 1

Factors Affecting Out-of-Pocket Expenditure

• Insurance coverage significantly impacts expenditure, with uninsured individuals having 3.8 times higher odds of facing catastrophic medical expenditure 3.
• Only about 22% of injury patients have access to medical insurance 3.
• Treatment in private hospitals increases the risk of catastrophic medical expenditure by 5.2 times compared to public hospitals 3.
• The burden of out-of-pocket medical expenditure is mainly associated with the number of days spent in the hospital (Eta = 0.191) 3.

Regional Variations

• Patients from states like Punjab, Haryana, Uttar Pradesh, Gujarat, Karnataka, and Andhra Pradesh are more likely to use private facilities for injury treatment 2.
• People from Jammu and Kashmir, Orissa, West Bengal, and North Eastern states tend to utilize public facilities more frequently 2.
• Regional affiliation significantly influences the level of out-of-pocket expenditure and catastrophic health expenditure 4.

Distress Financing

• The prevalence of distress financing (borrowing money or selling assets) for injury treatment is approximately 69% 3.
• Distress financing is significantly higher for:
  • Patients reporting to public hospitals (2.8 times higher odds) 3
  • Those belonging to the lowest per capita annual household income quartile (7.0 times higher odds) 3
  • Individuals without insurance access (3.4 times higher odds) 3

Impact of Health Insurance Programs

• Despite government efforts to reduce financial burden through public health insurance programs for the poor, a large number of households still pay significant amounts out-of-pocket 4.
• Enrollment in public health insurance programs increases utilization of inpatient healthcare (1.21 higher odds of hospitalization) but does not significantly reduce out-of-pocket expenditure 5.
• Current insurance programs have limitations in coverage, particularly for outpatient services, which may lead to overutilization of inpatient services 5.