Understanding out-of-pocket expenditure in India: a systematic review
Sagarika Kamath1, Jeffin Maliyekkal2, S Elstin Anbu Raj3
1Department of International Health, Care and Public Health Research Institute-CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.
Frontiers in Public Health
|June 24, 2025
Summary
High out-of-pocket expenditure (OOPE) in India burdens households, despite a recent decline. This systematic review identifies key factors influencing OOPE, highlighting the need for healthcare financing reforms.
Area of Science:
- Health Economics
- Public Health Policy
- Systematic Review Methodology
Background:
- Out-of-pocket expenditure (OOPE) remains a significant component of India's Total Health Expenditure.
- Despite a decline, OOPE contributes to catastrophic health costs and household impoverishment.
Purpose of the Study:
- To systematically review and analyze the determinants of out-of-pocket expenditures (OOPE) in India.
- To identify factors influencing healthcare financial burden on Indian households.
Main Methods:
- Systematic review of 702 retrieved citations, with 36 studies included after rigorous screening.
- Narrative synthesis and thematic analysis to identify determinants of OOPE.
- Data organized in tables and descriptive formats to address heterogeneity.
Main Results:
- Eleven key themes emerged, including source of care, place of residence, economic status, and health insurance.
- Factors such as age, gender, and educational attainment also influence OOPE.
- Coping strategies and components of OOPE were analyzed.
Conclusions:
- India's reliance on OOPE indicates significant healthcare financing gaps.
- Reforms in public investment, insurance, and primary care are crucial for equity and financial protection.
- Addressing equitable healthcare financing is essential to reduce reliance on distress financing.
Keywords:
Ayushman BharatNational Family Health Survey (NFHS)National Sample Survey Office (NSSO)out of pocket expenditurepublicly funded health insuranceMore Related Videos
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