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Financial Burden, Out-of-Pocket Health Spending, and Household Economic Well-Being in Heart Failure Patients in
Panniyammakal Jeemon1, Reethu Salim1,2, K Safvan1,2
1Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
Insights
Heart failure patients in India face significant financial burden, with out-of-pocket expenses comprising over 90% of total health spending. Addressing this financial strain is crucial for improving patient well-being and health equity.
Area of Science:
- Cardiology
- Health Economics
- Public Health
Background:
- Heart failure (HF) management is resource-intensive, with significant economic implications, particularly in low- and middle-income countries (LMICs).
- The financial burden (FB) on patients is increasingly recognized as a critical non-clinical factor impacting HF management in India.
Purpose of the Study:
- To explore factors associated with financial burden (FB) in heart failure (HF) patients in India.
- To assess the economic impact of HF on patients and households in the Indian context.
Main Methods:
- Recruited 1,859 HF patients from 21 diverse hospitals across India.
- Collected clinical and economic data using a validated questionnaire, recording expenditures in Indian Rupees (INR) and International Dollars (INT$).
Main Results:
- Average annual out-of-pocket (OOP) expenditure was INR 1,06,566 (INT$ 4,709.10), representing 92.6% of total health expenditure.
- Catastrophic health spending (CHS) affected 37.7% and distress financing (DF) affected 17.7% of households.
- CHS and DF were lower among patients with health insurance compared to the uninsured.
Conclusions:
- Over 70% of HF patients in India lack financial health protection, with high OOP expenditures driving economic distress.
- Financial burden, including CHS and DF, significantly impacts HF patients' well-being and necessitates targeted interventions.
- Addressing financial burden is essential for improving clinical outcomes and achieving health equity for HF patients in India.
Background:
Heart failure (HF) is a complex clinical condition requiring resource-intensive management and substantial health expenditure. The adverse economic impact of medical care on patients or financial burden is increasingly recognised as a significant non-clinical entity affecting HF management in low- and middle-income countries (LMIC). We explored the factors associated with Financial Burden (FB) in HF patients in India.
Methods:
We recruited HF patients from 21 hospitals across India, selected to reflect regional diversity and varying stages of epidemiological transition. Trained personnel collected clinical and economic data using a validated and structured questionnaire. Expenditures were recorded in Indian rupees (INR) and converted to international dollars (INT$).
Results:
We recruited 1,859 participants. Nearly one-third of participants (30.2%) were women. The mean age was 55.9 (11.3) years, and the mean duration of formal education was 11.3 (3.8) years. Health insurance coverage was reported in one-third (32.2%) of the study population. The average annual out-of-pocket (OOP) expenditure was INR 1,06,566 (INT$ 4,709.10), constituting 92.6% (95% CI: 92.5-92.7) of the total health expenditure. Compared to the previous year, a decline in monthly income was reported by 32.3% of individuals and 36.2% of households. Catastrophic health spending (CHS) and distress financing (DF) were observed in 37.7% (35.5-39.9) and 17.7% (15.9-19.4) of the households, respectively. However, CHS and DF were lower [30.8% (26.2-35.4) and 13.6% (10.2-17.0), respectively] among those with health insurance compared to the uninsured [40.3% (37.6-43.0) and 18.9% (16.7-21.1), respectively].
Conclusion:
Seven out of 10 HF patients in India lack financial health protection. OOP expenditures, accounting for over 90% of total health spending, contribute significantly to economic distress in HF patients. Financial burden, affecting more than one-third of HF patients, carries profound implications for individual well-being. Addressing this financial burden, including CHS and DF, is essential for improving clinical outcomes and ensuring health equity.
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