Prevalence Of Catastrophic Health Expenditure Due To Out-Of-Pocket Health Care Expenses Among Households With And Without Chronic Illness In An Urban Area Bangalore, India - A Longitudinal Study



India, one of the economic powerhouses of the world, is lacking in health development. And it is facing ‘Triple burden of disease’. Indians have one of highest proportion of out-of –pocket (OOP) health expenses. Salient reasons are poor quality public health care, costly private care and lack of health insurance. This has led to catastrophic health expenditure (CHE). Another contributor to this CHE is the chronic illness which require long-term follow-up. It is estimated that catastrophic health expenditure impoverishes 3.3% of Indians every year.  This study was undertaken with an aim to estimate the prevalence of catastrophic health expenditure.


A longitudinal study with one year follow-up period was conducted among 350 households of an urban area in Bangalore city. Simple random sampling method was used to select the study sample. Data collection done using pre-tested, semi-structured questionnaire by interview method.


Chronic illness mean health expenditure was 1155.67 INR. 56.09% of the direct cost was spent on drugs. In acute illness, mean health expenditure was 567.45 INR. 59.54% of the direct cost was spent on drugs. 48 (14.86%) of the households experienced CHE in the one year. Statistically significant association was found between socio-economic status and catastrophic health expenditure. 85.42% of the households who experienced CHE had a member with chronic illness in it.


Reducing the financial burden of high health care expenses is possible by improving the government health care system, free quality regular supply of medications to chronic disease patients and also to improve the beneficiaries under insurance schemes.


Keywords:Government health care, financial burden, direct costs,


Balarajan Y, Selvaraj S, Subramaniam S V. Health care and equity in India. Lancet [serial online] 2011 Feb 5; 377(9764):505-515. Available from URL:


Economic Research Foundation. ―Government Health Expenditure in India: A Benchmark Study‖. Undertaken for the MacArthur Foundation, India, New Delhi. 2006 Aug. Available from URL:


Skordis-Worrall J, Pace N, Bapat U, Das S, More N S, Joshi W. Maternal and Neonatal Health Expenditure in Mumbai slums (India): a cross-sectional study. BMC Public Health . 2011 Mar 8; 11(150):1471-2458. Available from URL:


World Health Organisation. Global Health Observatory [online] 2012; Available from URL:


N. Barua. How to develop a pro-poor private health sector in urban India? Global Forum for Health Research.Forum9, Mumbai, 2005. Available from URL:


Ranson M K. Reduction of catastrophic health care expenditures by a community-based health insurance scheme in Gujarat, India: current experiences and challenges. Bull World Health Organ. 2002 Aug; 80(8):613. Available from URL:


Ellis R P, Alam M, Gupta I. Health insurance in India prognosis and prospects. Economic and Political weekly [serial online] 2000 Jan. Available from URL:


Ministry of Health and Family Welfare, Government of India. Report of the National Commission on Macroeconomics and Health, New Delhi. 2005 Aug. Available from URL:


Kawabata K, Xu K, Carrin G. Preventing impoverishment through protection against catastrophic health expenditure. Bull World Health Organ [serial online] 2002; 80(8):612. Available from URL:


Devadasan N, Criel B, Damme W, Ranson K, Van der Stuyft, P. Indian community health insurance schemes provide partial protection against catastrophic health expenditure. BMC Health Services Research. 2007 Mar; 7:43. Available from URL:


Bhojani U, Thriveni B S, Devadasan R, Munegowda C M, Devadasan N, Kolsteren P et al. Out-of-pocket healthcare payments on chronic conditions impoverish urban poor in Bangalore, India. BMC Public Health 2012; 12:990. Available from URL:


Kanungo S, Bhowmik K, Mahapatra T, Mahapatra S, Bhadra UK, Sarkar K. Perceived morbidity, healthcare-seeking behavior and their determinants in a poor-resource setting: observation from India. PLoS ONE . 2015 May; 10(5):e0125865. Available from URL:


Quintussi M, Poel E V, Panda P, Rutten F. Economic consequences of ill-health for households in northern rural India. BMC Health Services Research. 2015; 15:179. Available from URL:


Rehman A, Shaikh B T, Ronis K A. Health care seeking patterns and out of pocket payments for children under five years of age living in Katchi Abadis (slums), in Islamabad, Pakistan. International J for Equity in Health. 2014 Apr; 13:30. Available from URL:


Balasubramanian D, Prinja S, Aggarwal A K. Effect of user charges on secondary level surgical care utilization and out-of-pocket expenditures in Haryana State, India. PLoS ONE. 2015 May ; 10(5):e0125202. Available from URL: