Financial Burden, Out-of-Pocket Health Spending, and Household Economic Well-Being in Heart Failure Patients in India: A Multicentre Cross-Sectional Survey

TL;DR

Heart failure patients in India face high out-of-pocket health costs, leading to economic hardship, especially among those without health insurance.

Contribution

This study quantifies the financial burden and economic impact of heart failure management in India, highlighting disparities between insured and uninsured patients.

Findings

Average out-of-pocket health spending constitutes 92.6% of total health expenditure for heart failure patients in India.

Catastrophic health spending and distress financing are significantly lower among insured patients compared to uninsured ones.

Over 30% of households report a decline in monthly income due to heart failure-related expenses.

Abstract

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.

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$).

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].

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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