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High inpatient care cost of dying in India

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Abstract

Aim

This study sheds light on the high cost of inpatient care of decedents in comparison to that of survivors, a less known aspect of out of pocket (OOP) healthcare cost in India. The main objective is to compare the differentials in OOP inpatient care expenditures of decedents and survivors and examine the significant correlates of inpatient care cost controlling for survival status.

Subject and methods

This study uses nationally representative unit level data from the 60th round (2004–2005) of the National Sample Survey on morbidity and healthcare. Descriptive statistics and bivariate analysis are employed to describe characteristics of inpatients and compare unadjusted mean OOP expenditures for care of inpatient decedents and survivors, between public and private health facilities. A multilevel hierarchical model is used to model OOP expenditures for inpatient care.

Results

The inpatient care cost of decedents is much higher than that of survivors. The differential is significantly higher for those residing in rural areas, staying longer in hospitals, utilizing private health facilities and suffering from non-communicable and other serious diseases. There is significant differential in OOP inpatient care cost between individuals and between episodes of hospitalization of individuals.

Conclusion

The findings of this study can be used to assess the economic burden of inpatient care induced by increasing life expectancy and epidemiological transition in India. Social security and other social assistance programs in India should be made sensitive to the high cost of inpatient care at the end of life. There is an urgent need to expand the outreach of the public health system in India to rural areas.

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Declaration of conflicting interests

The authors declare no potential conflict of interest with respect of the authorship and/or publication of this article. There is no ethical issue as the study is based on data available in the public domain.

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Authors and Affiliations

  1. International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088, India

    Laishram Ladusingh & Anamika Pandey

Authors
  1. Laishram Ladusingh
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  2. Anamika Pandey
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Corresponding author

Correspondence to Laishram Ladusingh.

Appendix

Appendix

  1. 1.

    Gastro-intestinal diseases include diarrhoea/dysentery, gastritis/gastric or peptic ulcer, worm infestation, amoebiosis, and hepatitis/jaundice.

  2. 2.

    Febrile illness includes malaria, eruptive, mumps, diphtheria, whooping cough, and fever of unknown origin.

  3. 3.

    Other communicable diseases include tetanus, filariasis/elephantiasis, and diseases of skin, gynaecological disorder, under-nutrition/anaemia, sexually transmitted disease, and respiratory (including ear/nose/throat) ailments for ages <15 years.

  4. 4.

    Cardiovascular disease includes hypertension and heart attack.

  5. 5.

    Other non-communicable diseases include disorders of joints and bones, psychiatric disorders, prostatic disorder, and respiratory (including ear/nose/throat) ailments for ages >15 years.

  6. 6.

    Other diseases and disabilities includes goitre, eye ailments (cataract, glaucoma, conjunctivitis), diseases of the mouth, teeth and gums, disabilities, other diagnosed ailments, and other undiagnosed ailments.

  7. 7.

    Other medical expenditures include diagnostic charges, bed charges, attendant charges, physiotherapy charges, and cost of personal medical appliances.

  8. 8.

    Other charges under medical expenditure include expenditure on food and other materials, blood, oxygen cylinder, etc., services (ambulance etc.).

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Ladusingh, L., Pandey, A. High inpatient care cost of dying in India. J Public Health 21, 435–443 (2013). https://doi.org/10.1007/s10389-013-0572-9

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  • DOI: https://doi.org/10.1007/s10389-013-0572-9

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