Out of pocket expenditure on hypertension and diabetes mellitus among people residing in the rural field practice area of a medical college: a community based cross-sectional study

Chinta Archana; Krishnaveni Avvaru; Helena Kanta

doi:10.18203/2394-6040.ijcmph20261411

Authors

Chinta Archana Department of Community Medicine, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India
Krishnaveni Avvaru Department of Community Medicine, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India
Helena Kanta Department of Community Medicine, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20261411

Keywords:

Diabetes, Hypertension, Out-of-pocket expenditure

Abstract

Background: Out-of-pocket expenditure (OOPE) on health care especially with non-communicable diseases forces households into poverty. The study was conducted with the aim of understanding the out-of-pocket health expenditure and their coping mechanisms in patients suffering from hypertension and diabetes mellitus in the rural field practice area.

Methods: A community-based cross-sectional study was conducted among 230 study participants suffering from hypertension or diabetes mellitus or both in the rural field practice area of Andhra Medical College, Visakhapatnam.

Results: The total mean OOPE among hypertensives was ₹ 501.69, among diabetics it was ₹ 1522.27, and among both hypertensives and diabetics, it was ₹1352.93. Age<50 years, being literate, belonging to upper-middle and lower-middle socioeconomic status, being married, suffering from diabetes mellitus and receiving treatment from a private hospital were associated with the presence of OOPE.

Conclusions: The current study highlights the rising economic burden of hypertension and diabetes mellitus. There is a significant impact of OOPE on household finances. Many households resort to coping mechanisms such as family members providing the money, borrowing money, selling assets or spending from savings or pension.

References

National Health Systems Resource Centre (NHSRC). State wise Out-of-Pocket Expenditures in Urban Areas. New Delhi: NHSRC. 2017. Available at: https://nhsrcindia.org/sites/default/files/2021 06/Health%20care%20Utilization%20and%20Expenditure%20in%20urban%20ar eas.pdf. Accessed on 20 December 2025.

National Health Systems Resource Centre (NHSRC). National Health Accounts Estimates for India (2019-20). New Delhi: Ministry of Health and Family Welfare, Government of India. 2023. Available at: https://main.mohfw.gov.in/sites/default/files/5NHA_1920_dt%2019%20April%202023_web_version_1.pdf . Accessed on 20 December 2025.

Palal D, Jadhav SL, Gangurde S, Thakur K, Rathod H, S J, et al. People’s Perspective on Out-of-Pocket Expenditure for Healthcare: A Qualitative Study from Pune, India. Cureus. 2023. Available at: https://www.cureus.com/articles/133595-peoples-perspective-on-out-of-pocket-expenditure-for-healthcare-a-qualitative-study-from-pune-india. Accessed on 20 December 2025.

WHO. Non communicable diseases. 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases. Accessed on 20 December 2025.

Mohanty SK. Trend in Out-of-Pocket Expenditure and Catastrophic Health Spending in India 2004-2018. Mumbai: International Institute for Population Sciences. 2021.

Puri P, Singh SK. Exploring the non-communicable disease (NCD) network of multi-morbid individuals in India: A network analysis. PLOS Glob Public Health. 2022;2(6):e0000512.

Asogwa OA, Boateng D, Marzà-Florensa A, Peters S, Levitt N, Van Olmen J, et al. Multimorbidity of non-communicable diseases in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Open. 2022;12(1):e049133.

Ismail S, Stanley A, Jeemon P. Prevalence of multimorbidity and associated treatment burden in primary care settings in Kerala: a cross-sectional study in Malappuram District, Kerala, India. Wellcome Open Res. 2022;7:67.

WHO. SDG 3.8.2 Catastrophic health spending (and related indicators). 2025. Available at: https://www.who.int/data/gho/data/themes/topics/financial-protection. Accessed on 20 December 2025.

Mehta R, Mantri N, Goel A, Gupta M, Joshi N, Bhardwaj P. Out-of-pocket spending on hypertension and diabetes among patients reporting in a health -care teaching institute of the Western Rajasthan. J Fam Med Prim Care. 2022;11(3):1083-8.

Fernandes SD, Fernandes SDA. Economic burden of diabetes mellitus and its socio-economic impact on household expenditure in an urban slum area. Int J Res Med Sci. 2017;5(5):1808-13.

Chakraborty S, Rai RK, Biswas AK, Barik A, Gurung P, Praveen D. Health care seeking behaviour and financial protection of patients with hypertension: A cross-sectional study in rural West Bengal, India. PLOS ONE. 2022;17(2):e0264314.

Ram AA, Kalyani P, Felix AJW. A study on the out-of-pocket expenditure among households with diabetic and hypertensive patients in Chidambaram, Tamil Nadu. Int J Adv Community Med. 2019;2(3):100-4.

Rakesh PS, Renjini BA, Mohandas S, Menon J, Numpelil M, Sreedevi A, et al. Hypertension in urban slums of southern India: Burden, awareness, health seeking, control and risk factor profile. Indian Heart J. 2023;75(4):258-62.

Puri P, Pati S. Exploring the Linkages Between Non-Communicable Disease Multimorbidity, Health Care Utilization and Expenditure Among Aboriginal Older Adult Population in India. Int J Public Health. 2022;67:1604333.

Brar S, Kaur G, Muniyandi M, Karikalan N, Bano H, Bhansali A, et al. Cost of screening, out-of-pocket expenditure and quality of life for diabetes & hypertension in India. Indian J Med Res. 2023;157(6):498-507.

Ramanna MK, A R, Janti SS, Eerike M, Prabu RL. Burden of therapy in patients suffering from diabetes mellitus and hypertension. Int J Pharm Pharm Sci. 2017;9(5):210-3.

Bedane SN. Out of Pocket Expenditures among Hypertensive Patients and their Households who Visit Public Hospitals in Addis Ababa, Ethiopia, 2016. Health Econ Outcome Res Open Access. 2018;4(1):1-7.

Joshi A, Mohan K, Grin G, Perin DMP. Burden of Healthcare Utilization and Out-of-Pocket Costs Among Individuals with NCDs in an Indian Setting. J Community Health. 2013;38(2):320-7.

Nanda M, Sharma R. Financial burden of seeking diabetes mellitus care in India: Evidence from a Nationally Representative Sample Survey. Health Care Sci. 2023;2(5):291-305.

MK, Ashraf MN, Rahman MM, Khan KNK. Cost burden of type 2 diabetes mellitus (DM) in an urban area of Bangladesh: A hospital-based mixed method study. medRxiv. 2020.

Huluka SA. Economic Burden of Diabetic Mellitus and its Associated Factors among Patients on Follow up at Public Regional Hospitals in Addis Ababa, Ethiopia. Health Econ. 2022;9:1-9.

Okoronkwo I, Ekpemiro J, Onwujekwe O, Nwaneri A, Iheanacho P. Socioeconomic inequities and payment coping mechanisms used in the treatment of type 2 diabetes mellitus in Nigeria. Niger J Clin Pract. 2016;19(1):104-10.

Chaikledkaew U, Pongchareonsuk P, Chaiyakunapruk N, Ongphiphadhanakul B. Factors Affecting Health-Care Costs and Hospitalizations among Diabetic Patients in Thai Public Hospitals. Value Health. 2008;11(1):S69-74.

Swain S, Samal S, Sahu K, Rout S. Out-of-pocket expenditure and drug adherence of patients with diabetes in Odisha. J Fam Med Prim Care. 2018;7(6):1229-34.

L A, Cutinha RM, Sahoo SS, Dsouza JD, Shetty S, Gururaj C, et al. Effect of healthcare expenditure on the health-related quality of life among diabetic patients of South India: A cross- sectional study. Clin Epidemiol Glob Health. 2024;25:101460.

Zhai X, Zhou Z, Liu G, Lu J, Zhao Y, Cao D, et al. Catastrophic health expenditure of households with hypertension: a comparative study in China. Front Public Health. 2023;11:1176170.

Kansra P, Oberoi S. Cost of diabetes and its complications: results from a STEPS survey in Punjab, India. Glob Health Res Policy. 2023;8(1):11.

Pushparani JP, Paulin DG. Out-of-pocket expenditure on diabetes care in an urban population of Tamil Nadu: A community-based study. Int J Adv Community Med. 2019;2(2):125-30.

Alemayehu M, Addis B, Hagos T. Out-of-pocket health expenditure and associated factors among patients with hypertension in Debre-Tabor Comphrensive Specialized Hospital, South Gondar zone, Northwest Ethiopia, 2020. Front Public Health. 2023;11:1014364.

Naren K, Mangasuli V, Vijeth S, Amrutha A, Ahmed N, Sidenu B. Economic impact of hypertension in Urban chitradurga: A cross-sectional study. MRIMS J Health Sci. 2022;10(4):70-5.

Mathew R, Olickal JJ. Out-of-pocket expenditure on non-communicable diseases during Covid-19. A cross-sectional study from a semi-urban area of Kannur, Kerala. Clin Epidemiol Glob Health. 2023;19:101210.

Ipinnimo TM, Ipinnimo MT, Alabi AK, Buari TH, Ajida-Hun EO, Olasehinde KO, et al. Coping with the economic burden of non-communicable diseases among hypertensive and diabetic patients in private and public health facilities in Ado-Ekiti, Nigeria. Ghana Med J. 2023;57(3):218-25.

Patel MR, Anthony Tolentino D, Smith A, Heisler M. Economic burden, financial stress, and cost-related coping among people with uncontrolled diabetes in the U.S. Prev Med Rep. 2023;34:102246.

Rahman T, Gasbarro D, Alam K. Financial risk protection from out-of-pocket health spending in low- and middle-income countries: a scoping review of the literature. Health Res Policy Syst. 2022;20(1):83.

Nazir S, Mir AR, Rashid A. Financial Coping Mechanisms in Patients with Type II Diabetes Mellitus in Rural India. Int J Health Sci Res. 2020;10(5):176-80.

Murphy A, McGowan C, McKee M, Suhrcke M, Hanson K. Coping with healthcare costs for chronic illness in low-income and middle-income countries: a systematic literature review. BMJ Glob Health. 2019;4(4):e001475.