Assessment of out-of–pocket health expenditure and prevalence of protective mechanisms against it among the households in an urban area, Bangalore: a longitudinal study

N. B. Swetha, Shobha ., S. Sriram


Background: Achieving Universal Health Coverage according to The World Health Assembly’s way to reinforce the principle of human right to health in 2005 has been a huge task for India. India has one of the highest proportions of household out-of-pocket expenditures on health in the world, estimated at 71.1% in 2008–09. The unpredictable payments are impoverishing an estimated 3.3% of India's population every year. In this regard various strategies have been adopted such as—reforming tax based health financing or introducing health insurance. This highlights the need for alternative finances which includes the provision of medical insurance. The study was conducted to assess the out-of-pocket health expenditure and estimate the prevalence of protective mechanisms against it in an urban area- Bangalore.

Methods: A longitudinal study was conducted in the urban area of Bangalore. Sample size was calculated to be 350 households. Data regarding socio-demographic profile, protective mechanisms and other details were obtained by interview method using a pre-tested and semi-structured questionnaire.

Results: Majority were in the productive age group i.e. 991 (62.68%) individuals. Female population was slightly higher in our study. Most of the households belonged to upper lower class (54.29%). A major burden of health care cost was experienced both in acute as well as chronic illness by the households. Only 8.9% (31 households) had one or the other type of health insurance.

Conclusions: Population has profound chances of experiencing catastrophic health expenditure in times of severe illness.


Insurance, Health care, Chronic illness, Direct and indirect cost

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