Health care utilization and out of pocket expenditure in a rural area of Kerala: a cross sectional study

Sajna Mathumkunnath Vijayan, Safa Puliyakkadi, Swathi Chalil


Background: Out-of-pocket expenditure in health has substantial negative side effects. They may lead to impoverishment. The knowledge of pattern of health care utilization and out of pocket expenditure is imperative for policy making in health care. Objectives of this study were to study utilization pattern of health care services of the population in a rural area of Thrissur district and study of the self-reported chronic morbidity profile and out of pocket expenditure for chronic diseases among the population.

Methods: A community based cross sectional study was conducted in Tholur panchayath area of Thrissur district of Kerala. The calculated sample size was 552 households. House hold was considered as primary sampling units. All family members of the house hold were included in the study. Cluster sampling method was adopted. Data was collected using a pre tested semi-structured questionnaire.

Results: A total of 809 individuals from 583 households were found to have chronic diseases. Among them, 54.8% were utilizing private health facility for their treatment. Majority (86%) were following modern medicine system for treatment. Health insurance was availed by 26.6 % of the study participants. Most common reported morbidity was combination of hypertension, diabetes mellitus, and hypercholesterolemia. The total median out of pocket expenditure for chronic diseases was found to be 5000 Indian Rupees. It was found that 41.6% of the total income of study participants was spent for health care of chronic diseases which indicate catastrophic health expenditure.

Conclusions: The burden of chronic disease is high and the private hospitals are approached more by the study population for treatment rather than government hospitals. Health insurance coverage is low, and social assistance availed for treatment is marginal. These factors lead to high out of pocket expenditure amounting to catastrophic health expenditure.


Chronic morbidity, Health care utilization, Out of pocket expenditure

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