Household out-of-pocket expenditure on health care - A cross-sectional study among urban and rural households, Puducherry

CONTEXT: A major proportion of health expenditure is by households as out-of-pocket expenditure (OOPE) in India. Recent estimates at district level are required for planning implementation of Universal Health Coverage. AIMS: To estimate the proportion of households incurring OOPE and the average amount spent by the household for healthcare. SETTINGS AND DESIGN: A cross-sectional study was conducted during August 2016 in the field practice areas of a medical college in Puducherry. A random sample of 240 households (120 rural and 120 urban) with 1,029 participants (531 rural and 498 urban) were surveyed. SUBJECTS AND METHODS: A pretested questionnaire was used to collect information on sociodemographic details, morbidity, healthcare services utilized, and expenses incurred. Recall period of 1 month was fixed for OP/Pharmacy Services and 6 months for IP services. RESULTS: In total, 120 rural and 120 urban households were surveyed; out of which, majority of the households were below poverty line [rural (83.3%, n = 100), urban (69.2%, n = 83)] and belonged to other backward classes [rural (60.8%, n = 73), urban (83.3%, n = 100)]. The proportion (95% CI) of households which incurred OOPE was 68.3% (59.5%–76%) in rural and 65.8% (57%–73.7%) in urban areas. The median (inter quartile range) proportion of OOPE out of the household budget was 3.31% (0.4%–10.96%) in rural and 5.15% (0.83%–16.3%) in urban areas. CONCLUSIONS: Even in a resource rich setting as the selected areas of Puducherry, majority of the households (67%) reported OOPE. The study estimates are lesser than the national estimates, but the availability and accessibility of resources are higher in Puducherry compared with the other parts of country.