Out Of Pocket (OOP) Health Expenditure and Utilization of Financial Risk Protection Measures Among COVID-19 Affected Individuals in Chennai- A Cross-Sectional Study


  • Swetha NB Sree Balaji Medical College and Hospital, Chennai, India
  • Angeline Grace Sree Balaji Medical College and Hospital, Chennai, India
  • Sujitha P Sree Balaji Medical College and Hospital, Chennai, India
  • Umadevi R Sree Balaji Medical College and Hospital, Chennai, India




Public health spending, Health insurance, Private hospital, Direct cost


Background: Pandemic has affected people physically, mentally and economically. India being a growing economic power house, spends only around 1.2% of GDP on health which thereby leads to high OOP spending. This study aims to estimate out of pocket health expenditure and proportion of financial risk protection.

Methods: Cross sectional study conducted among Covid-19 affected individuals in Chennai. It was a questionnaire based study with questions about covid-19 management status, cost and insurance utilization. Descriptive statistics and regression analysis was used for analysis.

Results: Total of 47 were treated at hospital and 85% of them were treated at private hospital.. The mean cost investigations for patients treated at hospital was of Rs. 50000+11547 and for medicines was Rs. 110000+57735. 53% of study participants had health insurance. 29 (54.72%) of them had Covid-19 treatment cost covered under insurance. The multiple regression analysis showed a statistically significant association between total OOPE incurred and age, religion and socio-economic status.

Conclusion: Majority of participants spent for their treatment through savings and borrowing money. OOPE was compensated by reimbursement through health insurance. Provision of quality health care in government hospitals, increase public health spending and creating awareness about health insurance are ways to reduce OOP costs.


Eissa N. Pandemic Preparedness and Public Health Expenditure. Economies [Internet]. 2020 Sep [cited 2021 Jun 23];8(3):60. Available from: https://www.mdpi.com/2227-7099/8/3/60 doi: https://doi.org/10.3390/economies8030060 DOI: https://doi.org/10.3390/economies8030060

Pandey A, Ploubidis GB, Clarke L, Dandona L. Trends in catastrophic health expenditure in India: 1993 to 2014. Bull World Health Organ [Internet]. 2018 Jan 1 [cited 2022 May 20];96(1):18-28. Doi: https://doi.org/10.2471/BLT.17.191759 PMid:29403097 PMCid:PMC5791868 DOI: https://doi.org/10.2471/BLT.17.191759

Srinivisan R. HEALTH CARE IN INDIA - VISION 2020. :22.

national_health_policy_2017.pdf [Internet]. [cited 2022 May 20]. Available from: https://www.nhp.gov.in/nhpfiles/national_health_policy_2017.pdf

Swetha NB, Shobha S, Sriram S. Prevalence of catastrophic health expenditure and its associated factors, due to out-of-pocket health care expenses among households with and without chronic illness in Bangalore, India: a longitudinal study. J Prev Med Hyg. 2020 Mar;61(1):E92-7.

Shukla D, Pradhan A, Malik P. Economic impact of COVID-19 on the Indian healthcare sector: an overview. Int J Community Med Public Health. 2020 Dec 25;8:489. Doi: https://doi.org/10.18203/2394-6040.ijcmph20205741 DOI: https://doi.org/10.18203/2394-6040.ijcmph20205741

Siddiqui AF, Wiederkehr M, Rozanova L, Flahault A. Situation of India in the COVID-19 Pandemic: India's Initial Pandemic Experience. Int J Environ Res Public Health [Internet]. 2020 Dec [cited 2022 May 21];17(23):8994. Doi: https://doi.org/10.3390/ijerph17238994 PMid:33276678 PMCid:PMC7730885 DOI: https://doi.org/10.3390/ijerph17238994

Coronavirus treatment: Covid-19 treatment to be covered under Ayushman Bharat - The Economic Times [Internet]. [cited 2022 May 20]. Available from: https://economictimes.indiatimes.com/news/politics-and-nation/covid-19-treatment-to-be-covered-under-ayushman-bharat/articleshow/74784764.cms

Kotwani P, Patwardhan V, Pandya A, Saha S, Patel GM, Jaiswal S, et al. Valuing Out-of-Pocket Expenditure and Health Related Quality of Life of COVID-19 patients from Gujarat, India. J Commun Dis E-ISSN 2581-351X P-ISSN 0019-5138 [Internet]. 2021 Mar 31 [cited 2021 Jun 23];53(1):104-9. Doi: https://doi.org/10.24321/0019.5138.202117 DOI: https://doi.org/10.24321/0019.5138.202117

Saleem S, Jan SS. Modified Kuppuswamy socioeconomic scale updated for the year 2021. Indian J Forensic Community Med. 2021 Apr 10;8:1-3.doi: https://doi.org/10.18231/j.ijfcm.2021.001 DOI: https://doi.org/10.18231/j.ijfcm.2021.001

Swetha NB, Shobha, Sriram S. 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. Int J Community Med Public Health [Internet]. 2018 Dec 24 [cited 2022 May 20];6(1):263-7. doi: https://doi.org/10.18203/2394-6040.ijcmph20185254 DOI: https://doi.org/10.18203/2394-6040.ijcmph20185254

Rehman A, Shaikh BT, Ronis KA. Health care seeking patterns and out of pocket payments for children under five years of age living in Katchi Abadis (slums), in Islamabad, Pakistan. Int J Equity Health [Internet]. 2014 Apr 16 [cited 2022 May 21];13(1):30. Doi: https://doi.org/10.1186/1475-9276-13-30 PMid:24739395 PMCid:PMC3997188 DOI: https://doi.org/10.1186/1475-9276-13-30

Balasubramanian D, Prinja S, Aggarwal AK. Effect of User Charges on Secondary Level Surgical Care Utilization and Out-of-Pocket Ex-penditures in Haryana State, India. PLOS ONE [Internet]. 2015 May 4 [cited 2022 May 21];10(5):e0125202. Doi: https://doi.org/10.1371/journal.pone.0125202 PMid:25938670 PMCid:PMC4418577 DOI: https://doi.org/10.1371/journal.pone.0125202

Sriram S, Khan MM. Effect of health insurance program for the poor on out-of-pocket inpatient care cost in India: evidence from a nationally representative cross-sectional survey. BMC Health Serv Res [Internet]. 2020 Dec [cited 2021 Jun 23];20(1):839. Doi: https://doi.org/10.1186/s12913-020-05692-7 PMid:32894118 PMCid:PMC7487854 DOI: https://doi.org/10.1186/s12913-020-05692-7

Brandhub. All you need to know about Coronavirus Health Insurance Covers. The Hindu. 2020. Available from: https://www.thehindu.com/brand-hub/all-you-need-to-know-about-coronavirus-health-insurance-covers/article31629765.ece.

Health insurance online sale spurts up to 30%, offline sales fall due to coronavirus impact - The Economic Times [Internet]. [cited 2022 May 20]. Available from: https://economictimes.indiatimes.com/wealth/insure/health-insurance/health-insurance-online-sale-spurts-up-to-30-offline-sales-fall-due-to-coronavirus-impact/articleshow/75059947.cms




How to Cite

NB S, Grace A, P S, R U. Out Of Pocket (OOP) Health Expenditure and Utilization of Financial Risk Protection Measures Among COVID-19 Affected Individuals in Chennai- A Cross-Sectional Study. Natl J Community Med [Internet]. 2022 Jul. 31 [cited 2022 Aug. 12];13(07):453-7. Available from: https://www.njcmindia.com/index.php/file/article/view/2104



Original Research Articles