Pattern and determinants of health care use and expenditures at the end-of-life in India

The burden of out-of-pocket expenditure on health care is unduly heavy on poor and vulnerable households. A national study shows that almost one quarter of households fall into poverty as a direct consequence of the medical expenses they pay after being hospitalized. Further, more than two-fifths of individuals who were hospitalized during the last year borrowed money or sold assets to cover the hospital expenses. Health and social insurance mechanisms in India have not been adequately developed to mitigate such adverse impact. The consequences on those households get elevated further when the hospitalization eventually results into a death event. One possible outcome could be pushing these families into a zone of permanent poverty. The main objectives of the study are: • to examine the type of medical attention received at the end-of-life • to analyse differentials in the use of hospital care and expenditure on treatment at the end-of-life by socio-economic groups • to compare financial burden of treatment (direct and indirect) on households reporting fatal and non-fatal outcomes. Conclusions 1. The poor and rural population persistently report lower levels of medical attention and use of hospital care at the end-of-life, thus pinpointing accessibility and equity concerns. 2.An incidence of hospitalization puts severe financial burden on a household and the burden becomes unduly heavy when resulting into death. In both rural and urban areas the burden rises with expenditure class, much sharply among fatal than non-fatal cases. Impoverishment burden is felt much more for rural than urban population. 3. There is need for a comprehensive health insurance coverage for poor and rural population to mitigate the adverse impact of meeting hospitalization costs.