Household Catastrophic Health Expenditure for COVID-19 during March-August 2021, in South India: A Cross-Sectional Study (preprint)

ABSTRACT

Background The Coronavirus disease 2019 (COVID-19) pandemic increased the utilisation of healthcare services. Such utilization could lead to higher out-of-pocket expenditure (OOPE) and catastrophic health expenditures (CHE). We estimated OOPE and the proportion of households that experienced CHE by conducting a cross-sectional survey of 1200 randomly selected COVID-19.Methods A cross-sectional survey was conducted by telephonic interviews of 1200 randomly selected COVID-19 patients who tested positive between 1 March and 31 August 2021. We collected household-level information on demographics, income, expenditure, insurance coverage, direct medical and non-medical costs incurred toward COVID-19 management. We estimated the proportion of CHE with a 95% Confidence interval. Multivariate logistic regression was used to examine the association between the number of severe COVID-19 and CHE.Results The mean OOPE per household was INR 122,221 (92,744 to 51,698) [US$1,643 (1,247 to 2,040)]. Among households, 61.7% faced OOPE, and 25.8% experienced CHE due to COVID-19. The odds of facing CHE were high among the households; with a family member over 65 years [OR = 2.89 (2.03 to 4.12)], with a comorbid individual [OR = 3.38 (2.41 to 4.75)], in the lowest income quintile [OR = 1.82 (1.12 to 2.95)], any member visited private hospital [OR = 11.85 (7.68 to 18.27)]. The odds of having CHE in a household who have received insurance claims [OR = 5.8 (2.81 to 11.97)] were high. Households having one severe COVID-19 and more than one increased the risk of CHE by four-times [AOR = 4.33 (2.13–8.34)] and five-times [AOR = 5.10 (2.42–10.74)] respectively.Conclusion COVID-19 severity increases household OOPE and CHE. Strengthening the public healthcare and health insurance with higher health financing is indispensable for financial risk protection of households with severe COVID-19 from CHE.