Financial Burden, Out-of-Pocket Health Spending, and Household Economic Well-Being in Heart Failure Patients in India: A Multicentre Cross-Sectional Survey.

The average annual out-of-pocket expenditure for heart failure patients in India was INR 1,06,566 (INT$ 4,709.10), constituting 92.6% of total health expenditure.

• OOP expenditure was INR 1,06,566 (INT$ 4,709.10) annually on average
• OOP spending constituted 92.6% (95% CI: 92.5–92.7) of total health expenditure
• Expenditures were recorded in Indian rupees and converted to international dollars for comparability
• Data were collected from 1,859 participants across 21 hospitals in India

Catastrophic health spending and distress financing were observed in 37.7% and 17.7% of households with heart failure, respectively.

• Catastrophic health spending (CHS) was observed in 37.7% (95% CI: 35.5–39.9) of households
• Distress financing (DF) was observed in 17.7% (95% CI: 15.9–19.4) of households
• CHS and DF were lower among insured patients [30.8% (26.2–35.4) and 13.6% (10.2–17.0), respectively]
• CHS and DF were higher among uninsured patients [40.3% (37.6–43.0) and 18.9% (16.7–21.1), respectively]

Health insurance coverage was associated with lower rates of catastrophic health spending and distress financing in heart failure patients.

• Only one-third (32.2%) of the study population reported health insurance coverage
• Insured patients had CHS of 30.8% compared to 40.3% among uninsured patients
• Insured patients had DF of 13.6% compared to 18.9% among uninsured patients
• Seven out of 10 HF patients in India were noted to lack financial health protection

A substantial proportion of heart failure patients and their households reported a decline in income compared to the previous year.

• 32.3% of individuals reported a decline in monthly income compared to the previous year
• 36.2% of households reported a decline in monthly income compared to the previous year
• The mean age of participants was 55.9 (SD 11.3) years
• Mean duration of formal education was 11.3 (SD 3.8) years

The study recruited 1,859 heart failure patients from 21 hospitals across India selected to reflect regional diversity and varying stages of epidemiological transition.

• Total sample size was 1,859 participants
• Nearly one-third of participants (30.2%) were women
• Hospitals were selected to reflect regional diversity and varying stages of epidemiological transition
• Clinical and economic data were collected using a validated and structured questionnaire by trained personnel