Table 1
Socio-demographic details and clinical history of study participants.
| VARIABLES | INSURANCE (n = 600) | NO INSURANCE (n = 1259) | TOTAL (n = 1859) |
|---|---|---|---|
| Age in years, mean (SD) | 55.64 (11.41) | 56.09 (11.18) | 55.95 (11.26) |
| Male, n (%) | 416 (69.33) | 882 (70.06) | 1298 (69.82) |
| Female, n (%) | 184 (30.67) | 377 (29.94) | 561 (30.18) |
| Currently married, n (%) | 516 (86.00) | 1121 (89.04) | 1637 (88.06) |
| Years of education, mean (SD) | 11.51 (3.83) | 11.23 (3.79) | 11.32 (3.81) |
| Employed, n (%) | 395 (65.83) | 823 (65.37) | 1218 (65.52) |
| Unemployed (including students and homemakers), n (%) | 205 (34.17) | 436 (34.63) | 641 (34.48) |
| Duration of hospital stay, median (Q1, Q3) | 5 (4, 8) | 5 (4, 8) | 5.00 (4.00, 8.00) |
| Rural, n (%) | 296 (49.33) | 607 (48.21) | 903 (48.6) |
| Diabetes, n (%) | 220 (36.7) | 468 (37.2) | 688 (37.0) |
| Hypertension, n (%) | 259 (43.2) | 519 (41.2) | 778 (41.9) |
[i] SD: Standard deviation, Q1: lower quartile part, Q3: upper quartile part.
Table 2
Expenditure pattern and financing measures in the study population.
| VARIABLES | INSURANCE (n = 600) | NO INSURANCE (n = 1259) | TOTAL (n = 1859) |
|---|---|---|---|
| Total hospitalisation expenditure, median (Q1, Q3) | INR: 51600 (27100, 125750) INT$: 2283.2 (1199.1, 5564.2) | INR: 48000 (20270, 143000) INT$: 2123.9 (896.9, 6327.4) | INR: 49600 (23500, 135000) INT$: 2194.7 (1039.8, 5973.5) |
| Total hospitalisation expenditure, mean (SD) | INR: 103637 (129828) INT$: 4579.6 (5744.6) | INR: 126254 (191435) INT$: 5579.1 (8470.6) | INR: 118954 (174238) INT$: 5256.5 (7709.6) |
| Total expenditure on food, median (Q1, Q3) | INR: 5000 (3000, 8000) INT$: 221.2 (132.7, 353.9) | INR: 5000 (2500, 8000) INT$: 221.2 (110.6, 353.9) | INR: 5000 (2500, 8000) INT$: 221.2 (110.6, 353.9) |
| Total expenditure on food, mean (SD) | INR: 6412.1 (6804) INT$: 283.34 (301.1) | INR: 29734 (845373) INT$: 1313.92 (37405.9) | INR: 22206 (695707) INT$: 981.30 (30783.5) |
| Total out-of-pocket expenditure, median (Q1, Q3) | INR: 39842 (20525, 82000) INT$: 1762.9 (908.2, 3628.3) | INR: 45200 (20000, 140500) INT$: 2000 (884.9, 6216.8) | INR: 43000 (20100, 115000) INT$: 1902.7 (889.4, 5088.5) |
| Total out-of-pocket expenditure, mean (SD) | INR: 70869 (97919) INT$: 3131.6 (4332.7) | INR: 123580 (190211) INT$: 5460.9 (8416.4) | INR: 106567 (167915) INT$: 4709.1 (7429.9) |
| Distress financing measures | |||
| Own savings, n (%) | 423 (70.5) | 836 (66.4) | 1259 (67.7) |
| Family member paid, n (%) | 317 (52.8) | 694 (55.1) | 1011 (54.4) |
| Employer paid, n (%) | 7 (1.2) | 16 (1.3) | 23 (1.2) |
| Borrowed from friends, family, and employer, n (%) | 72 (12) | 199 (15.8) | 271 (14.6) |
| Borrowed from banks, moneylenders, n (%) | 33 (5.5) | 109 (8.7) | 142 (7.6) |
| Sold house, land, or other assets, n (%) | 8 (1.3) | 62 (4.9) | 70 (3.8) |
| Household expenditure | |||
| Decrease in individual monthly income, n (%) | 204 (34.00) | 396 (31.45) | 600 (32.3) |
| Baseline monthly individual income before heart failure, median (Q1, Q3) | INR: 4000 (500, 20000) INT$: 176.9 (22.6, 884.9) | INR: 5000 (350, 20000) INT$: 221.2 (15.5, 884.9) | INR: 5000 (400, 20000) INT$: 221.2 (17.7, 884.9) |
| Baseline monthly individual income before heart failure, mean (SD) | INR: 13229.2 (21039.4) INT$: 584.6 | INR: 12293.5 (16307.3) INT$: 543.2 | INR: 12595.5 (17970.8) INT$: 556.6 |
| Current monthly individual income in INR, median (Q1, Q3) | INR: 2000 (200, 10000) INT$: 88.5 (8.9, 442.5) | INR: 1800 (100, 10000) INT$: 79.6 (4.4, 442.5) | INR: 1950 (150, 10000) INT$: 86.3 (6.6, 442.5) |
| Current monthly individual income, mean (SD) | INR: 8016.8 (14474.3) INT$: 354.3 (640.5) | INR: 7794.6 (12189.3) INT$: 344.4 (539.3) | INR: 7866.2 (12966.5) INT$: 347.6 (573.7) |
| Decrease in individual monthly household income, n (%) | 195 (32.50) | 478 (37.97) | 673 (36.2) |
| Baseline monthly household income before heart failure in INR, median (Q1, Q3) | INR: 30000 (15000, 45000) INT$: 1327.4 (663.7, 1991.2) | INR: 26000 (15000, 45000) INT$: 1150.4 (663.7, 1991.2) | INR: 28000 (15000, 45000) INT$: 1238.9 (663.7, 1991.2) |
| Baseline monthly household income before heart failure, mean (SD) | INR: 33295.4 (34537.6) INT$: 1471.3 (1528.2) | INR: 31932.6 (26875.9) INT$: 1411.1 (1189.2) | INR: 32372.4 (29563.9) INT$: 1430.5 (1306.9) |
| Current monthly household income in INR, median (Q1, Q3) | INR: 25000 (10000, 40000) INT$: 1106.2 (442.5, 1769.9) | INR: 20000 (10000, 40000) INT$: 884.9 (442.5, 1769.9) | INR: 25000 (10000, 40000) INT$: 1106.2 (442.5, 1769.9) |
| Current monthly household income | INR: 30051.0 (34858.6) INT$: 1327.9 (1542.4) | INR: 26735.6 (26062.9) INT$: 1181.4 (1153.2) | INR: 27805.7 (29224.4) INT$: 1228.7 (1293.1) |
[i] SD: Standard deviation, Q1: lower quartile part, Q3: upper quartile part, INR: Indian Rupees, INT$: International Dollar.
Table 3
Characteristics of participants with and without distress financing and catastrophic health spending.
| VARIABLES | DF, n = 329 | NO DF, n = 1530 | CHS, n = 700 | NO CHS, n = 1159 | BOTH CHS AND DF, n = 120 | WITHOUT BOTH CHS AND DF, n = 1739 |
|---|---|---|---|---|---|---|
| Male, n (%) | 230 (17.7) | 1068 (82.3) | 477 (36.7) | 821 (63.3) | 85 (6.5) | 1213 (93.5) |
| Female, n (%) | 99 (17.6) | 462 (82.4) | 223 (39.8) | 338 (60.2) | 35 (6.2) | 526 (93.8) |
| Urban, n (%) | 137 (14.3) | 819 (85.7) | 288 (30.1) | 668 (69.9) | 34 (3.6) | 922 (96.4) |
| Rural, n (%) | 192 (21.3) | 711 (78.7) | 412 (45.6) | 491 (54.4) | 86 (9.5) | 817 (90.5) |
| Employed, n (%) | 198 (16.3) | 1020 (83.7) | 421 (34.6) | 797 (65.4) | 69 (5.7) | 1149 (94.3) |
| Unemployed, n (%) | 131 (20.4) | 510 (79.6) | 279 (43.5) | 362 (56.5) | 51 (8.0) | 590 (92.0) |
| Education < 10 years, n (%) | 201 (20.6) | 774 (79.4) | 413 (42.4) | 562 (57.6) | 83 (8.5) | 892 (91.5) |
| Education > 10 years, n (%) | 128 (14.5) | 756 (85.5) | 287 (32.5) | 597 (67.5) | 37 (4.2) | 847 (95.8) |
| More than one hospitalisation, n (%) | 66 (22.2) | 231 (77.8) | 139 (46.8) | 158 (53.2) | 30 (10.1) | 267 (89.9) |
| Only one hospitalisation, n (%) | 258 (17.8) | 1194 (82.2) | 554 (38.2) | 898 (61.8) | 90 (6.2) | 1362 (93.8) |
| High socioeconomic status, n (%) | 1 (3) | 32 (97) | 4 (12.1) | 29 (87.9) | 0 (0) | 33 (100) |
| Middle socio-economic status, n (%) | 113 (15.4) | 619 (84.6) | 228 (31.1) | 504 (68.9) | 35 (4.8) | 697 (95.2) |
| Lower socioeconomic status, n (%) | 215 (19.7) | 879 (80.3) | 468 (42.8) | 626 (57.2) | 85 (7.8) | 1009 (92.2) |
| Higher ETL, n (%) | 110 (16.5) | 556 (53.5) | 310 (46.5) | 356 (53.4) | 55 (8.3) | 611 (91.7) |
| Higher Middle ETL, n (%) | 87 (15.1) | 487 (84.9) | 186 (32.4) | 358 (67.6) | 25 (4.4) | 549 (95.6) |
| Low and lower middle ETL, n (%) | 132 (21.3) | 487 (78.7) | 204 (32.9) | 415 (67) | 40 (6.5) | 579 (93.5) |
[i] *ETL: epidemiological transition level, CHS: catastrophic health spending, DF: distress financing.
Figure 1
Economic Impact of heart failure in India.
OOPE: Out of pocket Expenditure, CHS: Catastrophic health spending, DF: Distress financing.
Table 4
Total expenditure and out-of-pocket expenditure pattern in the study population.
| VARIABLES | NO INSURANCE (n = 1259) | SOCIAL INSURANCE (PMJAY & SHI) (n = 390) | ESI, CGHS, ECHS (n = 48) | PRIVATE INSURANCE (n = 162) |
|---|---|---|---|---|
| Total IP expenses, mean, INR(USD) | 101155.48(4469.97) | 63699.57(2814.83) | 110845.10(4898.15) | 110427.30(4879.69) |
| Total OP expenses, mean, INR(USD) | 20809.32(919.55) | 21420.78(946.57) | 25919.09(1145.34) | 16716.09(738.67) |
| Total expenditure, mean, INR(USD) | 126253.94(5579.05) | 86320.59(3814.43) | 140900.23(6226.26) | 134283.52(5933.87) |
| Total OOPE, mean, INR(USD) | 123579.66(5460.88) | 63740.49(2816.64) | 102983.54(4550.75) | 78513.30(3469.43) |
| Proportion of OOPE | 97.88 | 73.84 | 73.09 | 58.47 |
| CHS, n (%) | 507 (40.3) | 120 (30.8) | 21 (43.8) | 52 (32.1) |
| Distress financing, n (%) | 238 (18.9) | 53 (13.6) | 9 (18.8) | 29 (17.9) |
[i] *IP: in-patient, OP: out-patient, OOPE: out-of-pocket expenditure, CHS: catastrophic health spending, PMJAY: Pradhan Mantri Jan Arogya Yojana, SHI: state health insurance (specific for each state), ESI: Employee state insurance, CGHS: Central Government Health Scheme, ECHS: Ex-Servicemen Contributory Health Scheme.
Figure 2
Multivariable regression analysis of catastrophic health spending.
Model 1: Cluster-adjusted generalised estimating equation (Cluster GEE) adjusted for age, gender, health insurance status, NYHA classification, and epidemiological transition level (ETL). Model 2: Mixed-effects logistic regression adjusted for age, gender, health insurance status, NYHA classification, and epidemiological transition level (ETL). HI: Health insurance, NYHA: New York Heart Association Functional Classification.
Figure 3
Multivariable logistic regression analysis of distress financing.
Model 1: Cluster-adjusted generalised estimating equation (Cluster GEE) adjusted for age, gender, health insurance status, NYHA classification, and epidemiological transition level (ETL). Model 2: Mixed-effects logistic regression adjusted for age, gender, health insurance status, NYHA classification, and epidemiological transition level (ETL). HI: Health insurance, NYHA: New York Heart Association Functional Classification.