Out of Pocket Expenditure among Critical Care Insured Patients Admitted in a Tertiary Care Hospital in Coastal Karnataka, India: A Cross-Sectional Study

Background: Critical illnesses such as cardiovascular diseases, stroke, cancer etc., are known to cause heavy financial burden for the patient and their caregivers despite having insurance coverage and high out-of-pocket expenditure (OPE) is still incurred due to the poor knowledge and awareness regarding the type of policy. The present study aims to evaluate the OPE of critical care insured patients admitted in a tertiary care hospital. Materials and Methods: This study was conducted at Kasturba Hospital, Manipal from September 2020 to September 2022, among patients with eight critical illness admitted under selected health insurance (HI), and this study was cross-sectional in nature. Results: Results depicted that 98.8% of the patients incurred OPE (22.6% incurred a high OPE of >Rs. 50,000). 24.3% of the total bill was paid as OPE. The overall median OPE was Rs 14,160 Inter Quartile Range (IQR)-Rs. 5728.5–42506, but the difference in median OPE among government and private HI was not statistically significant. Increased duration of stay in hospital and prolonged stay in intensive care unit (ICU) were associated with an OPE of >Rs. 50,000 (Rs = Indian National Rupees). Conclusion: Prolonged duration of admission and prolonged stay in ICU were found to be associated with an out-of-pocket expenditure of >Rs. 50,000. There is a need to create awareness among public regarding the different clauses of a HI policy (inclusions, exclusions, top up facility, co-payment option, deductibles, limits, riders etc.) before they enroll into any policy.