Out-of-Pocket Expenditure Among Patients with Hypertension and Diabetes Mellitus in an Urban Community of Central India

Abstract

Background: Non-communicable diseases (NCDs) like Hypertension (HTN) and Diabetes Mellitus (DM) are rising globally. In India, out-of-pocket expenditure (OOPE) accounts for 39.4% to 47.1% of total health spending, often leading to household impoverishment. This study assesses the economic burden and determinants of OOPE for HTN and DM in an urban field practice area.

Methods: A community-based cross-sectional study was conducted among 180 adults (Mean age: 58.62 ± 16.34 years). Data on direct medical, non-medical, and indirect costs were collected using pre-tested, semi-structured questionnaires. Socioeconomic status was classified using the updated BG Prasad Scale. Statistical associations were tested using Chi-square analysis.

Results: The Total Median Out-of-Pocket Expenditure (OOPE) was highest for participants with concomitant conditions (₹1,550), followed by diabetes mellitus only (₹1,250) and hypertension only (₹450). The prevalence of Catastrophic Health Expenditure (CHE), defined at the 40% non-food capacity-to-pay threshold, was 38.3% (n=69). Medication costs were the primary driver of expenditure across all disease groups. Private facility utilization was the strongest independent predictor of incurring OOPE (p<0.001). Literacy (p<0.001), age ≤ 50 years (p=0.014), and being married (p=0.007) were also significantly associated with the presence of spending. Approximately 12.4% of participants resorted to distress financing through borrowing money or selling assets.

Conclusion: Chronic disease management imposes a substantial financial strain on urban households, driven largely by medication costs and private sector reliance. Policy interventions must focus on strengthening public primary care and expanding access to affordable generic drugs through initiatives like Janaushadhi Kendras to prevent health-related impoverishment.