Most low- and middle-income families in India are just one hospital admission away from financial ruin, especially when dealing with multiple chronic health conditions.
Published Jan 31, 2025 | 9:00 AM ⚊ Updated Jan 31, 2025 | 9:00 AM
Healthcare spending in South India.
Imagine a person suffering from a chronic illness like diabetes or hypertension. A single visit to the hospital can drain their savings, pushing them into debt.
Now, imagine that same person suffering from multiple chronic conditions – diabetes, hypertension, and heart disease, for example. The financial burden becomes unbearable.
A recent study, titled Assessing the Financial Burden of Multimorbidity Among Patients Aged 30 and Above in India and published in BMC Health Services Research has revealed that low- and middle-income families in India are just one hospital admission away from financial ruin, especially when dealing with multiple chronic health conditions.
It highlights the severe financial strain faced by individuals suffering from multimorbidity – defined as the coexistence of two or more chronic health conditions.
The research, conducted by a team from the Health Systems Transformation Platform (HSTP), analysed healthcare data from 26,905 patients across India. It found that over half (51 percent) of patients with multimorbidity face significant financial burdens when seeking treatment at private hospitals.
For many Indian families, healthcare expenses translate to massive debts, asset liquidation, or skipping necessary medical care altogether. The study found that the average out-of-pocket expenses (OOPE) for outpatient care in private hospitals were ₹950, whilst inpatient care costs soared to ₹69,438.
To put this into perspective, ₹69,438 is more than the annual income of many low-income families in India. For a family earning ₹20,000 a month, this amount is equivalent to more than three months of income.
“Patients with multiple morbidities rely on private healthcare, which significantly increases their financial burden. Private care is often associated with high out-of-pocket expenditure, making quality healthcare inaccessible for a large section of the population,” said the researchers.
The situation is even worse for vulnerable groups such as the elderly and those from rural areas. The study found that 80 percent of elderly inpatients in private hospitals face catastrophic medical expenses.
Nearly 70 percent of rural inpatients suffer similarly, highlighting the stark urban-rural divide in healthcare accessibility and affordability. “Urban – rural and socioeconomic disparities in OOPE, especially for inpatient care, underscore the need for targeted interventions. Urban patients incur higher OOPE for outpatient care across all illness categories, particularly for multimorbidity.
However, rural multimorbidity patients face significantly higher inpatient OOPE (₹80,822) than urban counterparts (₹56,171), likely due to travel, accommodation costs, and limited local healthcare access.
The wealthiest income group spends significantly more on healthcare than the poorest, mainly due to private hospital reliance. Older adults (70+ years) and males report higher OOPE for multimorbidity, reflecting increased disease burden,” the authors explained.
Healthcare expenses in India are often split between medicines, diagnostic tests, hospital stays, and procedural costs. The study found that for patients with multiple chronic conditions:
Out-of-pocket expenditure for medicines: ₹682 for outpatient care, ₹21,106 for inpatient care. Expenditure on diagnostic tests: A patient with multiple chronic conditions spends ₹10,807 on diagnostic tests alone in private hospitals. Costs for non-communicable diseases (NCDs): Patients suffering from serious illnesses such as cancer, heart disease, kidney disease, and liver disorders pay significantly more. In inpatient care, those with NCDs spend ₹75,882 compared to ₹53,196 for those without NCDs.
Catastrophic health expenditure (CHE): a ticking time bomb The study also highlighted the alarming incidence of catastrophic health expenditure (CHE), which occurs when a household’s healthcare costs exceed 10 percent of its total consumption expenditure.
Among patients with multimorbidity, 51.3 percent faced CHE in outpatient care, whilst a staggering 69.6 percent experienced CHE in inpatient care. The situation was even worse for rural patients, with 79.9 percent of inpatients from rural areas facing CHE. Elderly patients were particularly vulnerable, with 80 percent of elderly inpatients in private hospitals suffering high medical expenses.
Despite the heavy costs, nearly 60 percent of patients with chronic illnesses prefer private hospitals over government facilities. The study attributes this trend to multiple factors:
Better perceived quality of care: Patients often believe that private hospitals offer superior facilities, specialised doctors, and shorter wait times. Lack of trust in public healthcare: Reports of overcrowding, outdated equipment, and inconsistent treatment in government hospitals push patients towards private options.
Long waiting periods: Delays in getting appointments, diagnostic tests, and surgical procedures force many to seek faster (but more expensive) private care. Limited coverage of outpatient services under government schemes: Whilst initiatives like the Pradhan Mantri Jan Arogya Yojana (PMJAY) cover hospitalisations, they do not offer substantial support for outpatient consultations, diagnostics, and medication costs.
“Patients with multimorbidity predominantly seek private healthcare, indicating significant barriers to public healthcare access. Long wait times, lower perceived quality, and limited specialised services in public hospitals contribute to this preference. As a result, reliance on private healthcare increases out-of-pocket expenditure (OOPE), imposing a heavy financial burden,” the authors explained.
The financial burden is even more pronounced for patients with non-communicable diseases (NCDs) such as cancer, heart disease, and diabetes. The study found that patients with NCDs incurred higher OOPE across all illness categories. For multimorbidity in inpatient care, the OOPE for those with NCDs was ₹75,882, compared to ₹53,196 for patients without NCDs.
The study also shed light on the geographic and socioeconomic disparities in healthcare costs. Patients in low Epidemiological Transition Level (ETL) states, such as Assam and Odisha, faced the highest financial burdens. In these states, 100 percent of multimorbidity patients faced CHE in both outpatient and inpatient care. Similarly, the poorest rural patients were 5.5 times more likely to experience CHE compared to wealthier urban residents.
The study’s findings have significant implications for healthcare policy in India. The researchers emphasised the need for comprehensive health policies to address the financial risks associated with multimorbidity, particularly at the primary care level.
One of the key recommendations is to expand public healthcare coverage to include outpatient care, which currently accounts for a significant portion of OOPE. The study suggests that extending financial protection schemes like the Pradhan Mantri Jan Arogya Yojana (PMJAY) to cover outpatient consultations, diagnostic tests, and medications could help reduce the financial burden on multimorbidity patients.
The study also highlighted the role of polypharmacy – the use of multiple medications – in driving high OOPE. Managing multiple chronic conditions often requires numerous medications, which can lead to adverse drug reactions, medication non-adherence, and increased healthcare costs. The researchers recommend implementing standardised treatment protocols and reducing unnecessary medications to mitigate the risks associated with polypharmacy.
(Edited by Dese Gowda)
