Risk of Inpatient Death and Cost of Hospitalization in India

Abstract

Background: This study sought to identify background of households whose members are at risk of death while undergoing treatment in tertiary care hospitals as inpatients. In addition, the study aimed to find the differentials in out-of-pocket (OOP) household expenditure incurred during hospitalization between decedents and survivors and to assess the household and state-level factors which explained OOP hospitalization expenditure. 

Methods: A cross-sectional study was conducted using nationally representative data on morbidity and healthcare from the National Sample Survey Organization. Differential in OOP hospitalization expenditure between decedents' and survivors' households by household characteristics, types of facilities, medical and non-medical items of expenditures were assessed. Multilevel logistic and multiple regressions were used for the identification of households at risk of death of its members while undergoing care at a tertiary healthcare hospital and for the assessment of factors explaining the variation in OOP household hospitalization expenditure. 

Results: Female-headed households, small households and rural residents were found to be at risk of death of their family members during hospitalization. Mean OOP cost for hospitalization was higher for decedents than for survivors regardless of the household background and types of facilities used. The differential was statistically significant by place of residence, for physician fees and cost of medicines. The economically better-off households incurred higher OOP hospitalization expenditure. 

Conclusions: The study has provided evidence that regardless of the nature of ailment the inpatient OOP expenditure of patients who die during hospital stay is about 1.5 times higher that of patients who are discharged alive after hospitalization. Limited evidence is available on OOP expenditure of inpatients that die during hospitalization in India and the results are pertinent for reorientation of the country's health system and strengthening public and social support to vulnerable households.