• David M Dror, Olga van Putten-Rademaker, and Ruth Koren.
• Institute for Health Policy & Management, Erasmus University Rotterdam/MC. daviddror@socialre.org
• Indian J Med Res. 2008 Apr 1;127(4):347-61.

Background & ObjectiveIn India, health services are funded largely through out-of-pocket spendings (OOPS). We carried out this study to collect data on the cost of an illness episode and parameters affecting cost in five locations in India.MethodsThe data were obtained through a household survey carried out in 2005 in five locations among resource-poor persons in rural India. The analysis was based on self-reported illness episodes and their costs. The study was based on 3,531 households (representing 17,323 persons) and 4,316 illness episodes.ResultsThe median cost of one illness episode was INR 340. When costs were calculated as per cent of monthly income per person, the median value was 73 per cent of that monthly income, and could reach as much as 780 per cent among the 10 per cent most exposed households. The estimated median per-capita cost of illness was 6 per cent of annual per-capita income. The ratio of direct costs to indirect costs was 67:30. The cost of illness was lower among females in all age groups, due to lower indirect costs. 61 per cent of total illnesses, costing 37.4 per cent of total OOPS, were due to acute illnesses; chronic diseases represented 17.7 per cent of illnesses but 32 per cent of costs. Our study showed that hospitalizations were the single most costly component on average, yet accounted for only 11 per cent of total on an aggregated basis, compared to drugs that accounted for 49 per cent of total aggregated costs. Locations differed from each other in the absolute cost of care, in distribution of items composing the total cost of care, and in supply.Interpretation & ConclusionInterventions to reduce the cost of illness should be context-specific, as there is no "one-size-fits-all" model to establish the cost of healthcare for the entire sub-continent. Aggregated expenses, rather than only hospitalizations, can cause catastrophic consequences of illness.

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