High inpatient care cost of dying in India.

Aim: This study sheds light on the high cost of inpatient care of decedents in comparison to that of survivors, a less known aspect of out of pocket (OOP) healthcare cost in India. The main objective is to compare the differentials in OOP inpatient care expenditures of decedents and survivors and examine the significant correlates of inpatient care cost controlling for survival status. Subject and methods: This study uses nationally representative unit level data from the 60th round (2004-2005) of the National Sample Survey on morbidity and healthcare. Descriptive statistics and bivariate analysis are employed to describe characteristics of inpatients and compare unadjusted mean OOP expenditures for care of inpatient decedents and survivors, between public and private health facilities. A multilevel hierarchical model is used to model OOP expenditures for inpatient care. Results: The inpatient care cost of decedents is much higher than that of survivors. The differential is significantly higher for those residing in rural areas, staying longer in hospitals, utilizing private health facilities and suffering from non-communicable and other serious diseases. There is significant differential in OOP inpatient care cost between individuals and between episodes of hospitalization of individuals. Conclusion: The findings of this study can be used to assess the economic burden of inpatient care induced by increasing life expectancy and epidemiological transition in India. Social security and other social assistance programs in India should be made sensitive to the high cost of inpatient care at the end of life. There is an urgent need to expand the outreach of the public health system in India to rural areas. [ABSTRACT FROM AUTHOR]