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Journal of Public Health

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01-10-2013 | Original Article

High inpatient care cost of dying in India

Authors: Laishram Ladusingh, Anamika Pandey

Published in: Journal of Public Health | Issue 5/2013

Abstract

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.

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Emanuel E, Fairelough DL, Slutsman J, Emanuel L (2000) Understanding economic and other burdens of terminal illness: the expenditure of parents and their caregivers. Ann Intern Med 132:451–459PubMedCrossRef

Engelgau MM, Karan A, Mahal A (2012) The economic impact of non-communicable diseases on households in India. Glob Heal 89:1–10

Garg CC, Karan AK (2009) Reducing out-of-pocket expenditure to reduce rural poverty: a disaggregated analysis at rural–urban level in India. Health Policy Plann 24(2):116–128CrossRef

Ginzberg E (1980) The high cost of dying. Inquiry 17:293–295PubMed

Hogan C, Lunney J, Gabel J, Lynn J (2001) Medicare beneficiaries’ costs of care in the last year of life. Health Aff 20(4):188–195CrossRef

Ladusingh L, Pandey A (2013) Health expenditure and impoverishment in India. J Health Manag 15(1):57–74. doi:10.1177/0972063413486031

Lubitz JD, Riley GF (1993) Trends in medicare payment in the last year of life. N Engl J Med 328:1092–1096PubMedCrossRef

National Sample Survey Organization (2004) Morbidity, healthcare and the condition of the aged. Report no. 507, Department of Statistics, Government of India, New Delhi

Payne G, Laporte A, Foot DK, Coyte PC (2009) Temporal trends in the relative cost of dying: evidence from Canada. Health Policy 90:270–276PubMedCrossRef

Raphael C, Attens J, Fowlex N (2001) Financing end of life care in the USA. J R Soc Med 94:458–461PubMed

Scitovsky AA (2005) The high cost of dying: what do the data show? The Milbank Q 83(4):825–841CrossRef

Seshamani M, Garg AM (2004a) Time to death and health expenditure: an improved model for the impact of demographic change on health care costs. Age Ageing 33:556–561PubMedCrossRef

Seshamani M, Garg AM (2004b) A longitudinal study of the effects of age and time to death on hospital costs. J Health Econ 23:217–235PubMedCrossRef

Singh CH, Ladusingh L (2010) Inpatient length of stay: a finite mixture modeling analysis. Eur J Health Econ 11(2):119–126PubMedCrossRef

Stearns SC, Norton EC (2004) Time to include time to death? The future of health care expenditure. Health Econ 13(4):315–327PubMedCrossRef

Sutton GF (1965) ‘Hospitalization in the last year of life, United States, 1961’. Vital and health statistics, Series 22(1), US Department of Health, Education and Welfare, Washington, DC

Werblow A, Felder S, Zweifel P (2005) Population aging and health care expenditure: a school of ‘red herring’. Working paper no. 11, Faculty of Economics and Management, Univ. of Magdeburg, Magdeburg, Germany

Zweifel P, Felder S, Werblow A (2004) Population aging and health care expenditure: new evidence on the red herring. Health Econ 8(6):485–496CrossRef

Title: High inpatient care cost of dying in India
Authors: Laishram Ladusingh
Anamika Pandey
Publication date: 01-10-2013
Publisher: Springer Berlin Heidelberg
Published in: Journal of Public Health / Issue 5/2013
Print ISSN: 2198-1833
Electronic ISSN: 1613-2238
DOI: https://doi.org/10.1007/s10389-013-0572-9

At a glance: The STEP trials

Springer Medicine

High inpatient care cost of dying in India

Abstract

Aim

Subject and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Aim

Subject and methods

Results

Conclusion

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