Prevalence and Determinants of Out-of-Pocket Expenditure among Urban Households in Puducherry – A Cross-Sectional Study

Abstract

Background: Out-Of-Pocket Expenditure (OOPE) on healthcare is a significant concern in many parts of the world, particularly in developing countries. It represents the direct payments made by households to healthcare providers at the point-of-service. Urban households face the dual challenge of accessing quality healthcare while managing high costs. Objective: To study the prevalence of OOPE and to determine the factors associated with health expenditure among urban households. Methods: A cross-sectional study was carried out among urban households of Puducherry. By using simple random sampling method (Random Number Generation Method), the Sample size was calculated to be 347 households. A semi-structured, interviewer administered questionnaire was used to record the information. Chi-square test was applied to find the association between OOPE and factors influencing it. Results: A total of 347 households participated in the study, of which 165 (47.6%) had health insurance coverage, while 182 (52.4%) were uninsured. Out-of-Pocket Expenditure (OOPE) was observed in both the groups, affecting 20 insured households (12.12%) and 49 uninsured households (26.9%). A significant association was found between OOPE and having active health insurance coverage (p = 0.005). Conclusion: The urban households of Puducherry, despite high resources, have incurred a conspicuous OOPE. Implementing cost-reduction strategies through policy interventions and expanding insurance coverage are essential steps towards achieving the goal of "Zero Out-Of-Pocket Expenditure" envisioned under Universal Health Coverage.