Out-of-pocket health expenditure on diarrheal illness among under-five children in a teaching hospital ins Odisha, India.

Pradhan, Himanshu Sekhar; Mohakud, Nirmal Kumar; Kavitha, A K; Nayak, Manas Kumar; Satpathy, Sudhir Kumar

Background Diarrhea is the most common illness in children under 5 years of age, accounting for a financial burden for families in developing countries. Objective The aim of this study is to determine the out-of-pocket health expenditure for the management of diarrhoeal illness among the under-five children in in-patient and out-patient cases. Methods A cross-sectional study was conducted during January-April 2018 among 60 under-five children with diarrheal illness reporting to pediatric outpatient department (OPD) and 60 under-five children admitted to pediatric ward of a tertiary care teaching hospital. For determining the out-of-pocket health expenditure, both direct and indirect costs for the management of diarrheal illness were estimated both for out-patient and in-patient cases. The cost of the treatment has been presented as the cost of prehospital visits, during a hospital visit and posthospital visit. Results Overall, median out-of-pocket health expenditure for the management of diarrheal illness for out-patient and in-patient cases were Rs. 1186 (interquartile range [IQR]: Rs. 510) and Rs. 6385 (IQR: Rs. 5889), respectively. The median direct expenditure for OPD cases was Rs. 778.50 (IQR: Rs. 263) and indirect expenditure for OPD cases were Rs. 407.50 (IQR: Rs. 336) The median direct and indirect expenditure for inpatient cases were Rs. 3823 (IQR: Rs. 1942) and Rs. 2237 (IQR: Rs. 4256) respectively. Only 13% of in-patient cases had some kind of medical insurance. Conclusion A considerable economic burden is faced by the families for treating diarrhea in under-five children. Improved access to safe drinking water and sanitation, promotion of hand hygiene, exclusive breastfeeding, rotavirus vaccination, and use of oral rehydration therapy will reduce hospitalization and out-of-pocket expenditure. The study findings recommend for appropriate policy for provision of financial protection while seeking health care services.