Household out-of-pocket spending on non-fatal road traffic injuries and its determining factors in the Indian state of Kerala

Presenter: S. K. Godwin, KNM Government College

Abstract

Context

Road traffic injuries (RTIs), a classic case of economic and medical uncertainty, are projected to be the third leading cause of DALY by the year 2020. The affect the poor and 15-44 age-group the most. Yet, they are the most neglected public health problem, especially in low-income countries, particularly in WHO African, Eastern-Mediterranean and South-East Asian regions. Treatment of RTIs requires costly interventions and forces households to make catastrophic expenditure. Although the disability/fatality associated with RTIs in India is relatively known, the cost of treating them and its impact on the household economic security has not been documented.

Objective

The paper presents estimates of OOPs on non-fatal RTIs and its determinants.

Methodology

The study was conducted in three districts - well, moderately and poorly performing in terms of RTI prevalence and infrastructure. In order to identify RTI patients, an institution-based survey was undertaken in 17 government and non-government RTI diagnostic, treatment and rehabilitation facilities. A set of four instruments viz., patient questionnaire, diagnostic facility checklist, hospital checklist, and key informant interview schedule were used. Patients were tracked and interviewed to elicit data on the RTI burden, treatment, expenditure, financing and economic security. A total of 302 RTI patients (average household income US$ 117) were interviewed.

Major findings

Over 75% of the injured were engaged in unorganized sector and 30% had a household income of US$ 2 or less per day. RTI patients had head (36.4%), upper limb (35%), and lower limb (72.5%) injuries. About 70% were hospitalized while 60% received care from government facilities. Average OOPs per episode of RTI was INR 4,615 (US$ 96 or 26.7% of annual non-food household expenditure); 41% spent the highest amount on the day of accident and 34% on the day of admission. Medical expenditure constituted 62% of it. Patients from the lowest quartile spent US$ 164 or 30.4% of their annual household income on RTI care per episode - US$ 180 (17.2% of annual household income) for the second, US$ 208 (13.9%) for the third, and US$ 344 (12.1%) for the richest quartile.

RTI care expenditure reduced annual household income by 5.6% for the lowest quartile, 6.5% for the second quartile, 6.1% for the third and 5.3% for the richest; household monthly food expenditure declined by 37.2%, 26.8%, 27.6% and 29.4% respectively. Severity, household income, provider, and treatment duration were the most significant factors influencing total cost of treatment. Household monthly income loss due to RTI was 68.2% for the lowest income quartile, 54.9% for second, 48% for third, and 106.5% for fourth. Only 1% of RTI patients were insured.

Conclusion

As the majority of RTI patients were poor, engaged in unorganized sector and were uninsured, seeking RTI care hit them hard in two ways - higher OOPs share in income and decline in income.