title: Burden of out-of-pocket expenditure for road traffic injuries in urban India.
abstract: BACKGROUND
  Road traffic injuries (RTI) are an increasing public health problem in India where out-of-pocket (OOP) expenditures on health are among the highest in the world. We estimated the OOP expenses for RTI in a large city in India.
  
  
  METHODS
  Information on medical and non-medical expenditure was documented for RTI cases of all ages that reported alive or dead to the emergency departments of two public hospitals and a large private hospital in Hyderabad. Differential risk of catastrophic OOP total expenditure (COPE-T) and medical expenditure (COPE-M), and distress financing was assessed for 723 RTI cases that arrived alive at the study hospitals with multiple logistic regression. Catastrophic expenditure was defined as expenditure > 25% of the RTI patient's annual household income. Variation in intensity of COPE-M in RTI was assessed using multiple classification analysis (MCA).
  
  
  RESULTS
  The median OOP medical and non-medical expenditure was USD 169 and USD 163, respectively. The prevalence of COPE-M and COPE-T was 21.9% (95% CI 18.8-24.9) and 46% (95% CI 42-49.3), respectively. Only 22% had access to medical insurance. Being admitted to a private hospital (OR 5.2, 95% CI 2.7-9.9) and not having access to insurance (OR 3.8, 95% CI 1.9-7.6) were significantly associated with risk of having COPE - M. Similar results were seen for COPE - T. MCA analysis showed that the burden of OOP medical expenditure was mainly associated with in-patient days in hospital (Eta =0.191). Prevalence of distress financing was 69% (95% CI 65.5-72.3) with it being significantly higher for those reporting to the public hospitals (OR 2.8, 95% CI 1.7-4.6), those belonging to the lowest per capita annual household income quartile (OR 7.0, 95% CI 3.7-13.3), and for those without insurance access (OR 3.4, 95% CI 2.0-5.7).
  
  
  CONCLUSIONS
  This paper has outlined the high burden of out-of-pocket medical and total expenditure associated with RTI in India. These data reinforce the need for implementing more effective financial protection mechanisms in India against the high out-of-pocket expenditure incurred on RTI.
authors.affiliation: Public Health Foundation of India, ISID Campus, 4, Institutional Area, Vasant Kunj, New Delhi 110 070, 1ndia.
authors.forename: G Anil
authors.initials: GA
authors.lastname: Kumar
authors.forename: T Ramachandran
authors.initials: TR
authors.lastname: Dilip
authors.forename: Lalit
authors.initials: L
authors.lastname: Dandona
authors.forename: Rakhi
authors.initials: R
authors.lastname: Dandona
mesh_terms: D000063:Accidents, Traffic / Q000191:economics*; D017281:Cost of Illness; D005382:Financing, Personal / Q000706:statistics & numerical data* / Q000639:trends; D005102:Health Expenditures; D006801:Humans; D007194:India / Q000453:epidemiology; D016015:Logistic Models; D014505:Urban Population; D014947:Wounds and Injuries / Q000191:economics* / Q000453:epidemiology / Q000401:mortality