title: Out of pocket expenditure among the households of a rural area in Puducherry, South India.
abstract: BACKGROUND
  As a measure to reduce the out of pocket health spending in our country, the high level expert group on Universal Health Coverage recommends a National Health Package free of cost to all. Whether availability of services free of cost, will reduce out of pocket expenditure?
  
  
  OBJECTIVE
  To assess this, we studied the out of pocket health spending among the households of a Ramanathpuram, a village in Puducherry, where surplus health services are available free of cost.
  
  
  METHODS
  An exploratory study was conducted in by 200 purposively selected households of Ramanathpuram, during the months of March-April 2012.
  
  
  METHODS
  Information was sought on socio-demographic details (age, gender, and income), expenditure incurred during OPD visits, follow up for chronic diseases, and hospitalization using a pretested questionnaire. Recall periods of 1 and 3 months were considered for OPD visits and hospitalizations, respectively.
  
  
  RESULTS
  Of the total 935 individuals from the 200 households included, 51.3% (480) were men and 455 (48.7%) were women. A total of 231 visits to health care facilities were recorded from 143 (71.5%) households, of which 153 (66.2%) were for acute illness and 68 (29.4%) for follow up of chronic diseases and 10 (4.3%) for hospitalization. The mean per visit expenditure for acute illness, chronic diseases, and hospitalization were INR72.7 ± 143.6, 135.7 ± 196.2, and 1340 ± 1192.9, respectively. Government facilities were availed for 175 (75.7%) visits. Majority of those who incurred health expenditure for acute illness (80.4%) and utilized the private sector for acute illness (78.4%) were from higher socioeconomic class (P = 0.001).
  
  
  CONCLUSIONS
  Majority (58.1%) of the households did not incur health care expenditure. Public health care facilities were preferred (75.5%) for seeking care. Availability of services free of cost reduces out of pocket expenditure among non-hospitalized cases.
authors.affiliation: Department of Preventive and Social Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India.
authors.forename: R
authors.initials: R
authors.lastname: Archana
authors.affiliation: Department of Preventive and Social Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India.
authors.forename: Sitanshu Sekhar
authors.initials: SS
authors.lastname: Kar
authors.affiliation: Department of Preventive and Social Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India.
authors.forename: Kc
authors.initials: K
authors.lastname: Premarajan
authors.affiliation: Department of Preventive and Social Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India.
authors.forename: Subitha
authors.initials: S
authors.lastname: Lakshminarayanan
keywords: Health care; out of pocket expenditure; rural households