title: Out of Pocket Expenditure for Hospitalization among Below Poverty Line Households in District Solan, Himachal Pradesh, India, 2013.
abstract: BACKGROUND
  Health insurance schemes, like Rashtriya Swasthya Bima Yojana (RSBY), should provide financial protection against catastrophic health costs by reducing out of pocket expenditure (OOPE) for hospitalizations. We estimated and compared the proportion and extent of OOPE among below poverty line (BPL) families beneficiaries and not beneficiaries by RSBY during hospitalizations in district Solan, H.P., India, 2013.
  
  
  METHODS
  We conducted a cross sectional survey among hospitalized BPL families in the beneficiaries and non-beneficiaries groups. We compared proportion incurring OOPE and its extent during hospitalization, pre/post-hospitalization periods in different domains.
  
  
  RESULTS
  Overall, proportion of non-beneficiaries who incurred OOPE was higher than the beneficiaries but it was not statistically significant (87.2% vs. 80.9%). The median overall OOPE was $39 (Rs 2567) in the non-beneficiaries group as compared to $11 (Rs 713) in the beneficiaries group (p<0.01). Median expenditure on in house and out house drugs and consumables was $23 (Rs 1500) in the non beneficiaries group as compared to nil in the beneficiaries group (p<0.01). Non-beneficiary status was significantly associated [OR: 2.4 (1.3-4.3)] with OOPE above median independently and also after adjusting for various covariates.
  
  
  CONCLUSIONS
  RSBY has decreased the extent of OOPE among the beneficiaries; however OOPE was incurred mainly due to purchase of drugs from outside the health facility. The treatment seeking behaviour in beneficiaries group has improved among comparatively older group with chronic conditions. RSBY has enabled beneficiaries to get more facilities such as drugs, consumables and diagnostics from the health facility.
authors.affiliation: National Health Mission, Government of Himachal Pradesh, Block 6, SDA Complex, Kusumpti, Shimla, Himachal Pradesh, India, 171009.
authors.forename: Anadi
authors.initials: A
authors.lastname: Gupt
authors.affiliation: National Health Mission, Government of Himachal Pradesh, Block 6, SDA Complex, Kusumpti, Shimla, Himachal Pradesh, India, 171009.
authors.forename: Prabhdeep
authors.initials: P
authors.lastname: Kaur
authors.affiliation: National Health Mission, Government of Himachal Pradesh, Block 6, SDA Complex, Kusumpti, Shimla, Himachal Pradesh, India, 171009.
authors.forename: P
authors.initials: P
authors.lastname: Kamraj
authors.affiliation: National Health Mission, Government of Himachal Pradesh, Block 6, SDA Complex, Kusumpti, Shimla, Himachal Pradesh, India, 171009.
authors.forename: B N
authors.initials: BN
authors.lastname: Murthy
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D005102:Health Expenditures; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007194:India; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D011203:Poverty