title: Direct Cost of Critical Illness Associated Healthcare Expenditures among Children Admitted in Pediatric Intensive Care Unit in Rural India.
abstract: OBJECTIVE
  To assess the direct costs involved in treatment of children receiving intensive care in a university-affiliated teaching hospital and its associated implications on the children's families, in rural India.
  
  
  METHODS
  It was a prospective observational study for cost-analysis using questionnaire based interviews and billing records data collection for admissions to the PICU over 27 consecutive months (January 2010 through March 2012).
  
  
  RESULTS
  A total of 784 children were admitted to the unit during the assessment period. Full details of 633 children were included for analysis. The average length of stay was 6.16 d, average hospital expenditure was US$185.67, average hospital expenses per day was US$44.00, average pharmacy expenditure was US$109.67 and average pharmacy expenditure per day was US$20.62 per patient. Children who were ventilated had approximately 61 % more expense per day as compared to non-ventilated ones. Boys and those with health insurance reported higher length of stay. Linear hierarchical regression with backward LR model showed that mechanical ventilation, multiple organ dysfunction, length of stay and insurance cover were the variables significantly affecting the final expenses.
  
  
  CONCLUSIONS
  There is a high direct expenditure incurred by families of children receiving intensive care when seen in perspective of high rates of extreme poverty in rural India. These high expenditures make critical care unaffordable to majority of the population lacking insurance cover in resource limited regions with limited universal health coverage, which ultimately leads to suboptimal care and high childhood mortality. It is highly imperative for the governments and global health organizations to be sensitive towards this issue and to plan strategies for the same across different nations.
authors.affiliation: Division of Neonatology, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada.
authors.forename: Vivek V
authors.initials: VV
authors.lastname: Shukla
authors.affiliation: Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India.
authors.forename: Somashekhar M
authors.initials: SM
authors.lastname: Nimbalkar
authors.affiliation: Department of Community Medicine, Pramukhswami Medical College, Karamsad, Anand, Gujarat, 388325, India. jaishreeg@charutarhealth.org.
authors.forename: Jaishree D
authors.initials: JD
authors.lastname: Ganjiwale
authors.affiliation: Department of Health Economics, People's Open Access Education Initiative, 34 Stafford Road, Eccles, Manchester, M30 9HN, UK.
authors.forename: Denny
authors.initials: D
authors.lastname: John
mesh_terms: D002648:Child; D016638:Critical Illness; D005102:Health Expenditures; D006801:Humans; D007194:India; D015278:Intensive Care Units, Pediatric; D008297:Male; D011446:Prospective Studies; D012424:Rural Population
keywords: Health insurance; Out of pocket expenditure on healthcare; Pediatric critical illness; Rural India