title: Out of pocket expenditure on surgical and nonsurgical conditions in Odisha.
abstract: BACKGROUND
  Out of pocket expenditure (OOPE) for any illness is still a major problem in India. Several evidence is available regarding growing OOPE and its impact on household poverty. However, limited evidence is there regarding OOPE on multiple disease conditions in public hospitals.
  
  
  OBJECTIVE
  To estimate the OOPE for various hospitalized conditions at the secondary level of care in Odisha and find out various financial coping mechanisms adopted by the patients.
  
  
  METHODS
  The primary survey was done in the secondary care hospitals in the two districts of Odisha using a semi-structured interview schedule. Data were collected from 284 subjects (212 males, 72 females) in 2014 on the socioeconomic status and OOPE on multiple disease conditions. Descriptive statistics using Stata Version 11 were used to estimate the results.
  
  
  RESULTS
  The mean total OOPE was Indian Rupees (INR) 2107 (95% confidence interval [CI]: 1788-2426) for single episode of hospitalization out of which medical expenditure was INR 1530 (95% CI: 1238-1821) and nonmedical expenditure was INR 577 (95% CI: 501-653). The OOPE on surgical conditions was 1.7 times more than the nonsurgical conditions. Drugs and diagnostics were the major components of hospital expenditure, whereas the share of transportation expenditure was more in the nonmedical expenditure. Further, most of the patients had to face hardship financing due to limited financial protection measures.
  
  
  CONCLUSIONS
  With the growing debate on the rolling out of universal health insurance scheme in India, this study assumes significance by providing critical information for designing public financing strategies to protect the interest of the poor in public health care institutions.
authors.affiliation: Indian Institute of Public Health, Bhubaneswar, Odisha, PHFI, India.
authors.forename: Sarit Kumar
authors.initials: SK
authors.lastname: Rout
authors.affiliation: Indian Institute of Public Health, Bhubaneswar, Odisha, PHFI, India.
authors.forename: Kirti Sundar
authors.initials: KS
authors.lastname: Sahu
authors.affiliation: Indian Institute of Public Health, Bhubaneswar, Odisha, PHFI, India.
authors.forename: Subhashisa
authors.initials: S
authors.lastname: Swain
authors.affiliation: Indian Institute of Public Health, Bhubaneswar, Odisha, PHFI, India.
authors.forename: Sanghamitra
authors.initials: S
authors.lastname: Pati
keywords: Financial protection; hospitalization expenditure; multiple disease conditions; secondary level of care; surgical and nonsurgical conditions