Understanding out-of-pocket expenditure in India: a systematic review
IntroductionOut-of-pocket expenditure (OOPE) constitutes a substantial portion of healthcare costs in India, accounting for 47.1% of the Total Health Expenditure in 2019–20. Despite a decline from previous years, OOPE remains a significant financial burden, contributing to catastrophic health expend...
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Frontiers Media S.A.
2025-06-01
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| Series: | Frontiers in Public Health |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2025.1594542/full |
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| author | Sagarika Kamath Jeffin Maliyekkal S. Elstin Anbu Raj R. J. Varshini Helmut Brand Andria Sirur Vishwajeet Singh Vidya Prabhu Kumar Sumit Rajesh Kamath |
| author_facet | Sagarika Kamath Jeffin Maliyekkal S. Elstin Anbu Raj R. J. Varshini Helmut Brand Andria Sirur Vishwajeet Singh Vidya Prabhu Kumar Sumit Rajesh Kamath |
| author_sort | Sagarika Kamath |
| collection | DOAJ |
| description | IntroductionOut-of-pocket expenditure (OOPE) constitutes a substantial portion of healthcare costs in India, accounting for 47.1% of the Total Health Expenditure in 2019–20. Despite a decline from previous years, OOPE remains a significant financial burden, contributing to catastrophic health expenditures and impoverishment for households.MethodsA systematic review was conducted to analyze factors influencing out-of-pocket expenditures (OOPE) in India. The review adhered to predefined inclusion and exclusion criteria. Search terms were tailored to the syntax of each database to maximize retrieval, using combinations of keywords such as “out of pocket,” “India,” and “national survey.” A total of 702 citations were retrieved (PubMed: 185, Web of Science: 183, Scopus: 334), with 316 identified as duplicates. After title and abstract screening of 386 citations, 128 articles were subjected to full-text review, leading to the inclusion of 36 studies. A narrative synthesis and thematic analysis identified determinants of OOPE in the Indian healthcare context, with findings organized in tables and descriptive formats to address study heterogeneity and enhance interpretation.ResultsThis systematic and rigorous methodology ensures a comprehensive and reliable understanding of the determinants of OOPE in the Indian healthcare context. Eleven themes emerged from the review: (1) source of care and disease/ condition, (2) place of residence, (3) economic status, (4) components of OOPE, (5) age, (6) gender, (7) strategies for coping with OOPE, (8) educational attainment, (9) OOPE and institutional deliveries, (11) health insurance.DiscussionIndia’s heavy reliance on OOPE emphasizes healthcare gaps, necessitating reforms in public investment, insurance, primary care, and affordable access to ensure equity and financial protection. The lack of equitable healthcare financing instigates the challenges, leading to widespread reliance on distress financing methods. |
| format | Article |
| id | doaj-art-ecd0abd17af641b482251ea64b166eb8 |
| institution | Kabale University |
| issn | 2296-2565 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Public Health |
| spelling | doaj-art-ecd0abd17af641b482251ea64b166eb82025-08-20T03:45:47ZengFrontiers Media S.A.Frontiers in Public Health2296-25652025-06-011310.3389/fpubh.2025.15945421594542Understanding out-of-pocket expenditure in India: a systematic reviewSagarika Kamath0Jeffin Maliyekkal1S. Elstin Anbu Raj2R. J. Varshini3Helmut Brand4Andria Sirur5Vishwajeet Singh6Vidya Prabhu7Kumar Sumit8Rajesh Kamath9Department of International Health, Care and Public Health Research Institute—CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, NetherlandsDepartment of Social and Health Innovation, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, IndiaCentre for Evidence-Informed Decision Making, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, IndiaDepartment of Healthcare and Hospital Management, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, IndiaDepartment of International Health, Care and Public Health Research Institute—CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, NetherlandsManipal School of Commerce and Economics, Manipal Academy of Higher Education, Manipal, IndiaDirectorate of Online Education, Manipal Academy of Higher Education, Manipal, IndiaDepartment of Global Public Health Policy and Governance, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, IndiaDepartment of Global Public Health Policy and Governance, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, IndiaDepartment of Healthcare and Hospital Management, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, IndiaIntroductionOut-of-pocket expenditure (OOPE) constitutes a substantial portion of healthcare costs in India, accounting for 47.1% of the Total Health Expenditure in 2019–20. Despite a decline from previous years, OOPE remains a significant financial burden, contributing to catastrophic health expenditures and impoverishment for households.MethodsA systematic review was conducted to analyze factors influencing out-of-pocket expenditures (OOPE) in India. The review adhered to predefined inclusion and exclusion criteria. Search terms were tailored to the syntax of each database to maximize retrieval, using combinations of keywords such as “out of pocket,” “India,” and “national survey.” A total of 702 citations were retrieved (PubMed: 185, Web of Science: 183, Scopus: 334), with 316 identified as duplicates. After title and abstract screening of 386 citations, 128 articles were subjected to full-text review, leading to the inclusion of 36 studies. A narrative synthesis and thematic analysis identified determinants of OOPE in the Indian healthcare context, with findings organized in tables and descriptive formats to address study heterogeneity and enhance interpretation.ResultsThis systematic and rigorous methodology ensures a comprehensive and reliable understanding of the determinants of OOPE in the Indian healthcare context. Eleven themes emerged from the review: (1) source of care and disease/ condition, (2) place of residence, (3) economic status, (4) components of OOPE, (5) age, (6) gender, (7) strategies for coping with OOPE, (8) educational attainment, (9) OOPE and institutional deliveries, (11) health insurance.DiscussionIndia’s heavy reliance on OOPE emphasizes healthcare gaps, necessitating reforms in public investment, insurance, primary care, and affordable access to ensure equity and financial protection. The lack of equitable healthcare financing instigates the challenges, leading to widespread reliance on distress financing methods.https://www.frontiersin.org/articles/10.3389/fpubh.2025.1594542/fullout of pocket expenditureAyushman Bharatpublicly funded health insuranceNational Sample Survey Office (NSSO)National Family Health Survey (NFHS) |
| spellingShingle | Sagarika Kamath Jeffin Maliyekkal S. Elstin Anbu Raj R. J. Varshini Helmut Brand Andria Sirur Vishwajeet Singh Vidya Prabhu Kumar Sumit Rajesh Kamath Understanding out-of-pocket expenditure in India: a systematic review Frontiers in Public Health out of pocket expenditure Ayushman Bharat publicly funded health insurance National Sample Survey Office (NSSO) National Family Health Survey (NFHS) |
| title | Understanding out-of-pocket expenditure in India: a systematic review |
| title_full | Understanding out-of-pocket expenditure in India: a systematic review |
| title_fullStr | Understanding out-of-pocket expenditure in India: a systematic review |
| title_full_unstemmed | Understanding out-of-pocket expenditure in India: a systematic review |
| title_short | Understanding out-of-pocket expenditure in India: a systematic review |
| title_sort | understanding out of pocket expenditure in india a systematic review |
| topic | out of pocket expenditure Ayushman Bharat publicly funded health insurance National Sample Survey Office (NSSO) National Family Health Survey (NFHS) |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2025.1594542/full |
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