National
Health Accounts data of 2001-02 indicate that out of pocket
health expenditure contributes a significant 72% of the total
health expenditure in
India
(GOI, 2006). Out of pocket expenditure refers to direct and
indirect costs incurred by the individual and /or household in
securing or maintaining their health and includes health service
user fees, contribution to health insurance, costs on drugs,
medicines and diagnostics and additional cost incurred for
securing and maintaining health, such as that on nutritional
supplements and transport costs. Currently the primary source of
such data comes from household surveys conducted by the NSSO.
While such data is useful in understanding trends and making
overall estimates of out of pocket expenditure, the format in
which data is collected is not amenable for a more in depth
analysis of out of pocket expenditure on specific items such as
that on drugs and consumables at specific levels of care. Given
the 1 year recall period for expenditure on hospitalization,
data is subject to recall bias and misclassification. Further
such surveys do not provide much information on the volume of
drugs and investigations purchased privately by patients seeking
care at public hospitals. Given that cost of the same drug can
vary significantly from manufacturer to manufacturer and the
often unethical marketing and prescription practices, it is
highly likely that patients may be actually spending more than
what is required. Data for such expenditure is also not
available. Such estimates will help generate evidence for
appropriate allocation of resources for provision of drugs and
investigations in public hospitals and framing of policies
regarding prescription of drugs. This study has been
commissioned the MoHFW to address some of these issues. The
study is sponsored by the World Health Organization and is
expected to be completed by September 2008.[1]