Household healthcare expenditure: A cross-sectional analysis of urban and rural Puducherry, South India.

Background: The global healthcare financing landscape highlights the heavy out-of-pocket expenditure (OOPE) burden on households, particularly in low- and middle-income countries like India. Despite efforts towards Universal Health Coverage (UHC), challenges persist. This study in Puducherry aims to estimate the prevalence and amount of OOPE and catastrophic health expenditure (CHE), with a focus on comparing the findings with a 2016 study conducted in the same study setting. Methods: A cross-sectional study in rural and urban areas collected data from 378 households using a pilot-tested National Sample Survey Office (NSSO) questionnaire. Utilizing a systematic random sampling method, 189 households from each setting were selected. Data analysis was done using SPSS version 23, with OOPE and CHE prevalence presented as percentages with a 95% confidence interval (CI). Results: Overall, 46.6% (n = 378) of all households and 91.6% (n = 192) of households that utilized healthcare services in the past 6 months experienced OOPE. 36.5% of households incurred direct medical expenses, with higher prevalence in urban areas. Non-medical expenditures were reported by 41.5% of households, more prominently in rural settings. Moreover, 13.2% of households experienced CHE, with a higher proportion in rural areas. The study highlights a notable decrease in OOPE from 2016 to 2023, with higher expenditure risks associated with chronic diseases. Conclusion: The study unveils healthcare spending patterns in urban and rural Puducherry, emphasizing the significant burden of out-of-pocket expenses and CHEs. It underscores the urgency for interventions to enhance healthcare affordability, particularly in rural areas, where disparities are more pronounced, necessitating targeted efforts to alleviate economic strains and improve access to healthcare.