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Cost of injury care in India: cross-sectional analysis of National Sample Survey 2014
  1. JP Tripathy1,
  2. J Jagnoor2,3,
  3. BM Prasad1,
  4. R Ivers2
  1. 1 International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
  2. 2 The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
  3. 3 The George Institute for Global Health, New Delhi, India
  1. Correspondence to Dr JP Tripathy, International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi 110016, India; ijay.doc{at}


Background Injuries account for nearly 10% of total deaths in India and this burden is likely to rise. We aimed to estimate the out-of-pocket (OOP) expenditure and catastrophic expenditure due to hospitalisation or outpatient care as a result of any injury and factors associated with incurring catastrophic expenditure.

Methods Secondary analysis of nationally representative data for India collected by National Sample Survey Organization in 2014, reporting on health service utilisation and healthcare-related OOP expenditure by income quintiles and by type of health facility (public or private).

Results The median expenditure per episode of hospitalisation due to any injury was US$156, and it was three times higher among the richest quintile compared with the poorest quintile (p<0.001). There was a significantly higher prevalence (p<0.001) of catastrophic expenditure among the poorest quintile (32%) compared with the richest (21%). Mean private sector OOP hospitalisation expenditure was five times higher than in the public sector (p<0.001). Medicines accounted for 37% and 58% of public sector hospitalisation and outpatient care, respectively. Patients treated in a private facility, hospitalised for over 7 days, in the poorest wealth quintiles and of general caste had higher odds of incurring catastrophic expenditure.

Conclusion People who sustain an injury have a high risk of catastrophic household expenditure, particularly for those in lowest income quartiles. There is a clear need for publicly funded risk protection mechanisms targeting the poor. Promotion of generic medicines and subsidisation for the poorest wealth quintile may also reduce OOP expenditure in public sector facilities.

  • non communicable disease
  • injury
  • out-of-pocket expenditure
  • catastrophic expenditure

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  • Contributors JPT was responsible for conception, preparation of study proposal, acquisition of data, analysis and interpretation of data, and preparation of the first draft of the manuscript. JJ and RI were involved in writing of the study proposal, interpretation of data and critical review of the manuscript. BMP was involved in preparation of study proposal, acquisition of data, data interpretation and critical review of the manuscript. All the authors read and approved the final version of the draft.

  • Funding We thank the Department for International Development (DFID), UK, for funding the Global Operational Research Fellowship Programme at the International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, in which JPT works as an Operational Research Fellow.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The source of data is a representative nationwide survey data collected by the National Sample Survey Organization (NSSO). NSSO is a national organisation under the Ministry of Statistics In India, established in 1950 to regularly conduct surveys and provide useful statistics in the field of socioeconomic status of households, demography, health, industries, agriculture, consumer expenditure and so on. Data are available on public domain and can be procured from NSSO by paying a nominal charge. However, the authors have procured data from NSSO and will be made accessible on request at the following email address: