Out-of-Pocket Expenditure and its Determinants Amongst the Patients Undergoing Advanced Radiological Procedures in the Public Healthcare Facilities of Tamil Nadu, South India.

Abstract

Background: Advanced radiological procedures, such as CT, MRI, and PET scans, are crucial for accurate diagnostics and treatment planning but often result in substantial out-of-pocket expenditures (OOPE) for patients, especially in developing countries like India. Despite progressive health policies in Tamil Nadu, the financial burden on patients undergoing these procedures in public healthcare facilities remains a concern. Hence, this study was done to assess the OOPE and its determinants amongst patients undergoing CT, MRI and PET scan procedures in public healthcare facilities of Tamil Nadu.

Methods: This cross-sectional study analysed OOPE among 2415 patients undergoing advanced radiological procedures in public healthcare facilities across 12 districts in Tamil Nadu. A two-step sampling strategy was employed to select 23 healthcare facilities. Patient-level costs were calculated, including direct medical, direct non-medical, and indirect costs. Determinants of OOPE were assessed using log-linear regression models.

Results: PET scans were the costliest procedure, with median total cost per patient of INR 12,150 (USD 147.14), primarily due to direct medical expenses. Median total costs per patient for CT and MRI scans were INR 1460 (USD 17.68) and INR 3250 (USD 39.36), respectively. Factors significantly associated with higher OOPE included urban residence (e^β = 1.13 for CT; 1.17 for MRI), higher socioeconomic status (e^β = 1.25 for Class I vs. V in CT; 1.45 for Class I vs. V in MRI), lack of insurance utilisation (e^β = 1.75 for CT; 3.73 for MRI), absence of insurance (e^β = 1.89 for CT; 3.85 for MRI), greater travel distance (e^β = 1.51 for CT; 1.56 for MRI), and longer waiting times (e^β = 1.21 for CT).

Conclusions: The study reveals significant financial burdens on patients undergoing advanced radiological procedures, highlighting the need for policy reforms to enhance insurance coverage utilisation, reduce urban-rural disparities, and improve access to affordable care. Addressing these determinants is crucial for reducing OOPE and ensuring equitable access to essential diagnostic services.