{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T14:26:16Z","timestamp":1793456776730,"version":"4.5.0"},"reference-count":38,"publisher":"BMJ","issue":"5","funder":[{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,1,25]]},"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The objective of this research is to generate new evidence on financial implications of medicines out-of-pocket (OOP) payments for households. Another objective is to investigate which disease conditions contributed to a significant proportion of households\u2019 financial burden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>All Indian states including union territories, 1993\u20132014.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Repeated cross-sectional household surveys.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data<\/jats:title>\n                    <jats:p>Secondary data of nationwide Consumer Expenditure Surveys for the years 1993\u20131994, 2004\u20132005 and 2011\u20132012 and one wave of Social Consumption: Health for the year 2014 from National Sample Survey Organisation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>OOP expenditure on healthcare in general and medicines in specific.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Total OOP payments and medicines OOP payments were estimated to be 6.77% (95% CI 6.70% to 6.84%) and 4.49% (95% CI 4.45% to 4.54%) of total consumption expenditure, respectively, in the year 2011\u20132012 which marked significant increase since 1993\u20131994. These proportions were 11.46% (95% CI 11.36% to 11.56%) and 7.60% (95% CI 7.54% to 7.67%) of non-food expenditure, respectively, in the same year. Total OOP payments and medicines OOP payments were catastrophic for 17.9% (95% CI 17.7% to 18.2%) and 11.2% (95% CI 11.0% to 11.4%) households, respectively, in 2011\u20132012 at the 10% of total consumption expenditure threshold, implying 29\u2009million households incurred catastrophic OOP payments in the year 2011\u20132012. Further, medicines OOP payments pushed 3.09% (95% CI 2.99% to 3.20%), implying 38\u2009million persons into poverty in the year 2011\u20132012. Among the leading cause of diseases that caused significant OOP payments are cancers, injuries, cardiovascular diseases, genitourinary conditions and mental disorders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Purchase of medicines constitutes the single largest component of the total OOP payments by households. Hence, strengthening government intervention in providing medicines free in public healthcare facilities has the potential to considerably reduce medicine-related spending and total OOP payments of households and reduction in OOP-induced poverty.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-018020","type":"journal-article","created":{"date-parts":[[2018,6,1]],"date-time":"2018-06-01T00:00:09Z","timestamp":1527811209000},"page":"e018020","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":170,"title":["Quantifying the financial burden of households\u2019 out-of-pocket payments on medicines in India: a repeated cross-sectional analysis of National Sample Survey data, 1994\u20132014"],"prefix":"10.1136","volume":"8","author":[{"given":"Sakthivel","family":"Selvaraj","sequence":"first","affiliation":[{"name":"Public Health Foundation of India, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3081-2929","authenticated-orcid":false,"given":"Habib Hasan","family":"Farooqui","sequence":"additional","affiliation":[{"name":"Public Health Foundation of India, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anup","family":"Karan","sequence":"additional","affiliation":[{"name":"Public Health Foundation of India, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,5,31]]},"reference":[{"key":"2025121513270444000_8.5.e018020.1","unstructured":"NHSRC. 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