Seven of 10 heart failure (HF) patients in India lack financial health protection, according to a new study.
HF accounts for 1.8 million hospitalisations in India annually and places a considerable burden on the health system due to prolonged inpatient care and the need for long-term management, straining already limited healthcare resources. Further, due to its debilitating nature, HF is also known for its massive financial burden on patients, caregivers, and society.
According to the study, the annual out of pocket (OOP) expenditure accounted for over 90 per cent of the total health spending. Lower socio-economic status, rural residence, lack of insurance, and multi-morbidity were key predictors of financial hardship.
The study published in Global Heart on March 12, 2026, stated that the financial burden affecting more than one-third of HF patients in India carries extreme implications for their well-being.
The adverse economic impact of medical care on patients or financial burden is increasingly recognised as a significant non-clinical entity affecting HF management in low- and middle-income countries (LMIC).
The study led by Dr Panniyammakal Jeemon from the Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST) in Thiruvananthapuram, Kerala explored the factors associated with financial burden in HF patients in India.
For the study, HF patients from 21 hospitals across India were recruited. Of the 1,859 recruited participants, nearly one-third were women. Approximately 48.6 per cent of the participants resided in rural areas.
The study population with an average age of 55 years was at least 10-15 years younger than the western or Chinese Heart Failure registries — highlighting the impact of the disease on people in their most productive years.
Health insurance coverage was reported in one-third (32.2 per cent) of the study population. The average annual OOP expenditure was Rs 1,06,566 (INT$ 4,709.10) — constituting 92.6 per cent of the total health expenditure. A single hospitalisation averaged Rs 1.19 lakh (INT$ 5,257), with a median of Rs 49,600.
Patients funded the health expenditure through personal savings (68 per cent), family aid (54 per cent), or loans from relatives (15 per cent). For the uninsured which amounted to 70 per cent of cases — OOP soared to 98 per cent of costs.
The study exposed catastrophic health spending (CHS) and distress financing (DF). Compared to the previous year, a decline in monthly income was reported by 32.3 per cent of individuals and 36.2 per cent of households. CHS and distress financing DF were observed in 37.7 per cent and 17.7 per cent of the households, respectively.
The prevalence of CHS was higher among females (39.8 per cent), individuals living in rural areas (45.6 per cent), unemployed individuals (43.5 per cent), and participants with less than secondary education (42.4 per cent).
DF was reported by 17.7 per cent of participants. Individuals living in rural areas (21.3 per cent) and unemployed individuals (20.4 per cent) reported relatively higher DF. Similarly, individuals with lower educational attainment (less than secondary school) experienced a relatively higher prevalence of DF (20.6 per cent).
CHS and DF were lower (30.8 per cent and 13.6 per cent respectively) among those with health insurance compared to the uninsured (40.3 per cent and 18.9 per cent respectively). Addressing the financial burden, including CHS and DF, is essential for improving clinical outcomes and ensuring health equity, the study emphasised.
Cost analysis from Manipal Heart Failure Registry (December 2019) found that the average cost per HF hospitalisation was approximately Rs 1.34 lakh (INT$5.9K), of which 62 per cent was OOP expenses. Similarly, in a study from Punjab, cardiovascular diseases (CVDs) conditions incurred the highest inpatient and outpatient costs among non-communicable diseases.
Despite improved insurance coverage through schemes like the Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana financial impact of CVDs, particularly HF, remains substantial for economically vulnerable households in India.
The Ayushman Bharat scheme provides cashless hospitalisation coverage of Rs 5,00,000 per family per year to poor and vulnerable families for secondary and tertiary healthcare services. However, gaps remain in awareness, enrolment, and access, particularly for chronic conditions like HF.
A 2024 study published in BMC Health Services Research looked at the impact of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) on the quality of inpatient care and financial protection in India. It found that enrollment under AB-PMJAY was not associated with increased utilisation of inpatient care. Enrollment under AB-PMJAY was not associated with reduced out-of-pocket expenditure or catastrophic health expenditure.