Out-of-Pocket Expenditure (OOPE) Among COVID-19 Patients by Insurance Status in a Quaternary Hospital in Karnataka, India
Abstract
1. Introduction
2. Research Methodology
- (1)
- Medical record department;
- (2)
- IT department;
- (3)
- Finance department.
- (1)
- COVID-19 inpatients from June 2020 to June 2022;
- (2)
- COVID-19 inpatients with publicly funded health insurance (AB-PMJAY), with private health insurance, and with no insurance.
- (1)
- COVID-19 deaths were excluded from the analysis due to inconsistencies in billing documentation and challenges in capturing final OOPE values. In many cases, bills were either waived, subsidized, or contested, which could lead to misrepresentation of the actual financial burden. Additionally, ethical and procedural considerations limited access to comprehensive financial records for deceased patients.
- (2)
- Outpatient services were not included in this analysis, as they are generally not covered under AB-PMJAY or standard private health insurance policies in India. The focus of the study was on inpatient financial burden, which forms the core of coverage under publicly funded and most private insurance schemes.
3. Results
4. Variation in OOPE Across Various Patient Categories
5. Discussion
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Patient Category | No. of Cases | Percentage |
---|---|---|
ABPMJAY | 1161 | 42.76% |
Private Health Insurance | 606 | 22.32% |
Uninsured Patients | 948 | 34.91% |
Total | 2715 | 100 |
Patient Category | No. of Cases | Total Percentage of Cases (%) | Median Billing Amount/Mean Billing Amount (INR) | OOPE as an Average Percentage (%) of the Billing Amount | Median OOPE/Mean OOPE (INR) |
---|---|---|---|---|---|
ABPMJAY | 1161 | 43 | 126,260 * (USD 1694.40) | 0 | 0 |
Private Health Insurance | 606 | 22 | 92,938 * (USD 1247.22) | 21.16 | 19,728 *** (USD 264.75) |
Uninsured Patients | 948 | 35 | 66,929 * (USD 898.18) | 100 | 66,929 *** (USD 898.18) |
Private Health Insurance | No. of Cases | Total Percentage of Cases (%) | Median Billing Amount/Mean Billing Amount (INR) | Average OOPE as a Percentage (%) of the Billing Amount | Median/Mean OOPE |
---|---|---|---|---|---|
Future Generali India Insurance | 1 | 0.03 | 146,496 ** (USD 1966) | 0.28 | 415 **** |
Good Health Insurance TPA | 1 | 0.03 | 5977 ** (USD 80) | 25.84 | 1545 **** |
IFFCO-Tokio General Insurance | 1 | 0.03 | 115,883 ** (USD 1555) | 22.22 | 25,750 **** |
Reliance General Insurance | 1 | 0.03 | 72,426 ** (USD 971.95) | 21.80 | 15,784 **** |
Tata AIG General Insurance | 1 | 0.03 | 141,805 ** (USD 1903) | 0.0 | 0 **** |
Vipul Medcorp TPA | 1 | 0.03 | 267,885 ** (USD 3595) | 4.05 | 10,870 **** |
Aditya Birla Health Insurance | 2 | 0.09 | 46,150 ** (USD 619.33) | 9.78 | 4515 **** |
Health India | 2 | 0.09 | 254,460 ** (USD 3415) | 3.96 | 10,084 **** |
Ecron Acunova | 3 | 0.13 | 19,769 ** (USD 265.30) | 0 | 0 |
Apollo Munich Health Insurance | 3 | 0.13 | 41,004 ** (USD 550.27) | 7.39 | 3032 **** |
Care Health Insurance Company | 3 | 0.13 | 120,878 ** (USD 1622) | 14.81 | 17,898 **** |
United Healthcare India | 3 | 0.13 | 86,576 ** (USD 1162) | 21.91 | 18,969 **** |
Universal Sompo General Insurance | 3 | 0.13 | 238,099 **** (USD 3195.3) | 32.48 | 77,330 |
Religare Health Insurance | 5 | 0.18 | 96,553 (USD 1296) | 24.33 | 23,489 |
Bajaj Allianz General Insurance | 6 | 0.22 | 105,474 ** (USD 1416) | 10.60 | 11,181 *** |
HDFC | 6 | 0.22 | 62,332 ** (USD 836.49) | 12.50 | 7789 **** |
ICICI Lombard General Insurance | 6 | 0.22 | 119,793 ** (USD 1608) | 5.56 | 6667 **** |
Paramount Health Services Insurance TPA | 6 | 0.22 | 106,817 ** (USD 1434) | 26.55 | 28,362 *** |
United Healthcare India | 8 | 0.062 | 146,374 ** (USD 1964) | 18.69 | 27,369 **** |
MDINDIA Health Insurance TPA | 15 | 0.55 | 143,916 ** (USD 1931) | 18.90 | 27,198 **** |
Sampoorna Suraksha | 29 | 1.06 | 60,819 ** (USD 816.19) | 40.26 | 24,488 *** |
Vidal Health TPA | 37 | 1.36 | 109,275 ** (USD 1467) | 26.42 | 28,874 **** |
Star Health and Allied Insurance | 50 | 1.84 | 144,049 * (USD 1933) | 32.53 | 46,855 *** |
Medi Assist India TPA | 99 | 3.65 | 121,473 ** (USD 1630) | 21.98 | 26,697 *** |
Medicare | 314 | 11.57 | 70,814 ** (USD 950.32) | 16.58 | 11,743 *** |
Total | 606 | 22.16% | 17.03 |
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Kamath, R.; Sebastian, C.; Jayapriya, V.R.; Acharya, S.S.; Kamat, A.; Brand, H.; D’Souza, R.M.C.; Salins, P.; Sugunan, A.; Kamath, S.; et al. Out-of-Pocket Expenditure (OOPE) Among COVID-19 Patients by Insurance Status in a Quaternary Hospital in Karnataka, India. Int. J. Environ. Res. Public Health 2025, 22, 1289. https://doi.org/10.3390/ijerph22081289
Kamath R, Sebastian C, Jayapriya VR, Acharya SS, Kamat A, Brand H, D’Souza RMC, Salins P, Sugunan A, Kamath S, et al. Out-of-Pocket Expenditure (OOPE) Among COVID-19 Patients by Insurance Status in a Quaternary Hospital in Karnataka, India. International Journal of Environmental Research and Public Health. 2025; 22(8):1289. https://doi.org/10.3390/ijerph22081289
Chicago/Turabian StyleKamath, Rajesh, Chris Sebastian, Varshini R. Jayapriya, Siddhartha Sankar Acharya, Ashok Kamat, Helmut Brand, Reshma Maria Cocess D’Souza, Prajwal Salins, Aswin Sugunan, Sagarika Kamath, and et al. 2025. "Out-of-Pocket Expenditure (OOPE) Among COVID-19 Patients by Insurance Status in a Quaternary Hospital in Karnataka, India" International Journal of Environmental Research and Public Health 22, no. 8: 1289. https://doi.org/10.3390/ijerph22081289
APA StyleKamath, R., Sebastian, C., Jayapriya, V. R., Acharya, S. S., Kamat, A., Brand, H., D’Souza, R. M. C., Salins, P., Sugunan, A., Kamath, S., Kamath, S. G., & Kini, S. B. (2025). Out-of-Pocket Expenditure (OOPE) Among COVID-19 Patients by Insurance Status in a Quaternary Hospital in Karnataka, India. International Journal of Environmental Research and Public Health, 22(8), 1289. https://doi.org/10.3390/ijerph22081289