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Saurav Panda

The author is COO of Carecover.in

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Medical Out Of Pocket Expense

Inspite of a global focus on comprehensive healthcare coverage, Out of Pocket expenses in healthcare are rising across the world. India has one of the highest Out of Pocket expense (OPEX) in healthcare.

Ayushman Bharat

Out of Pocket Expense (OPEX) is the amount paid by an individual for his healthcare needs from his own pocket. It includes any direct payment paid by the uninsured and the deductibles and exclusions paid by insured patients. Many times, even the insured patients must pay and get the reimbursement later.

In one of the first studies to link healthcare costs with poverty, a study published in British Medical Journal(BMJ) points out that the proportion of the population in India reporting OPEX on healthcare have increased from about 60 percent in 1993–1994 to 80 percent in 2011–12. In such uninsured households, one healthcare incident can throw the family into poverty. The same research shows, In 2011–12, OPEX for healthcare pushed about 3.8 crore persons into poverty, of the 5.5 crore that were impoverished due to total health costs, including lab tests, diagnostics, doctor and surgeon fees. (Hence annually about 10–15% of BPL families are due to healthcare costs) Many other research reports peg healthcare incident in the family as one of the top reasons for family falling below the poverty line. In such cases many times the patients family are not able to afford it leading to bad healthcare outcomes and sometimes loss of lives too.

Currently the patients do not have many avenues to pay for these OPEX bills. Traditional loans are not an option as they take time and many in need would not be able to avail one as it requires collateral or a good credit history. They either have to dig into their savings, or resort to selling their assets in fire sale or worse take loans from loan sharks exposing them to exploitation.

Recently some companies have launched medical OPEX finance card. The holders of this card get access to instant disbursal in the time of need at hospitals and pay it later through EMIs. It has almost no exclusions. This card is like a credit card but not exactly as its usage is restricted to procedures in hospitals and the best thing is the financing is at 0% interest rate compared to high interest rates of credit cards. This is a complete solution for the Indian population.

Disclaimer: The views expressed in the article above are those of the authors' and do not necessarily represent or reflect the views of this publishing house


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