Impact of out-of-pocket medical expenditure after major illness in the family on food consumption of a household
Authors: Singh Namrata , Qamar Sumaira , Dasarathy Dhweeja , Sardana Hardik , Kumari Sanjana , Saraya Anoop 
Published: August 2023

Purpose
The purpose of this study was to see the impact of increased out-of-pocket expenditure oh health care exerting budget pressure on households, which leads to change in dietary consumption.

Design/methodology/approach
It was a hospital-based cross-sectional study comprising 414 patients with a chronic or major illness attending a large tertiary care public hospital at Delhi, India. Each patient represented a household with total number of family members of 2,550 in the study. Questionnaire was used to gather data on factors responsible for changes in consumption of 12 major food items.

Findings
Moderate decrease in food consumption of a household after major illness is associated with: rural residence (p < 0.001), decrease in savings (p < 0.001), more number of household items sold (p < 0.001), education of the children affected (p < 0.001), upper socio-economic status (SES) (p < 0.001) and children started working after illness in family (p = 0.043). In addition to decrease in food items, there was also deterioration in quality of food preparation. More than 80% of the families did not change the intake of cereals (rice and wheat), pulses and sugar. Food items that were decreased by most families were fruits, followed by milk and its products, vegetables, meat and egg, oils and ghee.

Research limitations/implications
This study is a subset of other two studies previously published. The authors had not been able to cover this aspect fully in those two studies but understood the importance of impact of expenditure on illness on food consumption. The authors studied change in food consumption pattern (not amount) in subjects after illness. The impact of weather changes in food consumption on the impacted nutritional status of family has not been studied. The authors only collected cross-sectional, observational data and recall bias cannot be completely ruled out and corrected. With such data, only associations could be concluded, not causality. The illness condition of a household was measured by presence of chronic disease and inpatient treatment. Such measures did not take into account the types of illness and number of episodes. Data of this study cannot capture whether food intake of family prior to illness was sufficient/in excess/deficient. The Kuppuswamy scale, mostly used in urban and peri-urban settings, was also used for rural subjects in the study, which might have resulted in impaired capture of rural SES. The authors did not assess whether families were allocated food grains by schemes like public distribution system, which might have resulted in biased decrease in food consumption. Questionnaire used was not validated.

Practical implications
This study demonstrates the various factors that act as barriers to proper food consumption, including non-financial factors. The policy of user fee in government is hitting poorer section, and equity and access to health are compromised. Health expenditure should be increased by public sector policies to implement uniform healthcare. There is need for more studies to identify measures that could be put in place when designing policies and interventions for the uniform distribution of benefits.

Social implications
The policy of user fee in government is hitting poorer section, and equity and access to health are compromised. Health expenditure should be increased by public-sector policies to implement uniform healthcare.

Originality/value
Major or chronic illness affects money acquisition and priorities of expenditure, resulting in deterioration in quality of food consumption and by a household.