NEW DELHI: Road accidents, cancer, heart attacks and brain stroke treatments are the leading causes for people living in low-and middle-income countries like India to undergo catastrophic medical expenses, leading to severe financial distress, pushing many families into poverty, a recent article said.
The article, published in Kerala Medical Journal, also highlights doctors’ role in guiding patients in “good faith” towards less expensive yet effective alternatives in end-of-life care.
The article examined the causes, consequences, and potential solutions to mitigate the financial burden of healthcare and concluded that “futile ICU admissions should be minimised, especially for those individuals who need only comfort care towards the end of their life.”
“Along with discussions about making an accurate diagnosis during ward rounds and case presentations, medical students must receive early insights into the financial consequences of the advice they will eventually provide as doctors,” said the article, ‘Catastrophic medical expenses: A comorbidity requiring multilevel intervention.’
Speaking to TNIE, Dr Rajeev Jayadevan, author of the article and past president of the Indian Medical Association (IMA), Kochi, said, “Many people do not have sufficient health insurance coverage. Therefore, these expenses often require loans that destabilise their financial situation.”
“For people living on the margin, this pushes the whole family into poverty, affecting the nutrition, education, and health of other family members. Poverty then becomes a major comorbidity that further worsens health outcomes, creating a vicious cycle.”
He said that though the Indian government has launched Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PM-JAY) to cover the poorest segments, many hospitals avoid these patients, citing low reimbursement rates and significant payment delays.
“There is also reported misuse by wealthier people enrolling in these schemes through false declarations, diverting benefits from the truly needy. With about 70% of healthcare provided privately, expanding insurance coverage is crucial to prevent catastrophic expenses. Stronger regulation is needed to prevent unfair claim rejections,” said Dr Jayadevan, who is also Convener Research Cell, Kerala State IMA.
India's healthcare spending remains low compared to other large nations.
Increased public health funding would improve facilities and staffing and ultimately reduce patients' costs, he said, adding that expanding insurance coverage is essential but challenging.
He highlighted the need to address insurance claim rejections through better documentation and regulation.
“Many rejections occur because of failure to disclose pre-existing illnesses when purchasing the policy. While this may increase premiums, full disclosure is essential to avoid claim rejection. Inadequate paperwork is another major cause, which can be improved through hospital staff training and technology. There are concerns about unfair rejections by insurance companies that regulators should investigate,” Dr Jayadevan said.