Paper Details

Name: Vardana Sony Dinakar Rao
Country: India

Year: 2025
Volume: Volume No: 12, Issue No: 2, Year: 2025
Page Number: 406-413
DOI: https://doi.org/10.5281/zenodo.20509499

ABSTRACT
Out-of-pocket healthcare expenditure remains one of the major socio-economic challenges affecting healthcare accessibility and healthcare utilization among vulnerable urban populations in India. Rapid urbanization, expansion of slum settlements, inadequate social protection, and dependence on informal employment have intensified financial vulnerability among urban poor households. In response to growing urban health inequalities, the Government of India introduced the National Urban Health Mission (NUHM) with the objective of strengthening urban primary healthcare systems and reducing healthcare-related financial burden among economically weaker populations. Despite expansion of Urban Primary Health Centres (UPHCs) and preventive healthcare programmes under NUHM, indirect healthcare expenditure and institutional inadequacies continue to affect affordability and continuity of healthcare services among slum households.
The present study examines the nature, extent, and determinants of out-of-pocket healthcare expenditure among urban slum households in Kurnool district of Andhra Pradesh. The study is based on both primary and secondary data collected from 580 respondents including urban slum households, healthcare providers, ASHA workers, ANM personnel, and administrative staff functioning under NUHM. Statistical tools such as percentage analysis, regression analysis, Chi-Square test, correlation analysis, and ANOVA were employed using SPSS software for empirical interpretation.
The findings reveal that Urban Primary Health Centres functioning under NUHM significantly reduced direct healthcare expenditure through subsidized consultations, free medicines, immunization services, maternal healthcare support, and preventive healthcare outreach programmes. However, transportation expenditure, wage loss during illness, diagnostic costs, and shortage of medicines continued to increase indirect healthcare burden among economically weaker households. Daily wage labourers, migrant workers, and low-income households experienced relatively higher financial vulnerability. The study further observed that healthcare awareness, social security coverage, and accessibility of healthcare institutions positively influenced reduction of healthcare expenditure among respondents.
The study concludes that strengthening healthcare infrastructure, expanding diagnostic facilities, reducing indirect healthcare costs, improving medicine availability, and strengthening healthcare outreach systems are essential for improving healthcare affordability and sustainability of urban public healthcare systems under the National Urban Health Mission.
Keywords: Out-of-Pocket Healthcare Expenditure, Urban Health, Healthcare Affordability, National Urban Health Mission, Urban Slums, Public Health, Health Economics, Kurnool District.