Mumbai: India’s growing burden of heart failure is exposing a parallel crisis—rising treatment costs, falling incomes, and limited insurance coverage—leaving a majority of patients financially vulnerable.
Heart failure, a chronic condition in which the heart cannot pump blood efficiently, is increasingly affecting Indians at a younger age. Driven by underlying issues such as coronary artery disease, hypertension, and cardiomyopathy, the condition demands long-term care, frequent hospitalisation, and continuous medication—making it both a medical and economic challenge.
Rising Burden, Limited Coverage
Globally, heart failure affects nearly 26 million people. In India, it accounts for around 1.8 million hospitalisations each year. Despite this growing burden, financial protection remains low.
A recent multicentre study published in the journal Global Heart, conducted by researchers from the Sree Chitra Tirunal Institute of Medical Sciences and Technology, found that only 32.2% of heart failure patients in India have any form of health insurance.
The study analysed 1,859 patients across 21 hospitals nationwide, offering a comprehensive look at both clinical and financial realities.
High Out-of-Pocket Costs
The findings highlight a heavy reliance on out-of-pocket spending. Patients spend an average of ₹1,06,566 annually, which accounts for over 92% of total healthcare expenses.
Beyond medical bills, the disease significantly impacts household income. Around 32.3% of patients and 36.2% of families reported a drop in monthly income, often due to inability to work or caregiving responsibilities.
Financial Distress Widespread
The study revealed alarming levels of financial strain:
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37.7% of households faced catastrophic health spending (CHS)
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17.7% resorted to distress financing, including loans or selling assets
While insurance offered some relief, it was limited. Among insured patients:
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CHS reduced to 30.8% (vs 40.3% uninsured)
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Distress financing dropped to 13.6% (vs 18.9% uninsured)
However, most insurance schemes cover only hospitalisation, leaving outpatient care and long-term medication—key components of heart failure management—uncovered.
Who Is Most Affected?
The financial burden is highest among:
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Low-income households
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Rural populations
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Uninsured patients
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Individuals with multiple health conditions
Patients in rural areas reported significantly higher economic stress compared to urban counterparts.
Why Insurance Coverage Remains Low
According to Dr Swarup Swaraj Pal, several factors contribute to poor insurance uptake:
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Lack of awareness: Many individuals do not purchase insurance while healthy
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Pre-existing condition barriers: Post-diagnosis, insurance becomes difficult due to rejections, waiting periods, or high premiums
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High-risk perception: Insurers view heart failure as a costly, recurring condition
“Patients often present very late, when the disease is already advanced, requiring intensive and expensive treatment,” he noted.
Cost of Advanced Care
Treatment costs escalate sharply in severe cases:
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Heart transplant: ₹25–30 lakh
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Artificial heart devices: up to ₹1.3 crore
Frequent hospitalisations further increase the financial burden, making long-term management unaffordable for many.
Younger Patients, Bigger Impact
The average age of patients in the study was 55.9 years, significantly younger than in Western countries. This means heart failure is affecting individuals during their most productive years, amplifying economic consequences at both household and national levels.
Study Limitations
While the study provides critical insights, researchers noted certain limitations:
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Exclusion of patients who could not access care due to financial constraints
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Reliance on self-reported expenditure data
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Focus on short-term costs post-hospitalisation rather than long-term burden
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Possible underestimation due to survival bias
The Way Forward
Experts stress the need for broader and more inclusive insurance coverage in India. Expanding schemes to include outpatient care, medications, and long-term disease management could significantly reduce financial distress.
“Moving towards universal or mandatory insurance coverage could improve access to life-saving treatments and ease the economic burden on patients,” Dr Pal suggested.
As heart failure cases continue to rise, addressing both medical and financial challenges will be crucial to ensuring equitable healthcare access in India.