Healthcare utilization and financial protection among those with mental disorders in India: Insights from the 75th round of the National Sample Survey

Abstract Background: Mental disorders pose a significant public health issue in India, with a prevalence rate of one in seven individuals diagnosed with varying severities of mental disorders in 2017. This study examined the patterns of socio-demographic factors associated with diseases burden, healthcare utilization, and financial protection among individuals reported to have a mental disorder across India.Methods: Data from the recently released (November 2019) 75th Round National Sample Survey (NSS), which was conducted from July 2017 to June 2018, across 8077 rural villages and 6181 urban wards was used. Data collected from 555,115 individuals (rural: 325,232; urban: 229,232) included 283 outpatient and 374 hospitalization cases due to mental disorders in India. Logistic regression models were used for analyses.Results: Self-reporting of mental health disorders was significantly higher in the general category compared to scheduled tribe, and among the richest income quintile compared to the poorest income quintile in India. The private sector was a major service provider for mental health services with a larger share for outpatient (66.1%) than inpatient care (59.2%). Over 63.5% of individuals with a mental disorder and who went to the private sector for hospitalization reported unavailability or poor service quality at public facilities. Out of total hospitalization cases, 23.5% had insurance coverage. Average out of pocket expenditure during hospitalization [public: Rs.7947 (107 USD); private: Rs. 37152 (502 USD)] and outpatient care [ public: Rs.544 (7 USD); private: Rs. 2358 (32 USD)] was higher under the private sector than the public sector. This led to high catastrophic health expenditure (CHE-10: public- 30.8%; private- 82.5%).Conclusions: Stigma associated with mental disorders may have decreased the self-reporting of mental disorders in this survey. India urgently needs greater investment in mental health resources to improve access and financial protection. To achieve universal health coverage under sustainable development goals, the country needs to strengthen its healthcare system, providing comprehensive primary care, along with robust tertiary and rehabilitative care referral linkages.Trial Registration: Not applicable