Year: 2026 | Month: October | Volume: 13 | Issue: 10 | Pages: 521-533
DOI: https://doi.org/10.52403/ijrr.20261047
Trends in Healthcare Financing Patterns Among Inpatients in Tertiary Care Trust Hospital: A Six-Year Retrospective Study (2020–2025)
Mahesh Gomasa1, Swetha Durai2, Mahender Manda3, Srilatha Tallapelly4, Kohul Kumar Maddineni5, Rashika Edha6, Lakshmi Yerukali7, Bhuvaneswara Ramanan8
1Indian Institute of Public Health, Hyderabad, Telangana, India.
2Independent Researcher (Biostatistician), Chennai, Tamil Nadu, India.
3Sri Chakra Hospitals, Managing Director, Hyderabad, Telangana, India.
4Indian Institute of Public Health, Hyderabad, Telangana, India.
5Indian Institute of Public Health, Hyderabad, Telangana, India.
6Indian Institute of Public Health, Hyderabad, Telangana, India.
7Indian Institute of Public Health, Hyderabad, Telangana, India.
8Department of Pharmacology, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India.
Corresponding Author: Mahesh Gomasa
ABSTRACT
Background: Though, Health insurance is important for financing inpatient healthcare. Out-of-pocket expenditure continues to dominate healthcare financing in India. This study examined temporal trends in Cash:(out of pocket expenditure) versus Credit:(insurance/funded) payment for hospitalization characteristics associated with payment mode, using six years of hospital admission records.
Methods: This retrospective study analysed routinely collected inpatients admission records data from a trust hospital in India, covering January 2020– December 2025 and analysed by year, age, gender, department, and length of stay. Using Pearson chi-square test, Cochran-Armitage trend, and Mann-Whitney U tests.
Results: Of all admissions, 15,659 (36.1%) were Credit and 27,704 (63.9%) were Cash. Credit patients were significantly younger (median 37.0 vs. 44.0 years, p <0.001). Credit utilization rose from 31.0% (2020) to a peak of 41.4% (2024) before falling to 32.1% (2025), with no significant linear trend overall (Cochran-Armitage p = 0.392), despite a significant year wise association χ²(5) = 247.7, p <0.001). State schemes' share fell from 59.8% to 49.1%, while private insurance share nearly doubled to 40.6% (p <0.001). Funded patients stayed significantly longer than Cash patients.
Conclusion: Nearly two in three admissions (63.5%) were paid entirely out of pocket, with funded financing covering just over a third. Credit patients were significantly younger and stayed significantly longer in hospital than cash patients in every department, a gap that may partly reflect cash paying patients curtailing their stay for cost reasons. These findings highlight a substantial, unevenly distributed gap in financial protection relevant to Universal health coverage goals.
Keywords: health insurance; hospital claims data; India; length of stay; out-of-pocket expenditure; payment mode; universal health coverage .
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