Healthcare seeking, associated costs and its consequences on household economy in India: design and baseline characteristics of an observational household survey

Background The high cost of care is a major barrier to access and, in extreme cases, can push families into poverty. Protection from financial hardship due to care seeking is fundamental to universal health coverage. We aim to generate high-quality evidence on care-seeking patterns and associated costs at the household and individual levels to quantify the financial risk from healthcare seeking in India. Method We established a cohort of 3,000 households in Haryana, India. We followed them on a monthly basis and collected data on care seeking and associated costs for all members of the household. Data on household consumption for different food and nonfood items were collected at baseline, at 6 months, and during the endline survey. A short recall period of 1 month was used to capture data for the utilization of preventive, promotive and curative healthcare services. Results We enrolled 15,390 individuals from 3,000 households with a mean household size of five. Most households owned their homes (95.9%) and belonged to marginalized communities, including Scheduled Castes (40.3%) and Other Backward Classes (26.4%). Approximately two-thirds held below poverty line (BPL) cards, and one-third were covered by health insurance. While 82.9% of individuals were literate, only 37.4% of those aged > 14 years were employed, among whom the majority were in private jobs (53.6%). The average monthly consumption expenditure was ₹ 26031; 310.7 USD. Most care-seeking was for communicable and maternal/neonatal diseases (62.2%), with 72.9% relying on informal care sources. Among those who sought care, expenses associated with inpatient care averaged ₹ 13,354.7,159.4 USD (105 individuals), higher than those associated with outpatient (₹ 4882.4; 58.3 USD; 1087 individuals) and informal care (₹ 829.3; 9.9 USD; 4571 individuals). Conclusion We have established a prospective cohort to generate robust, context-specific evidence on out-of-pocket health expenditures, care-seeking patterns, and associated costs in India. Our cohort is comparable to national-level surveys for key parameters such as age and sex distribution. Here, we describe the study design, plan of analysis and baseline characteristics of the enrolled cohort at the household and individual levels.