Health care seeking and financial protection among hypertensive population: a cross-sectional study in rural West Bengal, India

Introduction: Elevated blood pressure or hypertension is responsible for around 10 million annual deaths globally, and people residing in low and middle-income countries are disproportionately affected by it. India is no exception, where low rate of treatment seeking for hypertension coupled with wide spread out of pocket payments (OOPs) have been a challenge. Objectives: This study aimed to explore the pattern and predictors of health care seeking among hypertensive individuals along with financial protection. Study design and settings: This cross-sectional study was conducted in in Birbhum district of the state of West Bengal, India in 2017-2018. Study Population: 300 individuals were recruited after random sampling from the list of identified hypertensive subjects in the Birbhum Population Project. Outcome measure: Healthcare seeking along with two strings of financial protection, out of pocket expenditure, and relative expense were analyzed. Results: Findings indicated poor health care seeking (47% of hypertensive individuals were not on treatment), preference of private healthcare (80%), and wide-spread OOPs (91%) among study participants. Cost of medication bears major share of expenses with significant transport cost to access public health care facility. Multivariable logistic regression analysis indicated longer duration of disease and private health care seeking was associated with more incident of OOPs. Results from linear regression modeling (generalized linear model) demonstrates presence of co-morbidities was associated with higher relative expenditure. Individual belonged to poorer economic group suffered from high relative expenses for hypertension compared to the richest. Conclusion: Study suggested poor health care seeking, preference of private health care, suboptimal financial protection of population for hypertension care. Economically poorer section bears more relative burden of health expenditure.