70% of India's Heart Failure Patients Lack Insurance, Face Catastrophic Health Costs

Seven of ten heart failure patients in India are uninsured, with out-of-pocket expenditure accounting for 92.6 per cent of total health spending and averaging Rs 1,06,566 annually per patient, according to a study of 1,859 patients across 21 hospitals published in Global Heart on March 12, 2026. Among the uninsured, out-of-pocket costs rise to 98 per cent of total expenditure.

The study, led by Dr Panniyammakal Jeemon from SCTIMST in Thiruvananthapuram, found that health insurance coverage was reported by only 32.2 per cent of participants. A single hospitalisation averaged Rs 1.19 lakh with a median of Rs 49,600. Patients funded health expenses through personal savings at 68 per cent, family aid at 54 per cent, and loans from relatives at 15 per cent. Catastrophic health spending, defined as expenditure that severely disrupts household finances, was observed in 37.7 per cent of households, while distress financing was reported by 17.7 per cent.

The study population averaged 55 years old, 10 to 15 years younger than equivalent Western or Chinese heart failure registries, highlighting the disease burden on people in their most productive working years. Approximately 48.6 per cent of participants lived in rural areas. Rural residents faced a catastrophic health spending prevalence of 45.6 per cent compared to lower rates for urban residents, and 21.3 per cent of rural participants reported distress financing. Women, unemployed individuals, and those with less than secondary education consistently showed higher rates of both catastrophic spending and distress financing.

Despite the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana providing cashless hospitalisation coverage of Rs 5 lakh per family per year, gaps in awareness and enrolment limit its impact on heart failure patients. Heart failure accounts for 1.8 million hospitalisations in India annually. A 2024 study found that AB-PMJAY enrolment was not associated with reduced out-of-pocket expenditure or catastrophic health spending, pointing to implementation failures rather than scheme design. The authors emphasise that addressing financial burden is essential for improving clinical outcomes and ensuring health equity in cardiovascular care.

Key figure — Rs 1,06,566 average annual out-of-pocket expenditure per heart failure patient