Financial burden of treating non-fatal road traffic injuries: A decomposition analysis of its causal factors in Kerala

Godwin Sree Kulakkal (
Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences & Technology
May, 2009


CONTEXT: Access to affordable health care has been one of the prime objectives of all health systems and among the methods of financing household out-of-pocket payments at the point of delivery of service creates the maximum barriers to effective utilisation of health care especially by the lower income groups. Road traffic injury represents a classic case of uncertainty and the associated financial burden is assumed to impoverish households due to the out-of-pocket mode of financing injury care and Kerala is a high road accident zone in the country.
MISSION: Streamlining the “excess burden on households” by enhancing the efficiency of the health care resources forms the central motivation of the study.
METHODS: Using an integrated demand-supply framework, the study endeavours to decompose the role of inefficiency of providers, supplier-induced demand, the pattern of responses adopted by households when dealing with costs of treatment, its consequences on household resources due to financial burden of treating injuries. The study utilised secondary data to assess the incidence and intensity of road traffic accidents in Kerala and primary data was collected from the injured who were discharged immediately from selected public and private health facilities from three districts of Kerala.
RESULTS & DISCUSSION: Majority of the injured were males in the productive age group and road traffic accidents are no more an urban phenomenon in the State. Severity of injuries was comparatively higher indicated by the higher per cent of hospitalisation and longer length of stay. Public facilities were the preferred choice of injury treatment probably due to relatively high cost, better spread of health care facilities, medico-legal issues involved etc. Majority of the injured incurred catastrophic expenditure and the financial burden of injury treatment was distributed regressively with the lower income groups bearing a very high burden. Public hospitals face adverse case-mix and length of stay was abnormally higher probably due to higher pre-surgical length of stay. Some public hospitals were found to have under-treated patients while some private hospitals had induced treatment.

Copyright © 2016 Kermanshah University of Medical Sciences. All rights reserved.