OBJECTIVES: Universal Health Coverage (UHC) aims to provide quality health services to all without causing financial distress. In developing countries, people resort to ex-post distress financing when faced with a health shock. In India, intending to overcome this, the government has introduced a vast network of financial protection schemes for the poor and vulnerable, majorly at the inpatient level. However, studies suggest that free outpatient care is also critical in reaching the goal of UHC. Our study, based in India, uses hardship financing, which is ex-post informal borrowings, contributions from friends/ relatives, or sale of assets, as the indicator to measure financial constraints faced by individuals to meet the unforeseen health expenditures. The paper has two primary goals. The first is to identify the disease(s) causing the maximum financial hardship in the country. Secondly, it looks at the change in hardship financing over time.

METHODS: The paper analyses large-scale unit-level data from the National Sample Survey Organisation 71st and 75th rounds. Conducted bivariate analysis using chi-square test. Multivariate analysis uses logistic regression models for outpatient and inpatient cases separately and in each period. Pooled logistic regression is performed to check the robustness of the cross-sectional models, and average marginal effects are calculated to understand the change in financial hardship over time.

RESULTS: Our study reveals that cancer is most likely to cause financial hardship in India, irrespective of whether the case is inpatient or outpatient. The analysis suggests that from 2014 to 2018, economic hardship for inpatients has decreased, whereas, for outpatients, it has increased.

CONCLUSIONS: The paper makes important suggestions to policy makers. Primarily, it helps identify target groups that urgently need financial protection against illnesses. Secondly, it highlights the need and urgency of protecting individuals from economic shocks at the outpatient level so as to reach the goal of UHC.