AbstractIntroductionElevated 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.ObjectivesThis study aimed to explore the pattern and predictors of health care seeking among hypertensive individuals along with financial protection.Study design and settingsThis cross-sectional study was conducted in in Birbhum district of the state of West Bengal, India in 2017-2018.Study Population300 individuals were recruited after random sampling from the list of identified hypertensive subjects in the Birbhum Population Project.Outcome measureHealthcare seeking along with two strings of financial protection, out of pocket expenditure, and relative expense were analyzed.ResultsFindings 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.ConclusionStudy 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.Strengths and Limitations of the studyPopulation based cross-sectional study, nested in a well-defined population cohortUse of pretested and validated study tool with Computer Assisted Personal InterviewSelf-reported assessment of health care seeking for hypertension and related Out of pocket expenditureStatistical analysis with regression modelling to control confounding effects on outcomeRecall and reporting bias could not be ruled out completely
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