A nationwide study has found that seven out of 10 heart failure patients in India have no financial protection, forcing families to pay almost entirely from their own pockets. Published in the journal Global Heart, the study led by Dr Panniyammakal Jeemon of SCTIMST, Thiruvananthapuram, analyzed 1,859 patients across 21 tertiary hospitals between September 2019 and December 2022. It reveals that over 90% of treatment expenses are borne directly by patients, exposing a deep gap in financial protection for chronic illnesses.
Financial Burden on Patients
On average, a patient spends more than ₹1 lakh per year on treatment. Meanwhile, incomes are falling: nearly one in three patients and over a third of households reported a drop in earnings after diagnosis. Doctors note that income often declines as patients stop working and families cut back to provide care. About 38% face catastrophic spending, and nearly one in six borrow or sell assets, with many cutting basic expenses. The burden is highest on rural, low-income, and uninsured patients.
Insurance Gaps
Insurance offers some relief but not enough. Schemes such as Ayushman Bharat provide coverage for hospitalization, but gaps remain. Most schemes do not fully cover outpatient care, medicines, and long-term follow-up, which form a major part of treatment for chronic conditions like heart failure. As a result, patients continue to spend heavily out-of-pocket.
Expert Opinions
Dr Mohit Gupta, cardiologist at GTB Hospital, said, "Heart failure care in India shows a clear gap between acute treatment and long-term management, driven by affordability, accessibility, and availability. Costs often force patients to cut medicines, delay follow-ups, or skip tests. The biggest burden is repeated hospitalization, not drugs. We frequently tailor treatment to what patients can afford. Expanding access to affordable drugs and structured follow-up can improve outcomes and reduce costs."
Dr Ambuj Roy, Professor of Cardiology at AIIMS, noted that insurance schemes still favor one-time procedures over sustained care, while heart diseases demand long-term therapy. Even though newer drugs have improved survival and quality of life, most patients pay out of pocket, making heart failure treatment a significant financial burden.
Consequences and Recommendations
Experts warn that financial strain leads to delayed care and skipped medicines, worsening outcomes. Despite improved access, financial protection lags, making coverage of outpatient care and medicines critical. The study underscores the need for policy changes to expand insurance coverage for chronic outpatient care and ensure affordable medications for heart failure patients.
