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\begin{document}

\title{Impact of COVID-19 on Health Systems and household level OOPE: Evidence
from a developing state of India}



\author[1]{Ananda Meher}%
\author[2]{Sarit Rout}%
\author[2]{Pallavi Behera}%
\author[2]{Shridhar  M Kadam}%
\affil[1]{Kalinga Institute of Industrial Technology Deemed to be University}%
\affil[2]{Public Health Foundation of India}%


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  \date{May 22, 2024}


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\begin{abstract}
\textbf{Background \& Objective :} Covid-19 caused insurmountable misery
to individuals and health systems and caused millions of infections and
deaths globally. The situation was not different in India. This study
based upon primary household survey generated evidence on the health
seeking behavior during COVID 19, OOPE (Out Of Pocket Expenditure) due
to COVID related hospital visits and how a federal unit under the India
union responded to the crisis. \textbf{Methodology:} The study collected
primary data from a representative sample of 3,584 households and 276
COVID-19 positive patients who received treatment in an institution or
hospital as in-patients were selected from four district of Odisha,
India. Descriptive statistics like mean, median and percentage were used
to present the findings of the study. \textbf{Results:} More than half
of the sample households faced difficulty in accessing health services
during the COVID and a majority of them had difficulty due to
non-availability of transport facility followed by closure of medical
facilities. Our findings further suggested that 53\% of the households
in the first wave and 63\% in the second wave did not pay any anything
out of their pocket for availing outpatient care services. For inpatient
care, 70\% in the first wave and 62\% in the second wave did not spend
anything from their pocket. It was also observed that a majority around
90\% in the wave 1 and 74\% in the wave 2 accessed public health
facilities for Covid related inpatient care. From among those incurred
any OOPE, the average OOPE for the outpatient visit was INR 2312 in the
wave 1 and INR 2694 in the wave 2. Similarly for the inpatient care, it
was Rs 21,045 in the wave 1 and Rs 1,09,335 in the wave 2.
\textbf{Conclusion:} Our findings offer crucial insights into the
health-seeking behavior of individuals and the difficulties experienced
by both COVID and non-COVID-19 patients during the pandemic. Moreover,
the findings suggested that the initiatives introduced by the state
government resulted in averting OOPE by many households. Learning from
managing large disasters experienced earlier, the state's health
management strategies were unique which resulted in more individuals
accessed care from public health systems and incurred less OOPE.%
\end{abstract}%



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