Abstract
Background: India is taking steps to provide Universal Health Coverage (UHC). Out-of-pocket (OOP) health care payment is the most important mechanism for health care payment in India. This study aims to investigate the effect of OOP health care payments on catastrophic health expenditures (CHE). Methods: Data from the National Sample Survey Organization, Social Consumption in Health 2014 and 2018 are used to investigate the effect of OOP health expenditure on household welfare in India. Three aspects of catastrophic expenditure were analyzed in this paper: (i) incidence and intensity of 'catastrophic' health expenditure, (ii) socioeconomic inequality in catastrophic health expenditures, and (iii) factors affecting catastrophic health expenditures. Results: The odds of incidence and intensity of CHE were higher for the poorer households. Using the logistic regression model, it was observed that the odds of incidence of CHE was higher among the households with at least one child aged less than 5 years, one elderly person, one secondary educated female member, and if at least one member in the household used a private healthcare facility for treatment. The multiple regression model showed that the intensity of CHE was higher among households with members having chronic illness, and if members had higher duration of stay in the hospital. Subsidizing healthcare to the households having elderly members and children is necessary to reduce CHE. Conclusion: Expanding health insurance coverage, increasing coverage limits, and inclusion of coverage for outpatient and preventive services are vital to protect households. Strengthening public primary health infrastructure and setting up a regulatory organization to establish policies and conduct regular audits to ensure that private hospitals do not increase hospitalizations and the duration of stay is necessary.
Highlights
Goal 3 of the United Nation’s Sustainable Development agenda has the specific goal to provide universal health coverage (UHC) to its population and to improve financial protection
In 2014, among the households which experienced catastrophic health expenditures (CHE), the mean positive overshoot indicates that on average, the OOP health expenditures was 35.94% higher, but the overshoot decreased to 34.08% in 2018
Our study showed that both in 2014 and 2018, a higher odds of incidence of CHE among the households with children, elderly people and those who used a private hospital for treatment
Summary
Goal 3 of the United Nation’s Sustainable Development agenda has the specific goal to provide universal health coverage (UHC) to its population and to improve financial protection. Resolution 58.33 of the World Health Assembly recommends that all WHO member states should provide UHC to their entire population and protect households from catastrophic health expenditures (CHE) (Obermann et al, 2018). Financial protection needed to a population depends on their dependence on OOP health expenditure for paying for healthcare (Xu et al, 2003). Using the logistic regression model, it was observed that the odds of incidence of CHE was higher among the households with at least one child aged less than 5 years, one elderly person, one secondary educated female member, and if at least one member in the household used a private healthcare facility for treatment. Strengthening public primary health infrastructure and setting up a regulatory organization to establish policies and conduct regular audits to ensure that private hospitals do not increase hospitalizations and the duration of stay is necessary
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