Catastrophic health expenditure and health facility access among rural informal sector families

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BackgroundThe extension of industrialization in rural India during previous decade has opened wide employment opportunities. As a result, the per-capita income and expenditure capability of these individuals and their families have raised. However informal sectors in rural areas, particularly with restricted public health care facilities and lack of social security scheme coverage, out-of-pocket (OOP) health expenditure could result in catastrophic health expenditure (CHE). AimTo study the relation of sociodemographic and occupational factors with CHE among rural informal sector families. Methodology: All 13 villages of Gangad (Gujarat state, India) primary health care catchment area was cross sectionally investigated. After informed written consent, data regarding sociodemographic profile, total health expenditure and health facility access were collected from 429 representative households through pre-tested semi-structured questionnaire. The sample was categorized based on the major source of income (occupation). SPSS software was used to execute the statistical analysis. ResultsAbout 61.8% families accessed government health facilities. While 71% of families were from lower-middle and lower socioeconomic class experiencing the brunt of CHE (i.e. 57.9% of families in this sociodemographic group experienced CHE). The proportion of CHEs among families accessing public health care facilities had substantially lower (13.2%); whereas higher proportion of CHEs were reported among families of factory workers (45.5%) and agricultural labor (25.5%). ConclusionIn the interest of reducing the OOP health expenditure (thereby reducing the incidence of CHE) and sustainable growth, the vulnerable informal sector is recommended to be adequately protected under social security schemes by either government or employer.