Does spending matters? Re-looking into various covariates associated with Out of Pocket Expenditure (OOPE) and catastrophic spending on accidental injury from NSSO 71st round data

Sanghamitra Pati,Sarit Kumar Rout,Jalandhar Pradhan,Rinshu Dwivedi

doi:10.1186/s13561-017-0177-z

Abstract

BackgroundAccidental Injury is a traumatic event which not only influences physical, psychological, and social wellbeing of the households but also exerts extensive financial burden on them. Despite the devastating economic burden of injuries, in India, there is limited data available on injury epidemiology. This paper aims to, first, examine the socio-economic differentials in Out of Pocket Expenditure (OOPE) on accidental injury; second, to look into the level of Catastrophic Health Expenditure (CHE) at different threshold levels; and last, to explore the adjusted effect of various socio-economic covariates on the level of CHE.MethodsData was extracted from the key indicators of social consumption in India: Health, National Sample Survey Organisation (NSSO), conducted by the Government of India during January–June-2014. Logistic regression analysis was employed to analyse the various covariates of OOPE and CHE associated to accidental injury.FindingsBinary Logistic analysis has demonstrated a significant association between socioeconomic status of the households and the level of OOPE and CHE on accidental injury care. People who used private health services incurred 16 times higher odds of CHE than those who availed public facilities. The result shows that if the person is covered via any type of insurance, the odd of CHE was lower by about 28% than the uninsured. Longer duration of stay and death due to accidental injury was positively associated with higher level of OOPE. Economic status, nature of healthcare facility availed and regional affiliation significantly influence the level of OOPE and CHE.ConclusionDespite numerous efforts by the Central and State governments to reduce the financial burden of healthcare, large number of households are still paying a significant amount from their own pockets. There are huge differentials in cost for the treatment among public and private healthcare providers for accidental injury. It is expected that the findings would provide insights into the prevailing magnitude of accidental injuries in India, the profile of the population affected, and the level of OOPE among households.

Highlights

Injuries1 are well acknowledged globally as a major cause of death and disability, and road traffic injuries (RTI)2 accounted for nearly more than 1 million deaths in 2015 [1,2,3]
Despite numerous efforts by the Central and State governments to reduce the financial burden of healthcare, large number of households are still paying a significant amount from their own pockets
Socio-demographic profile of the respondents with accidental injury Socio-economic and demographic characteristics of the persons with accidental injury7 (Table 1) indicates that about 48% belonged to the age group of 30– 59 years, 24% were in age group of 15–29, 16% were aged 60+ and 12% were in the age group of less than 15 years

Summary

Introduction

Injuries are well acknowledged globally as a major cause of death and disability, and road traffic injuries (RTI) accounted for nearly more than 1 million deaths in 2015 [1,2,3]. The burden is disproportionately in Low and Middle-Income Countries (LMICs) where more than 90% of the mortality occurs due to unintentional injuries, primarily due to Road Traffic Accidents (RTA)3 [7, 8]. Individuals who sustain injuries in LMICs are six times more likely to die than those in High-Income Countries (HICs), given the limited capabilities for trauma care in low-income settings [9]. The impoverishment of households in India due to OOPE and the catastrophic health expenditure (CHE) on health are well documented [16, 21, 22] and these are reported to be higher for injuries than for other ailments [17]. Few previous works on a tertiary hospital had identified that fundamental information on patient demographics, circumstances under which accidents occur; treatment costs and modalities were frequently not recorded [25]

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