Exposure to Hardship Financing for Healthcare among Rural Poor in Chhattisgarh, India

Abstract

Background: This article examines the exposure of hardship financing in a cross-section of households in four blocks of Rajnandgaon district in Chhattisgarh state, India. We define hardship financing as having to borrow money with interest or to sell assets to pay out-of-pocket healthcare costs. Methods: We used survey data of 4,600 low-income rural households using a three-stage cluster sampling procedure. In first stage, blocks were selected purposively, the second stage involved selection of villages using probability proportional to size (PPS) sampling and lastly, households were randomly selected. Binary logistics regression analysis was used to identify the determinants of exposure to hardship financing related to out-of-pocket expenses for healthcare. Results: About 14.9 per cent of the total households were exposed to hardship financing. Hardship financing occurs not only for hospitalization (nearly 10 per cent) but also for outpatient care (7.91 per cent) and maternity (around 10 per cent). Our logistics regression revealed that health expenditure in the last year was positively associated with the risk for hardship financing. Other correlates of hardship financing included education-level of the head of the household, in-house toilet facility and place of residence/blocks. Conclusion: Rural households, especially the poorer households, spend higher average healthcare payments and are exposed to hardship financing on health.