Incidence, Inequality and Determinants of Catastrophic Health Expenditure in India

Abstract

This study tries to estimate the incidence, intensity and inequality of Catastrophic Health Expenditure in India and its determinants using unit-level data from the four consecutive surveys of NSSO on ‘Healthcare Consumption and Morbidity’ spread across a 23-year period. For CHE incidence, a 10% threshold level of household consumption expenditure is considered. Additionally, socio-economic determinants of CHE were identified using multivariate logistic regression. Study reveals that the demand for healthcare services has increased gradually during the period 1995–2014 but this demand is primarily financed from out-of-pocket expenditures and hence leading to an increased risk of financial catastrophe, peaking at 23.45% in 2014. But a significant reduction in demand for healthcare is seen in the latest 75th round. Although the incidence of catastrophe has decreased, the inequality of catastrophic burden has increased. The results show that economic and social vulnerability have a significant impact on the likelihood of CHE incidence in households. The findings suggest that a targeted approach is required to alleviate the socially and economically vulnerable households from health expenditure catastrophe.