Indian Households Research Articles

Multimorbidity, healthcare use and catastrophic health expenditure by households in India: a cross-section analysis of self-reported morbidity from national sample survey data 2017–18

BackgroundThe purpose of this research is to generate new evidence on the economic consequences of multimorbidity on households in terms of out-of-pocket (OOP) expenditures and their implications for catastrophic OOP expenditure.MethodsWe analyzed Social Consumption Health data from National Sample Survey Organization (NSSO) 75th round conducted in the year 2017–2018 in India. The sample included 1,13,823 households (64,552 rural and 49,271 urban) through a multistage stratified random sampling process. Prevalence of multimorbidity and related OOP expenditure were estimated. Using Coarsened Exact Matching (CEM) we estimated the mean OOP expenditure for individuals reporting multimorbidity and single morbidity for each episode of outpatient visits and hospital admission. We also estimated implications in terms of catastrophic OOP expenditure for households.ResultsResults suggest that outpatient OOP expenditure is invariably lower in the presence of multimorbidity as compared with single conditions of the selected Non-Communicable Diseases(NCDs) (overall, INR 720 [USD 11.3] for multimorbidity vs. INR 880 [USD 14.8] for single). In the case of hospitalization, the OOP expenditures were mostly higher for the same NCD conditions in the presence of multimorbidity as compared with single conditions, except for cancers and cardiovascular diseases. For cancers and cardiovascular, OOP expenditures in the presence of multimorbidity were lower by 39% and 14% respectively). Furthermore, around 46.7% (46.674—46.676) households reported incurring catastrophic spending (10% threshold) because of any NCD in the standalone disease scenario which rose to 63.3% (63.359–63.361) under the multimorbidity scenario. The catastrophic implications of cancer among individual diseases was the highest.ConclusionsMultimorbidity leads to high and catastrophic OOP payments by households and treatment of high expenditure diseases like cancers and cardiovascular are under-financed by households in the presence of competing multimorbidity conditions. Multimorbidity should be considered as an integrated treatment strategy under the existing financial risk protection measures (Ayushman Bharat) to reduce the burden of household OOP expenditure at the country level.

Quantifying the Magnitude and Composition of Out-of-Pocket Expenditure on Medicines in India2014 to 2017-18: A Repeated Cross-Sectional Analysis

Introduction: More than 60% of healthcare expenditure by households in India is paid as out-of-pocket expenditure and expenditure on medicines is the single largest component of these payments. Increasing longevity and rising incidence of chronic conditions is expected to further increase the utilization of medicines and aggravate the associated financial burden. Objectives: This paper quantifies the magnitude of out-of-pocket expenditure on medicines and changes there in, between 2014 and 2017-18. The paper looks at the expenditure across, states, types of providers and ailments. Method: Repeated cross-sectional analysis using two rounds of health surveys by National Sample Survey Organization has been used. Results: The mean out-of-pocket expenditure on medicines per episode fell from ₹ 4386 to ₹ 3857 for inpatient care and from ₹ 459 to ₹ 418, in constant prices, for outpatient care. Despite the decline in the magnitude of expenditure, its share in total out-of-pocket expenditure has remained high at 49%. The out-of-pocket expenditure on medicines for private provider was higher than that for public provider. Medication for cancer and tuberculosis have the highest expenditure and show an upward trend. A high percentage of people incur out-of-pocket expenditure on medicines for fever, respiratory and musculo-skeletal diseases. The percentage of people incurring expenditure on medication for cardio-vascular diseases and diabetes has increased. Conclusion: The mean out-of-pocket expenditure on medicines per episode has fallen, yet the expenditure remains high. People rely on utilization of medicines at private providers and pharmacies. Supply side and demand side policies needed to further reduce out-of-pocket expenditure on medicines.

Catastrophic health spending among older adults in India: Role of multiple deprivation

BackgroundPrevious studies have assessed catastrophic health spending (CHS) is high among households with older member, but no studies have examined its association with multiple deprivation. The purpose of this study is to compare the incidence and determinants of CHS between multiple deprived and non-deprived households in India. MethodsData for this paper was obtained from the 75th round of the National Sample Survey (NSS), a cross-sectional household survey conducted in 2017-18. The multiple deprivation index was estimated using Alkire and Foster method while CHS was estimated using the capacity to pay approach. Logistic regression analysis was used to identify the determinants of CHS in both types of households. ResultsThe study found 43% of households with an older member were deprived in multiple dimensions. We found the incidence of CHS was 19% among households with an older adults; 22% among multiple deprived and 16% among the multiple non-deprived older adult households. Regression analysis result suggest that the odds ratio of incurring CHS was 1.84 (p < 0.001) for the deprived older adult households than that of non-deprived households. Apart from multiple deprivation, any member being hospitalized or any member suffering from chronic diseases significantly associated with CHS in both type of households. ConclusionThis study established the higher financial catastrophes among the deprived older adult households. Therefore, there is an utmost need for the government and policymakers to focus on multiple aspects of geriatric wellbeing at one hand and improving financial mechanisms to reduce the CHS at other hand.

Low Cost Smart Ground System for Rainwater Harvesting for Indian Houses using IoT Technology

Water conservation is critical because it is one of the most significant factors for all species' survival. According to the Central Ground Water Board's estimates, underground water will be scarce in 15 Indian states by 2025 (Firstpost. Two-third of the world, much of India to face water scarcity, stress by 2025: Expert, 2018). However, as per the report from Ministry of Environment and Forest, only 10 to 20% rainwater is harvested. In urban areas, it is seen that nowadays concrete structures are constructed everywhere, so it is not possible to recharge the water table by natural process of raining. All the rainwater which is one of the sources for fresh water goes to drain. This causes the depletion of groundwater level which may be fatal in the future. Therefore, a rainwater harvesting system is required in Indian household to conserve water. On the other hand, the urban cities are having high pollutant levels which in turn affecting the quality of water. The government has defined certain parameters for quality checking of water. With the aid of the suitable sensors and IoT boards, quality checking, monitoring and water segregation can be easily achieved. In this work, an efficient and cost effective technique of rainwater harvesting has been presented. Some real case studies have been done at Indian houses in order to validate the effectiveness of system in terms of its implementation and cost analysis. As a result, the proposed system becomes one of the smart solutions to address the modern problem of rainwater harvesting with water quality management in low cost.

Financial access and household’s borrowing: Policy perspectives of an emerging economy

This paper analyzes access to finance based on the usage of financial services by Indian households. Based on two rounds of nationally representative All India Debt and Investment Survey (AIDIS) for 2002 and 2012, we examine how access to credit is associated with a household's socioeconomic and demographic characteristics using Heckman’s two-step approach procedure. Our results show that belonging to higher asset quintile groups has a statistically significant positive effect on the household's decision to take loans only from the formal sector in both rounds and significant negative effects on taking a loan only from the informal sector. Similarly, social and religious groups play a significant role in the decision of the household to take a loan. Households with more educated adults are more likely to take a loan. Households involved in regular wage-earning occupations in urban areas are more likely to take a loan from formal sources. Thus, the importance of policy placing greater emphasis on demand-side barriers rather than on improving the physical availability of formal financial services to promote financial inclusion in India.

Fifteen Years of India's NREGA: Employer of the Last Resort?

For the last decade, India’s National Rural Employment Guarantee Act (NREGA, 2005) has been the world’s largest public works programme. This legal entitlement provided employment to 28 per cent of rural Indian households in 2019–2020. After the COVID-19 pandemic, NREGA is increasingly emerging as an invaluable employer of the last resort. However, longitudinal data of implementation in its first fifteen years reveal distinctive trends. On the one hand, since inception, NREGA has rendered greater benefits to women and marginalised communities. But on the other, since 2014 till before the pandemic, the present National Democratic Alliance (NDA) regime has reduced NREGA coverage compared to its implementation during the previous United Progressive Alliance (UPA) coalition government which had enacted the legislation. Nevertheless, in light of the pandemic and based on international experiences in public work programmes, there is an urgent need for the expansion of the employment guarantee.

Impact of covid-19 on mediocre life-style and their psychology (Special emphasis on middle-class indian households)

India being the second most populated nation, observed the chronic outbreak of Novel Coronavirus as an instrumental factor for bringing about a major shift in the conduct of routine work and regular course of common life during the tragic year of 2020. The virus has given severe jolts to the economy, its distinct classes as well as its citizens alike, projecting far reaching effects across the country and disrupting the ordinary flow of the vital world. With special reference to the middle- class households in India, the purpose of this study is to highlight the impact of COVID-19 on the various facets of mediocre lifestyle including law and order, family and festivals, income and expenditure, mental and physical health, community welfare and social work, creativity and culture, citizen compliance and environmental concern etc. This research intends to provide a useful insight on how the virus is affecting the perspective of mediocre men under the exceptional circumstances of Pandemic and what are the surfacing pros and cons ascribed to the preventive measures like lock- down, quarantine and social distancing.

Antiviral perspectives of economically important Indian medicinal plants and spices

Human respiratory diseases caused by viral infections leads to morbidity. Among infectious diseases, viral infections associated with the respiratory tract remain the primary reason for global deaths due to their transmissibility. Since immemorial, traditional Indian medicinal plants, their extracts, and several phytochemicals can treat various diseases. Sources for this review paper are data derived from a peer-reviewed journal that emphasizes the economic importance of medicinal plants. Several plant-based medicines have been reported to be effective against multiple viral infections, including the Human Adenovirus, Enterovirus, Influenza virus, Hepatitis virus, etc. This review emphasizes use of the Indian medicinal plants like as Withania somnifera (Ashwagandha, Winter Cherry), Moringa oleifera (Drumstick), Ocimum tenuiflorum (Tulsi), Azadirachta indica (Neem), Curcuma longa (Turmeric), Terminalia chebula (Chebulic Myrobalan), Punica granatum (Pomegranate) and the Indian household spices (ginger, garlic and black pepper). It further describes their secondary phytoconstituents extraction procedure, mode of action and the potential application to improve clinical outcomes of neutraceuticals against various viral infections.

India consists of multiple food systems with scoioeconomic and environmental variations.

Agriculture in India accounts for 18% of greenhouse gas (GHG) emissions and uses significant land and water. Various socioeconomic factors and food subsidies influence diets in India. Indian food systems face the challenge of sustainably nourishing the 1.3 billion population. However, existing studies focus on a few food system components, and holistic analysis is still missing. We identify Indian food systems covering six food system components: food consumption, production, processing, policy, environmental footprints, and socioeconomic factors from the latest Indian household consumer expenditure survey. We identify 10 Indian food systems using k-means cluster analysis on 15 food system indicators belonging to the six components. Based on the major source of calorie intake, we classify the ten food systems into production-based (3), subsidy-based (3), and market-based (4) food systems. Home-produced and subsidized food contribute up to 2000 kcal/consumer unit (CU)/day and 1651 kcal/CU/day, respectively, in these food systems. The calorie intake of 2158 to 3530 kcal/CU/day in the food systems reveals issues of malnutrition in India. Environmental footprints are commensurate with calorie intake in the food systems. Embodied GHG, land footprint, and water footprint estimates range from 1.30 to 2.19 kg CO2eq/CU/day, 3.89 to 6.04 m2/CU/day, and 2.02 to 3.16 m3/CU/day, respectively. Our study provides a holistic understanding of Indian food systems for targeted nutritional interventions on household malnutrition in India while also protecting planetary health.

Multidimensional aspects of cooking fuel choices in Indian households

Multidimensional aspects of cooking fuel choices in Indian households

Are the Farmer Households Becoming Agricultural Labour Households in India? An Analysis of State-Wise SAS Data

Are the Farmer Households Becoming Agricultural Labour Households in India? An Analysis of State-Wise SAS Data

Covid-19 pandemic and food security in India: Can authorities alleviate the disproportionate burden on the disadvantaged?

The present study examines covariates of food security and the impact of Covid-19 induced shocks, among households in India using a nationally representative survey. Using a 2SLS panel regression model, we find an important role of incomes, relative food prices, household characteristics, as well as mobility restrictions in response to the rising number of infections in a given region in explaining varying food expenditure shares prior to and during the Covid-19 pandemic. The disproportionate burden of the pandemic induced lockdowns on the disadvantaged and minorities calls for effective action on the part of policymakers to boost aggregate demand, fix supply chains and reduce food price volatility.

Effect of Digital and Financial Awareness of Household Womens on the Use of Fin-Tech in India: Observing the Relation with (Utaut) Model

Era of COVID-19 resulted in contactless transactions and extensive use of technological applications. Similar was the case of Fin-Tech which has extensively been used by consumers all around the globe for making transactions and other financial and economic needs. Although there is a lack of research to reflect these forms of evidence from the developing as well as Indian sides of the globe. On the other side, some studies indicated the Unified Household Acceptance and Use of Technology (UTAUT) model as the base to prefer mobile methods of transaction and Fin-Tech use. Hence this paper has been developed systematically to relate the financial literacy of household females from Generation Y with the use of Fin-Tech during the eve of COVID-19. For devising this relationship research has been induced with the UTAUT model and data have been collected from married household females between twenty-four to thirty-five years of age. Results were analyzed through SMART-PLS which highlighted the financial literacy of Indian household females has a significant association with UTAUT model. However, the entire UTAUT model does not have a significant relationship with the use of Fin-Tech.

Climate Change and Household Debt in Rural India.

Climate change and indebtedness have been repeatedly highlighted as major causes of distress for rural households in India. However, despite the close connection between climate conditions and rural livelihoods, there has been little attempt to systematically examine the association between the two. To address this gap, we combine national-level longitudinal data from IHDS, MERRA-2, and the Indian Ministry of Agriculture to study the impact of climate anomalies on household indebtedness across rural India. Using a longitudinal approach that accounts for potential confounders at household, village, and district levels, we find pervasive effects of season-specific, five-year climate anomalies on multiple dimensions of household debt, particularly in arid and semi-arid areas. Most notably, temperature anomalies in the winter cropping season in arid and semi-arid areas are associated with increasing household indebtedness. We further find that climate change interacts with existing socioeconomic differences-caste and landholding in particular-to deepen both the size and the depth of indebtedness for rural households.

The effect of the Mahatma Gandhi National Rural Employment Guarantee Act on the size of outstanding debts in rural India

ABSTRACT MGNREGA was introduced in India in 2005 with the aim to improve the livelihood of rural Indian households. In 2012-13, around 156 million rural Indian households had an outstanding personal debt; 85% of the amount of credit being disbursed was given to those households in the bottom income decile for ‘non-business’ related purposes. This paper uses nationally representative household data from the NSS EUS collected in 2004-05 and 2009-10 to look at the impact MGNREGA has had on the rural households’ ability to repay outstanding debt. Results suggests that MGNREGA reduced the size of the outstanding debts for vulnerable households.

Modeling the Indian households' intention to adopt the solar net metering system

PurposeThe present study aims to develop and offer a model to evaluate the customers' attitude and intention to adopt solar net metering systems (commonly called solar NMS) in a developing economy. Therefore, the research examines different factors affecting the Indian households' attitudes and intention to adopt solar NMS.Design/methodology/approachThe data were collected from 247 solar NMS users from India. The structural equation modeling (SEM) technique was applied using SmartPLS 3.3.2 software to analyze the impact of various factors on their adoption intention. The conceptual model comprises environmental concern, perceived ease of use (PEOU), subjective norms, perceived usefulness (PU), attitude and behavioral intention to adopt solar NMS.FindingsSubjective norms and environmental concerns significantly influence the PU and PEOU of solar NMS. Also, PU and PEOU significantly influence their attitude and intentions toward adopting solar NMS. Thus, the perceived social pressure and environmental concern affect their perception of solar NMS's usefulness and ease of use, leading to favorable attitudes and adoption intentions. Additionally, the solar NMS benefits the customers, society and the environment by enhancing environmental quality, compatibility with the modern lifestyle, and reducing dependency on the power grid and electricity bills. These benefits shape the customers' overall perception and increase the adoption of solar technologies.Originality/valueThe present research helps bridge the gaps in the existing literature by identifying (1) factors affecting customers' intention toward solar technologies in developing nations and (2) describing the significant prediction of environmental concern and subjective norms to increase solar technologies adoption.

Barefoot Slip Risk in Indian Bathrooms: A Pilot Study

Barefoot slips and falls are commonly reported in bathrooms in Indian households and apartments. Due to lack of awareness on how to prevent such incidents, they are often neglected, and may lead to recurrent and severe traumatic injuries. To date, there is no way to assess the barefoot slip risk of the bathroom flooring tiles under realistic contaminated conditions such as with water and shampoo. In this work, a novel human heel surrogate was developed for barefoot slip testing, to address this gap. This surrogate was tuned to precisely mimic the frictional and biomechanical properties of the human heel, through three-dimensional (3D) scanning and printing. A mechanical slip testing device was employed with the heel surrogate to test 15 different bathroom floorings in residential apartments in dry and slippery conditions (i.e., wet and with shampoo spill). The barefoot available coefficient of friction (ACOF) was determined for the different floor conditions and tested for repeatability with two modeled heel surrogate samples. Also, the correlation of ACOF with surface roughness and between floorings was studied, across contaminant conditions. High repeatability (r 2 > 0.92) was confirmed in the dry condition, and the ACOF values decreased significantly when going from dry to wet and wet to shampoo spill conditions. The correlation of ACOF with surface roughness was found to be high (r 2 = 0.72), medium (r 2 = 0.62), and low (r 2 = 0.38) for the dry, wet, and shampoo spill conditions, respectively. Across contaminant conditions, several tiles exhibited high correlations in ACOF due to shampoo spills, indicating generalizability of barefoot slip risk. The findings of low barefoot frictional resistance on Indian bathroom floorings in wet and shampoo spill conditions, lack of correlations with surface roughness, and high generalizability of slip risk across floorings in the shampoo spill condition have not been reported to date, and shed light on the significant barefoot slip risks.

The gendered effects of droughts: Production shocks and labor response in agriculture

Climate change has increased rainfall uncertainty, leading to greater production risks in agriculture. We examine the gender-differentiated labor impacts of droughts using unique individual-level panel data for agricultural households in India over half a decade. Accounting for unobserved heterogeneity across individuals, we find that women’s workdays are 19% lower than men’s when a drought occurs, driven by the former’s lack of diversification to the non-farm sector. Women are less likely to work outside their village and migrate relative to men in response to droughts and are consequently unable to cope fully with the adverse agricultural productivity shock. We find suggestive evidence in support of social costs emanating from gender norms that constrain women’s access to non-farm work opportunities. The results highlight the gendered impact of climate shocks, potentially exacerbating extant gender gaps in the labor market.

Income, urbanisation and consumption of processed foods: Implications for nutrition and health policies for India

AbstractIndia has witnessed a rapid rise in personal income, increased spending on infrastructure and construction and urbanisation in the past three decades. Households have changed their eating habits by purchasing more processed food. This study examines the factors affecting India's consumption of and expenditures on processed foods. The study uses information from three rounds of data collected by the National Sample Survey Organisation (NSSO) and probit and selection bias‐controlled tobit and ordinary least square (OLS) estimation procedures to estimate the empirical model. Findings reveal that the average expected per capita monthly spending on processed foods increased by about 77% between 1990–1991 and 2011–2012. An increase in total consumption expenditure and rapid urbanisation were the primary drivers of consumption and spending on processed foods by Indian households. Secondly, households with salaried or stable incomes were more likely to consume processed foods than other households. This study suggests public and private initiatives to improve human health and nutritional outcomes in Indian households. The government should strengthen food safety regulations related to processed food preparation, distribution and consumption.

"Role of Information in Shaping Energy Efficiency Attitude: Case of Indian Urban Households"

With the recent announcement by the Indian Government to replace energy meters with smart meters, the study attempts to assess if the information provided by the smart meters to residential urban Indian energy consumers nudge them towards being energy efficient. For this purpose, we assess two types of information. First, innovative billing is provided by smart energy meters which provide information regarding consumers’ ‘own’ energy consumption and energy consumption by neighbors. Second, the information is provided through awareness programs by the government. By surveying 1751 urban Indian households and analyzing the data using two factorial ANOVA, the study finds that consumption-related information feedback through smart devices shall favorably shape the attitude towards energy efficiency. The paper also looks into the impact of various factors that affect the energy efficiency attitude of urban Indian households. The study has implications not only for the government but also for the marketers of smart meters.