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Disease-Specific Out-of-Pocket Payments, Catastrophic Health Expenditure and Impoverishment Effects in India: An Analysis of National Health Survey Data

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A Letter to the Editor to this article was published on 27 April 2021

Abstract

Background

In India, more than two-thirds of the total health expenditure is incurred through out-of-pocket expenditure (OOPE) by households. Morbidity events thus impose excessive financial risk on households. The Sustainable Development Goals Target 3.8 specifies financial risk protection for achieving universal health coverage (UHC) in developing countries. This study aimed to estimate the impact of OOPE on catastrophic health expenditure (CHE) and impoverishment effects by types of morbidity in India.

Methods

Data came from the 75th round of the National Sample Survey (NSS) on the theme ‘Social consumption in India: Health’, which was conducted during the period from July 2017 to June 2018. For the present study, 56,722 households for hospitalisation, 29,580 households for outpatient department (OPD) care and 6285 households for both (OPD care and hospitalisation) were analysed. Indices, namely health care burden, CHE, poverty head count ratio and poverty gap ratio using standard definitions were analysed.

Results

Households with members who underwent treatment for cancers, cardiovascular diseases, psychiatric conditions, injuries, musculoskeletal and genitourinary conditions spent a relatively high amount of their income on health care. Overall, 41.4% of the households spent > 10% of the total household consumption expenditure (HCE) and 24.6% of households spent > 20% of HCE for hospitalisation. A total of 20.4% and 10.0% of households faced CHE for hospitalisation based on the average per capita and average two capita consumption expenditure, respectively. Health care burden, CHE and impoverishment was higher in households who sought treatment in private health facilities than in public health facilities.

Conclusion

Our study suggests that there is an urgent need for political players and policymakers to design health system financing policies and strict implementation that will provide financial risk protection to households in India.

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Author information

Authors and Affiliations

  1. ICMR-National Institute of Medical Statistics, Ansari Nagar, New Delhi, 110029, India

    Jeetendra Yadav & Geetha R. Menon

  2. Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Ernakulam, Kerala, 682041, India

    Denny John

Authors
  1. Jeetendra Yadav
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  2. Geetha R. Menon
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  3. Denny John
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Corresponding author

Correspondence to Denny John.

Ethics declarations

Ethics statement

The present study utilised household-level data from current NSS 75th round survey on the theme ‘Social consumption in India: Health’. The NSS is a countrywide large-scale population-based survey organisation under the Ministry of Statistics and Programme Implementation (MoSPI), Government of India. The NSS obtained ethical consensus from the review committee of the project while in the second stage, consent was taken from the respondents and duly undersigned, and only once he/she had agreed to participate in the study was any data collected. This study utilised secondary data that is accessible in the public domain and this dataset does not include any personal information of respondents.

Conflict of interest

None declared.

Consent

The study results presented here do not involve human subject research, hence consent was not required.

Funding

Our study did not use any funding for conducting data acquisition and analysis.

Data availability statement

Our study utilised the NSS 75th round survey data, which is publicly accessible to individuals both countrywide and worldwide on http://www.mospi.gov.in/.

Author Contributions

JY conceived the idea for the study and developed the analysis plan. JY led the analysis and organised the first draft of manuscript. JY, DJ and GRM conducted data interpretation and manuscript writing. GRM, DJ and JY read and approved the preliminary manuscript. All authors approved the final version of the manuscript.

Acknowledgements

The author acknowledges the National Sample Survey Organisation (SSSO), MOSPI, India, for data collection and providing data for analysis.

Supplementary Information

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Supplementary file1 (DOCX 53 KB)

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Yadav, J., Menon, G.R. & John, D. Disease-Specific Out-of-Pocket Payments, Catastrophic Health Expenditure and Impoverishment Effects in India: An Analysis of National Health Survey Data. Appl Health Econ Health Policy 19, 769–782 (2021). https://doi.org/10.1007/s40258-021-00641-9

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