This study has tried to compare the earning and non-earning aspects of migrant workers from West Bengal engaged in different types of work in Karnataka and Kerala based on survey of 111 Bengali-speaking migrant workers and a number of in-depth interviews and FGDs. The study has found that most of the migrant workers landed in south India only after working in Kolkata, northern or western Indian cities. Lack of regular employment opportunities and low-wage rate in rural as well as urban West Bengal are the dominant reasons for their migration. Hostile social environment and increasing earning uncertainties in northern and western Indian cities along with higher-wage rate in south India are reasons for the migrant workers shifting to south India. On an average, they earn Rs. 1.7 lakhs annually and are able to send almost two-thirds of their earnings as remittances. Except the rag pickers in Bengaluru, all other migrant workers live without their families at destination locations. The living conditions of the migrant workers, especially the rag pickers, are poor. Continuous inflow of migrant workers from eastern and north-eastern India is now a challenge for the incumbent Bengali migrant workers in south India; however, majority of them are not willing to return to West Bengal in future. The pandemic and successive rounds of lockdown in destination and home states have unsettled their lives. Not only their income has fallen, getting job and movement across different destination locations has become uncertain too. They have now hardly any resource to cope up with this continuing uncertainty.

Background Medical care related catastrophe is generally identified by healthcare expenses crossing a certain percentage of household’s resources (Wagstaff and van Doorslaer, 2003). This paper attempts to examine medical care related ‘catastrophe’ by going beyond the threshold-oriented approach of catastrophic medical expenditure and include multiple indicators which seeks to explore the catastrophe from a multidimensional perspective. Methods Drawing from multidimensional vulnerability to poverty approach (Alkire and Forster, 2008), we provide a measure which incorporates multiple indicators that might put households in medical care related catastrophic situation. Our study uses data from a cross-sectional household survey conducted by the Society for Health and Demographic Surveillance (SHDS) of the Government of West Bengal in 2012. Using negative binomial and logistic regression, the study also attempts to find the correlates of healthcare utilization, incurring catastrophic health expenditure for both 10 per cent of household consumption expenditure and 40 per cent of non-food expenditure as well as resorting to distress financing and availing low quality/ no care despite chronic illness. Results Estimates show that illness, presence of elderly members, hospitalization and outpatient visits increases the risk of incurring catastrophic health expenditure and healthcare utilization counts. In addition, households belonging to backward socio-religious categories and having members engaged as casual labourers face higher odds of distressed financing and availing informal/ no healthcare. In contrast to Wagstaff and van Doorslaer’s measure of catastrophic medical expenses, the multidimensional measure shows a lower medical care catastrophe for the upper economic classes and forward caste groups and vice versa which is more realistic and convincing. Conclusions The evidence generated from the multidimensional analysis presents a more convincing and reliable picture of vulnerability imparted due to health shocks as compared to identifying households with catastrophic medical expenditure by Wagstaff and van Doorslaer’s method. However, this study has its limitations as it has given equal weightage to all the dimensions and restricted itself to headcount measures. However, extension and refinement of this approach can provide more insightful findings.