Analysing Catastrophic Oop Health Expenditure in India: Concepts, Determinants and Policy Implications

Pal, Rama

doi:10.2139/ssrn.1514165

Cited by 16 publications

(13 citation statements)

References 15 publications

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“…36,39 Pal analyzed the data of 61 st round of National Sample Survey and showed that socially deprived classes, household size, number of children and elderly persons in house increased the probability of catastrophic spending while education level of primary and above had significant negative impact on this probability, in rural sectors. 40 The present study did not found any significant difference in probability of CHE with these factors, however, presence of an underfive member and one/more events of delivery/ miscarriage/abortion were found to have significantly increased the probability of incurring CHE. The negative value of concentration index and MDK indicated that probability of incurring CHE was disproportionately concentrated among the poor and the financing system was degressive.…”

Section: Discussioncontrasting

confidence: 81%

Exploring the determinants of catastrophic health expenditure and socioeconomic horizontal equity in relation to it: a rural community based longitudinal study in West Bengal

Paul

Malick

Mondal

et al. 2018

Int J Community Med Public Health

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Background:Equity in health care is defined as equal access to available care for equal need. Out-of-pocket expenditures are the most inequitable means of health care financing. These payments become catastrophic health expenditure (CHE) if it exceeds the household’s ‘Capacity to Pay’. As fairness is one of the fundamental objectives of the health system, identification of the factors responsible for these expenditures is important. Hence this study was conducted to find out the determinants of CHE and to explore the socioeconomic horizontal equity in relation to it. Methods:Total 352 households from 9 villages of Amdanga block, North 24 Parganas, were studied for 12 months. Annual out-of-pocket healthcare expenditure exceeding 40% of annual household non-food expenditure was classified as CHE and determinants of the same were identified using logit-model. Equity was measured by Concentration index and modified Kakwani measure (MDK). Results:Overall prevalence of CHE was 20.7% and highest (39.3%) in the second income quintile. The odds of incurring CHE were highest (35.43) for the households with member/s requiring inpatient treatment followed by households having more than five members (12.81). Negative value of concentration index and MDK indicated that the probability of incurring CHE was disproportionately concentrated among the poor and the financing system was degressive, however some amount of equity was noted in the poorest quintile. Conclusions:Apart from the poorest section in the community the poorer and middle income sections are still exposed to healthcare expenditure shocks and the health care spending was diverse and less equitable.

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Section: Discussioncontrasting

confidence: 81%

Exploring the determinants of catastrophic health expenditure and socioeconomic horizontal equity in relation to it: a rural community based longitudinal study in West Bengal

Paul

Malick

Mondal

et al. 2018

Int J Community Med Public Health

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“…more number of employees. This result is consistent with the studies conducted by (Pal, 2012;Hajizadeh and Nghiem, 2011;Mondal, 2010). One of the innovations of the present study (which is not observed in previous studies) was to consider the development index of the province of the place of residence of households in terms of access to healthcare providers as a factor affecting the probability of facing CHE.…”

Section: Introductionsupporting

confidence: 93%

The impact of government subsidy programs on equity in health financing

Dizaj

Mosadeghrad

Kazemi

2020

Preprint

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Background: Iran government launched the targeted subsidy plan (TSP) in December 2011 to reduce inequality and poverty. In addition, Health Transformation Plan (HTP) was implemented in ministry of health to reduce people out of pocket payment. This study aimed to examine the impact of these two government subsidy programs on equity in health financing. Method: In this longitudinal study, data on 413,201 households were collected using household surveys during 11 years (2007-2017). The Fairness in Financial Contribution (FFCI) index and Catastrophic Health Expenditures (CHE) index were calculated.Also Logistic regression model was performed by the applied software of Stata V.14 to examine the effects of TSP and HTP policies and other socioeconomic characteristics of households on their exposure to CHE.Results: The FFC index was 0.829 and 0.830 respectively in 2007 and 2017. The trend analysis did not show significant changes in FFC index between 2007 and 2017. TSP and HTP implementation die not reduce households’ exposure to CHE significantly. Crowded households with more elder people, belonging to low income deciles, without houses, living in rural areas and deprived provinces, are more likely to be at risk of CHE. Health insurance coverage did not protect households from CHE. High educated and employed households were exposed to less CHE.Conclusion: The government subsidy programs have not been effective in improving FFC and reducing CHE indices. None of them has been able to realize the goal of the 6th National Development Plan of reducing CHE to 1%. The government should devise support packages for target household (households with more elderly people, lower incomes, without private house, crowded, rural and inhabited in deprived provinces), so they can protect households against CHE. Modifying and improving the quality of insurance coverage is strongly recommended due to its inefficiency.

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“…Thus, only around 15% of all health expenditure in the country is borne by the state, and rest 85% comes as “out-of-pocket payment” by the people. This makes the Indian public health system grossly inadequate and under-funded[ 18 19 20 ] Moreover, only about 5.5% of the Indian population has some form of medical insurance. [ 18 ] Virtually all of the families from poor rural areas lack any form of healthcare insurance.…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic rehabilitation of successful renal transplant patients and impact of funding source: Indian scenario

Kapoor¹,

Sharma²,

Srivastava³

et al. 2015

Indian J Urol

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Introduction:Socio-economic rehabilitation is an important outcome parameter in successful renal transplant recipients, particularly in developing countries with low income patients who often depend on extraneous sources to fund their surgery costs. We studied the socioeconomic rehabilitation and changes in socioeconomic status (SES) of successful renal allograft recipients among Indian patients and its correlation with their source of funding for the surgery.Materials and Method:A cross-sectional, questionnaire-based study was conducted on 183 patients between January 2010 to January 2013. Patients with follow up of at least 1 year after successful renal transplant were included. During interview, two questionnaires were administered, one related to the SES including source of funding before transplantation and another one relating to the same at time of interview. Changes in SES were categorized as improvement, stable and deterioration if post-transplant SES score increased >5%, increased or decreased by <5% and decreased >5% of pre-transplant value, respectively.Results:In this cohort, 97 (52.7%), 67 (36.4%) and 19 (10.3%) patients were non-funded (self-funded), one-time funded and continuous funded, respectively. Fifty-six (30.4%) recipients had improvement in SES, whereas 89 (48.4%) and 38 (20.7%) recipients had deterioration and stable SES. Improvement in SES was seen in 68% patients with continuous funding support whereas, in only 36% and 12% patients with non-funded and onetime funding support (P = 0.001) respectively. Significant correlation was found (R = 0.715) between baseline socioeconomic strata and changes in SES after transplant. 70% of the patients with upper and upper middle class status had improving SES. Patients with middle class, lower middle and lower class had deterioration of SES after transplant in 47.4%, 79.6% and 66.7% patients, respectively.Conclusions:Most of the recipients from middle and lower social strata, which included more than 65% of our patient's population, had deteriorating SES even after a successful transplant. One-time funding source for transplant had significant negative impact on SES and rehabilitation.

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Analysing Catastrophic Oop Health Expenditure in India: Concepts, Determinants and Policy Implications

Abstract: The present paper attempts to modify definition of catastrophic out-of-pocket

Cited by 16 publications

References 15 publications

Exploring the determinants of catastrophic health expenditure and socioeconomic horizontal equity in relation to it: a rural community based longitudinal study in West Bengal

Exploring the determinants of catastrophic health expenditure and socioeconomic horizontal equity in relation to it: a rural community based longitudinal study in West Bengal

The impact of government subsidy programs on equity in health financing

Socioeconomic rehabilitation of successful renal transplant patients and impact of funding source: Indian scenario

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