Distressed financing of household out-of-pocket health care payments in India: incidence and correlates

Abstract

Out-of-pocket (OOP) health care payments financed through borrowings or sale of household assets are referred to as distressed health care financing. This article expands this concept (to include contributions from friends or relatives) and examines the incidence and correlates of distressed health care financing in India. The analysis finds a decisive influence of distressed financing in India as over 60 and 40% of hospitalization cases from rural and urban areas, respectively, report use of such coping strategies. Altogether, sources such as borrowings, sale of household assets and contributions from friends and relatives account for 58 and 42% share in total OOP payments for inpatient care in rural and urban India, respectively. Further, the results show significant socioeconomic gradient in the distribution of distressed financing with huge disadvantages for marginalized sections, particularly females, elderly and backward social groups. Multivariate logistic regression informs that households are at an elevated risk of indebtedness while seeking treatment for non-communicable diseases, particularly cancer. Evidence based on intersectional framework reveals that, despite similar socioeconomic background, males are more likely to use borrowings for health care financing than females. In conclusion, the need for social protection policies and improved health care coverage is emphasized to curtail the incidence of distressed health care financing in India.

How great is the medical burden of disease on the aged? Research based on “System of Health Account 2011”

“…Many countries are trying to control the ever-increasing of public financing that make the OOP unceasingly increase. Rural and urban area’s patients in India have poverty health care financing are 40% and 60% respectively [27]. The Portuguese scholars believed that the huge medical expenses were in urgent need to cut down that used to risk resistance in elderly people cannot afford [28].…”

Economic burden of cancer in India: Evidence from cross-sectional nationally representative household survey, 2014

“…The survey elicits information regarding the major source of financing to capture whether bulk of the out of pocket expenditure was incurred via distressed means or not. The component such as borrowings (with or without interest), contribution from friends and relatives (with or without repaying option) and sale of assets is combined defined as distressed financing [27, 46]. …”

“…36,812 for the entire cancer therapy excluding non-medical costs [24]. It is also noted that out of pocket (OOP) expenditure on cancer hospitalization is about 2.5 times of overall average hospitalization expenditure [27]. While catastrophic expenditure on cancer inpatient treatment is highest among all NCDs, poor health financing mechanisms and heavy reliance on out-of-pocket healthcare payments compels several cancer patients to resort to distressed means for treatment financing [28–30].…”

“…While catastrophic expenditure on cancer inpatient treatment is highest among all NCDs, poor health financing mechanisms and heavy reliance on out-of-pocket healthcare payments compels several cancer patients to resort to distressed means for treatment financing [28–30]. In fact, previous studies on India suggest that about 60 and 32 percent households resort to borrowings and contributions (from friends and relatives) respectively for cancer hospitalization [27]. …”

Out-of-Pocket Spending on Out-Patient Care in India: Assessment and Options Based on Results from a District Level Survey

“…For example, using the 60 th health round of the NSS, researchers find that outpatient care is more impoverishing than inpatient care in urban and rural areas alike [2]. Another study shows that OOP payments on outpatient visits are mostly met through own income and savings raising the issue of ability-to-pay as a determinant of health-seeking behaviour for OPD [5]. Yet another study [6] showed that 3.5 percent of the population fell below the poverty line on account of OOPS, but this fell to 0.5 percent if OOP payments on outpatient care are excluded, with implications about the need for comprehensive coverage schemes that should include drugs or outpatient care in general.…”