Incidence, Inequality and Determinants of Catastrophic Health Expenditure in India

Abstract

This study tries to estimate the incidence, intensity and inequality of Catastrophic Health Expenditure in India and its determinants using unit-level data from the four consecutive surveys of NSSO on ‘Healthcare Consumption and Morbidity’ spread across a 23-year period. For CHE incidence, a 10% threshold level of household consumption expenditure is considered. Additionally, socio-economic determinants of CHE were identified using multivariate logistic regression. Study reveals that the demand for healthcare services has increased gradually during the period 1995–2014 but this demand is primarily financed from out-of-pocket expenditures and hence leading to an increased risk of financial catastrophe, peaking at 23.45% in 2014. But a significant reduction in demand for healthcare is seen in the latest 75th round. Although the incidence of catastrophe has decreased, the inequality of catastrophic burden has increased. The results show that economic and social vulnerability have a significant impact on the likelihood of CHE incidence in households. The findings suggest that a targeted approach is required to alleviate the socially and economically vulnerable households from health expenditure catastrophe.

Decomposing the inequalities in the catastrophic health expenditures on the hospitalization in India: empirical evidence from national sample survey data

“…Furthermore, evidence on hospitalization from countries such as Argentina, China, India, and Tanzania also revealed the disproportionate impact of CHE on the poor (21). Although there is some literature on the impact of socioeconomic inequalities on the incidence of catastrophic payments in the Indian context (22)(23)(24), the evidence is rather exiguous and does not commensurate with the policy implications.…”

Disparities in catastrophic health expenditure for hospitalization in Urban Kerala, India: Evidence from 75th round of the National Sample Survey

“…While the country has seen a decrease in CHE over the past decade, there has been a simultaneous rise in associated inequality (Mohanty & Dwivedi, 2021). A recent study by Gaddam and Rao (2023) revealed that despite a decline in catastrophic events, there has been a noticeable upsurge in the unequal distribution of the burdens these events impose on affected populations. As we move closer to universal healthcare, defining a fair financial contribution for healthcare service users is a key policy challenge (Moradi et al, 2018).…”