Catastrophic out-of-pocket payment for health care and its impact on households: Experience from West Bengal, India
Swadhin MondalBarun KanjilalHenry Lucas
iHEA Conference Toronto 2011
IIHMR
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• Population around 81 million.
• Highest population density of any state in India: 904 persons per square km.
• Almost 25% 0f population living below poverty line.
Study Area: West Bengal
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Context
• The government has substantially increased the health sector budget, but due to inequities in resource allocation this has not substantially improved access to quality services for the poor.
• Out-of-pocket (OOP) payment is the major health financing mechanism (~80%).
• OOP often places a huge financial burden on poorer households
• Financial protection mechanisms, especially for poor rural households, are few and very limited.
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• Primary data collected from three districts
• Covered 3,152 households comprising 15,206 individuals
• Data collected related to: • Inpatient care
• Outpatient care
• Delivery
• Chronic illnesses.
Household Survey
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Health expenditure as a percentage of total household expenditure by various category of treatment (rural and urban)
11.55
4.035.73
3.96
9.21
2.454.14 4.69
10.81
3.495.16
4.15
0
2
4
6
8
10
12
14
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Rural Urban All
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Percentage of households facing catastrophic health expenditure (>40% of non-food expenditure.)
10.19
11.32
6.55
0
2
4
6
8
10
12
All Rural Urban
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Significant determinants of catastrophic health expenditure (>40% non-food expenditure)
• Chronic illness (odds ratio 3.0)
• Inpatient care (odds ratio 1.3)
• Other household characteristics: Number of dependents (aged and
children) (odds ratio 1.4) Rural location (odds ratio 2.1)
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Vulnerability indicator• Removed children from education
• Reduced food consumption
• Postponed daughter’s marriage
• Stopped medical treatment of other member
• Reduced social obligations / functions
• Stopped purchase of consumer durables
• Stopped purchase or expansion of house
• Reduced household savings
• Borrowed with interest
• Borrowed without interest
• Sold property
• Mortgaged property
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Findings
• Catastrophic expenditure associated with outpatient visits was associated with a much greater impact on vulnerability index than catastrophic expenditure associated with inpatient care
• This is partly a consequence of the fact that outpatient catastrophic expenditure tended to be associated with poorer households.
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Discussion
• Healthcare expenditure for chronic illness was the most important determinant of catastrophic expenditure – substantially ahead of hospitalization.
• Expenditure on chronic illness acts as a cumulative burden that gradually drives households into poverty.
• Catastrophic heath expenditure on minor illnesses, strongly associated with poorer households, had the greatest impact on economic status.
• High healthcare expenditure for the poor often resulted in substantial reductions in consumption expenditures on food, education, and social activities.