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Catastrohpic out-of-pocket payment for health care and its impact on households: Experience from West Bengal, India
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Catastrohpic out-of-pocket payment for health care and its impact on households: Experience from West Bengal, India

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Henry Lucas presents briefly on findings from a study on catastrophic out-of-pocket payments for health care in West Bengal, India at the 2011 iHEA conference in Toronto, Canada.

Henry Lucas presents briefly on findings from a study on catastrophic out-of-pocket payments for health care in West Bengal, India at the 2011 iHEA conference in Toronto, Canada.


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  • 1. IIHMR
    Catastrophic out-of-pocket payment for health care and its impact on households: Experience from West Bengal, India
    Swadhin Mondal
    Barun Kanjilal
    Henry Lucas
    iHEA Conference Toronto 2011
  • 2. 2
    • Population around 81 million.
    • 3. Highest population density of any state in India: 904 persons per square km.
    • 4. Almost 25% 0f population living below poverty line.
    Study Area: West Bengal
  • 5. 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.
    • 6. Out-of-pocket (OOP) payment is the major health financing mechanism (~80%).
    • 7. OOP often places a huge financial burden on poorer households
    • 8. Financial protection mechanisms, especially for poor rural households, are few and very limited.
    3
  • 9. 4
    • Primary data collected from three districts
    • 10. Covered 3,152 households comprising 15,206 individuals
    • 11. Data collected related to:
    • 12. Inpatient care
    • 13. Outpatient care
    • 14. Delivery
    • 15. Chronic illnesses.
    Household Survey
  • 16. 5
    Health expenditure as a percentage of total household expenditure by various category of treatment (rural and urban)
  • 17. 6
    Percentage of households facing catastrophic health expenditure (>40% of non-food expenditure.)
  • 18. Significant determinants of catastrophic health expenditure (>40% non-food expenditure)
    • Chronic illness (odds ratio 3.0)
    • 19. Inpatient care (odds ratio 1.3)
    • 20. Other household characteristics:
    • 21. Number of dependents (aged and children) (odds ratio 1.4)
    • 22. Rural location (odds ratio 2.1)
    7
  • 23. Vulnerability indicator
    • Removed children from education
    • 24. Reduced food consumption
    • 25. Postponed daughter’s marriage
    • 26. Stopped medical treatment of other member
    • 27. Reduced social obligations / functions
    • 28. Stopped purchase of consumer durables
    • 29. Stopped purchase or expansion of house
    • 30. Reduced household savings
    • 31. Borrowed with interest
    • 32. Borrowed without interest
    • 33. Sold property
    • 34. Mortgaged property
    8
  • 35. Findings
    • Catastrophic expenditure associated with outpatient visits was associated with a much greater impact on vulnerability index than catastrophic expenditure associated with inpatient care
    • 36. This is partly a consequence of the fact that outpatient catastrophic expenditure tended to be associated with poorer households.
    9
  • 37. Discussion
    • Healthcare expenditure for chronic illness was the most important determinant of catastrophic expenditure – substantially ahead of hospitalization.
    • 38. Expenditure on chronic illness acts as a cumulative burden that gradually drives households into poverty.
    • 39. Catastrophic heath expenditure on minor illnesses, strongly associated with poorer households, had the greatest impact on economic status.
    • 40. High healthcare expenditure for the poor often resulted in substantial reductions in consumption expenditures on food, education, and social activities.
    10

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