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

  • 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
    • 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
  • 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.
    3
  • 4
    • 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
  • 5
    Health expenditure as a percentage of total household expenditure by various category of treatment (rural and urban)
  • 6
    Percentage of households facing catastrophic health expenditure (>40% of non-food expenditure.)
  • 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)
    7
  • 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
    8
  • 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.
    9
  • 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.
    10