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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.

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

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