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.

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

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

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

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.)

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

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 property8

36. This is partly a consequence of the fact that outpatient catastrophic expenditure tended to be associated with poorer households.9

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