Pandey, A;
Ploubidis, GB;
Clarke, L;
Dandona, L;
(2018)
Trends in catastrophic health expenditure in India: 1993 to 2014.
Bulletin of the World Health Organization
, 96
(1)
pp. 18-28.
10.2471/BLT.17.191759.
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Abstract
OBJECTIVE: To investigate trends in out-of-pocket health-care payments and catastrophic health expenditure in India by household age composition. METHODS: We obtained data from four national consumer expenditure surveys and three health-care utilization surveys conducted between 1993 and 2014. Households were divided into five groups by age composition. We defined catastrophic health expenditure as out-ofpocket payments equalling or exceeding 10% of household expenditure. Factors associated with catastrophic expenditure were identified by multivariable analysis. FINDINGS: Overall, the proportion of catastrophic health expenditure increased 1.47-fold between the 1993–1994 expenditure survey (12.4%) and the 2011–2012 expenditure survey (18.2%) and 2.24-fold between the 1995–1996 utilization survey (11.1%) and the 2014 utilization survey (24.9%). The proportion increased more in the poorest than the richest quintile: 3.00-fold versus 1.74-fold, respectively, across the utilization surveys. Catastrophic expenditure was commonest among households comprising only people aged 60 years or older: the adjusted odds ratio (aOR) was 3.26 (95% confidence interval, CI: 2.76–3.84) compared with households with no older people or children younger than 5 years. The risk was also increased among households with both older people and children (aOR: 2.58; 95% CI: 2.31–2.89), with a female head (aOR: 1.32; 95% CI: 1.19–1.47) and with a rural location (aOR: 1.27; 95% CI: 1.20–1.35). CONCLUSION: The proportion of households experiencing catastrophic health expenditure in India increased over the past two decades. Such expenditure was highest among households with older people. Financial protection mechanisms are needed for population groups at risk for catastrophic health expenditure.
| Type: | Article |
|---|---|
| Title: | Trends in catastrophic health expenditure in India: 1993 to 2014 |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.2471/BLT.17.191759 |
| Publisher version: | http://doi.org/10.2471/BLT.17.191759 |
| Language: | English |
| Additional information: | All articles are available under the Creative Commons Attribution 3.0 IGO licence (CC BY 3.0 IG0) (https://creativecommons.org/licenses/by/3.0/igo/) |
| Keywords: | Science & Technology, Life Sciences & Biomedicine, Public, Environmental & Occupational Health, OUT-OF-POCKET, CARE EXPENDITURE, OLDER-PEOPLE, POPULATION, HOUSEHOLDS, PAYMENTS, DETERMINANTS, INEQUALITY, INSURANCE, EXPENSES |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Education UCL > Provost and Vice Provost Offices > School of Education > UCL Institute of Education UCL > Provost and Vice Provost Offices > School of Education > UCL Institute of Education > IOE - Social Research Institute |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10047096 |
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