Dhanaraj Sowmya
Madras School of Economics, Kotturpuram, Chennai, 600025, Tamil Nadu, India
Health Policy Plan. 2016 Jul;31(6):749-58. doi: 10.1093/heapol/czv127. Epub 2016 Feb 2.
Empirical research has shown that households in developing countries are unable to sustain current levels of consumption during and after severe health crises due to substantial increase in medical expenditure and/or loss of income. Health events are also found to have an adverse impact on nutritional status and educational attainment of household members. Thus, in this study, we investigate: who are vulnerable to welfare loss from health shocks, what are the household responses to cope with the economic burden of health shocks and if policy responses like state health insurance schemes are effective in reducing the economic vulnerability. We use self-reported measures of health shocks and coping strategies from the longitudinal survey of the ongoing Young Lives project in India [Andhra Pradesh (AP)] to identify the characteristics of vulnerable groups and perform three-level random intercept logistic regression that takes into account contextual or environmental factors. What emerges is socioeconomic status of household (determined by education, wealth, occupation and caste/religious group) and its demographic characteristics like gender of the household head and proportion of elderly and disabled members matter for outcomes related to health events. Households adopt different strategies to cope with the economic costs of ill-health; borrowing is the most widely used strategy. For credit, majority of households rely on informal sources (moneylenders, friends, relatives, etc.) and have little or no access to formal sources. However, health shock to main breadwinner leads to households adopting costly strategies like reducing consumption or sending children to work. We found no evidence that the state health insurance scheme reduced the household welfare loss from health shocks and their coping strategies. The results suggest that health insurance schemes have to be complemented with access to micro-credit and social security schemes for self-employed persons/workers in informal sector to reduce the economic burden faced by households due to health shocks.
实证研究表明，由于医疗支出大幅增加和/或收入损失，发展中国家的家庭在严重健康危机期间及之后无法维持当前的消费水平。健康事件还被发现会对家庭成员的营养状况和教育程度产生不利影响。因此，在本研究中，我们调查：哪些人容易因健康冲击而遭受福利损失，家庭如何应对健康冲击带来的经济负担，以及诸如国家健康保险计划等政策应对措施在降低经济脆弱性方面是否有效。我们使用来自印度安得拉邦正在进行的“青年生活”项目纵向调查中自我报告的健康冲击和应对策略测量数据，以确定弱势群体的特征，并进行考虑了背景或环境因素的三级随机截距逻辑回归分析。研究发现，家庭的社会经济地位（由教育、财富、职业和种姓/宗教群体决定）及其人口特征，如户主性别以及老年人和残疾成员的比例，对于与健康事件相关的结果至关重要。家庭采取不同策略来应对健康不佳带来的经济成本；借贷是最广泛使用的策略。在信贷方面，大多数家庭依赖非正式渠道（放债人、朋友、亲戚等），很少或几乎无法获得正式渠道的信贷。然而，主要挣钱者遭受健康冲击会导致家庭采取诸如减少消费或送孩子去工作等成本高昂的策略。我们没有发现证据表明国家健康保险计划减少了家庭因健康冲击及其应对策略而遭受的福利损失。结果表明，健康保险计划必须辅之以向非正规部门的自营职业者/工人提供小额信贷和社会保障计划的机会，以减轻家庭因健康冲击而面临的经济负担。
