School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
Indian J Med Res. 2017 Dec;146(6):759-767. doi: 10.4103/ijmr.IJMR_2003_15.
BACKGROUND & OBJECTIVES: India aspires to achieve universal health coverage, which requires ensuring financial risk protection (FRP). This study was done to assess the extent of out-of-pocket (OOP) expenditure and FRP for hospitalization in Haryana State, India. Further, the determinants for FRP were also evaluated.
Data collected as a part of a household level survey conducted in Haryana 'Concurrent Evaluation of National Rural Health Mission: Haryana Health Survey' were analyzed. Descriptive analysis was undertaken to assess socio-demographic characteristics, hospitalization rate, extent and determinants of OOP expenditure and FRP. Prevalence of catastrophic health expenditure (CHE) (more than 40% of non-food expenditure) and impoverishment (Int$ 1.25) were estimated. Multivariate logistic regression was used to assess determinants of FRP.
Hospitalization rate was found to be 3106 persons or 3307 episodes per 100,000 population. Median OOP expenditure on hospitalization was ₹ 8000 (USD 133), which was predominantly attributed to medicines (37%). Prevalence of CHE was 25.2 per cent with higher prevalence amongst males [odds ratio (OR)=1.30], those belonging to scheduled caste and scheduled tribes (OR=1.35), poorest 20 per cent households (OR=3.05), having injuries (OR=4.03) and non-communicable diseases (OR=3.13) admitted in a private hospital (OR=2.69) and those who were insured (OR=1.74). There was a 12 per cent relative increase in poverty head count due to OOP payments on healthcare.
INTERPRETATION & CONCLUSIONS: Our findings showed that hospitalization resulted in significant OOP expenditure, leading to CHEs and impoverishment of households. Impact of OOP expenditures was inequitably more on the vulnerable groups. OOP expenditure may be curtailed through provision of free medicines and diagnostics and removal of any form of user charges.
印度致力于实现全民健康覆盖，这就需要确保其财务风险保护（FRP）。本研究旨在评估印度哈里亚纳邦住院治疗的自付支出（OOP）和 FRP 的程度。此外，还评估了 FRP 的决定因素。
分析了作为印度哈里亚纳邦“国家农村健康使命同步评估：哈里亚纳邦健康调查”一部分收集的家庭层面调查数据。进行了描述性分析，以评估社会人口统计学特征、住院率、OOP 支出和 FRP 的程度和决定因素。估计了灾难性卫生支出（CHE）（超过非食品支出的 40%）和贫困（Int$ 1.25）的发生率。使用多变量逻辑回归评估 FRP 的决定因素。
住院率为每 10 万人中有 3106 人或 3307 例。住院治疗的 OOP 支出中位数为₹8000（USD 133），主要归因于药品（37%）。CHE 的发生率为 25.2%，男性发生率较高[比值比（OR）=1.30]，属于在册种姓和在册部落（OR=1.35），最贫困的 20%家庭（OR=3.05），有受伤（OR=4.03）和非传染性疾病（OR=3.13），在私立医院住院（OR=2.69）和有保险的人（OR=1.74）。由于医疗保健的 OOP 支付，贫困人口增加了 12%。
我们的研究结果表明，住院治疗导致了大量的 OOP 支出，导致 CHE 和家庭贫困。OOP 支出的影响对弱势群体更为不公平。通过提供免费药品和诊断以及取消任何形式的用户收费，可以减少 OOP 支出。
