Public Health Foundation of India, National Capital Region, Gurugram, India.
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States of America.
PLoS One. 2018 Oct 22;13(10):e0205510. doi: 10.1371/journal.pone.0205510. eCollection 2018.
Financial protection is a key dimension of universal health coverage. Catastrophic health expenditure (CHE) has increased in India over time. The overall figures mask the subnational heterogeneity crucial for designing insurance coverage for 1.3 billion population across India. We estimated CHE in every state of India and the changes over a decade.
We used National Sample Survey data on health care utilisation in 2004 and 2014. The states were placed in four groups based on epidemiological transition level (ETL), defined on the basis of ratio of disability-adjusted life-years from communicable diseases to those from non-communicable diseases and injuries combined, with a low ratio denoting high ETL state group. CHE was defined as the proportion of households that had out-of-pocket payments for health care equalling or exceeding 10% of the household expenditure. We assessed variation in the magnitude and distribution of CHE between ETL state groups and between states of India.
In 2014, CHE was higher in the high (30.3%, 95% confidence interval: 28.5 to 32.1) and higher-middle (27.4%, 26.3 to 28.6) ETL state groups than the low (21.8%, 20.8 to 22.8) and lower-middle (19.0%, 17.1 to 21.0) groups. From 2004 to 2014, CHE increased only in the high and higher-middle ETL groups (1.19 and 1.34 times, respectively). However, the individual states with substantial increase in CHE were spread across all ETL groups. The gap between the highest CHE of an individual state and the lowest was 8-fold in 2014. CHE was disproportionately concentrated among the rich in 2004 for most of India, but in 2014 CHE was distributed equally among the rich and poor because of the substantial increase in CHE among the poor over time.
Better provision of quality health care should be accompanied by financial protection measures to safeguard the poor from increasing CHE in India. The state-specific CHE trends can provide useful input for the planning of the recently launched National Health Protection Mission such that it meets the requirement of each state.
财务保障是全民健康覆盖的一个关键方面。在印度，灾难性卫生支出（CHE）随着时间的推移而增加。这些总体数据掩盖了对于印度 13 亿人口的保险覆盖范围设计至关重要的国家内部差异。我们在印度的每个邦都估计了 CHE，并在十年内进行了变化。
我们使用了 2004 年和 2014 年的国家抽样调查数据，根据传染病调整生命年与非传染性疾病和伤害调整生命年的比值来确定各州的流行病学过渡水平（ETL），将各州分为四个组，比值低表示 ETL 水平高的州组。 CHE 被定义为家庭因医疗保健而自付的费用超过家庭支出的 10%的家庭比例。我们评估了 CHE 在 ETL 州组之间以及印度各州之间的程度和分布差异。
2014 年，高（30.3%，95%置信区间：28.5 至 32.1）和较高（27.4%，26.3 至 28.6）ETL 州组的 CHE 高于低（21.8%，20.8 至 22.8）和较低（19.0%，17.1 至 21.0）组。从 2004 年到 2014 年， CHE 仅在高和较高 ETL 组中增加（分别为 1.19 和 1.34 倍）。然而， CHE 大幅增加的个别州分布在所有 ETL 组中。2014 年，各州 CHE 最高和最低之间的差距达到 8 倍。在 2004 年， CHE 主要集中在富人中，因为当时印度大部分地区的 CHE 都很高，但到 2014 年， CHE 在穷人中的分配变得平等，因为随着时间的推移， CHE 在穷人中的大幅增加。
在为穷人提供更好的优质医疗保健的同时，还应采取财务保障措施，以防止 CHE 在印度不断增加。每个邦的 CHE 趋势可以为最近启动的国家健康保护任务的规划提供有用的信息，以便满足每个邦的要求。
