ICMR-National Institute of Medical Statistics, Ansari Nagar, New Delhi, 110029, India.
Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Ernakulam, Kerala, 682041, India.
Appl Health Econ Health Policy. 2021 Sep;19(5):769-782. doi: 10.1007/s40258-021-00641-9. Epub 2021 Feb 22.
In India, more than two-thirds of the total health expenditure is incurred through out-of-pocket expenditure (OOPE) by households. Morbidity events thus impose excessive financial risk on households. The Sustainable Development Goals Target 3.8 specifies financial risk protection for achieving universal health coverage (UHC) in developing countries. This study aimed to estimate the impact of OOPE on catastrophic health expenditure (CHE) and impoverishment effects by types of morbidity in India.
Data came from the 75th round of the National Sample Survey (NSS) on the theme 'Social consumption in India: Health', which was conducted during the period from July 2017 to June 2018. For the present study, 56,722 households for hospitalisation, 29,580 households for outpatient department (OPD) care and 6285 households for both (OPD care and hospitalisation) were analysed. Indices, namely health care burden, CHE, poverty head count ratio and poverty gap ratio using standard definitions were analysed.
Households with members who underwent treatment for cancers, cardiovascular diseases, psychiatric conditions, injuries, musculoskeletal and genitourinary conditions spent a relatively high amount of their income on health care. Overall, 41.4% of the households spent > 10% of the total household consumption expenditure (HCE) and 24.6% of households spent > 20% of HCE for hospitalisation. A total of 20.4% and 10.0% of households faced CHE for hospitalisation based on the average per capita and average two capita consumption expenditure, respectively. Health care burden, CHE and impoverishment was higher in households who sought treatment in private health facilities than in public health facilities.
Our study suggests that there is an urgent need for political players and policymakers to design health system financing policies and strict implementation that will provide financial risk protection to households in India.
在印度，超过三分之二的总卫生支出是由家庭通过自费（OOPE）承担的。因此，疾病的发生给家庭带来了过高的经济风险。可持续发展目标目标 3.8 规定了通过发展中国家的全民健康覆盖（UHC）来保护财务风险。本研究旨在评估印度各种疾病发病率对灾难性卫生支出（CHE）和贫困化效应的影响。
数据来自于 2017 年 7 月至 2018 年 6 月进行的主题为“印度社会消费：健康”的第 75 轮国家抽样调查（NSS）。本研究分析了 56722 户住院治疗、29580 户门诊治疗和 6285 户同时接受门诊和住院治疗的家庭。使用标准定义分析了卫生保健负担、CHE、贫困发生率和贫困差距比等指数。
患有癌症、心血管疾病、精神疾病、伤害、肌肉骨骼和泌尿生殖系统疾病的家庭在医疗保健上的支出占其总收入的比例相对较高。总体而言，41.4%的家庭用于医疗保健的支出超过了家庭总消费支出（HCE）的 10%，24.6%的家庭用于医疗保健的支出超过了 HCE 的 20%。基于人均和两人均消费支出，分别有 20.4%和 10.0%的家庭因住院治疗而面临 CHE。在寻求私人医疗设施治疗的家庭中，卫生保健负担、CHE 和贫困发生率高于寻求公共医疗设施治疗的家庭。
本研究表明，印度迫切需要政治参与者和政策制定者设计卫生系统融资政策并严格执行，为印度家庭提供财务风险保护。
