Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Department of Famiy and Community Medicine, Taibah University, Medina, Saudi Arabia.
F1000Res. 2022 Feb 3;11:141. doi: 10.12688/f1000research.75808.1. eCollection 2022.
India is taking steps to provide Universal Health Coverage (UHC). Out-of-pocket (OOP) health care payment is the most important mechanism for health care payment in India. This study aims to investigate the effect of OOP health care payments on catastrophic health expenditures (CHE). Data from the National Sample Survey Organization, Social Consumption in Health 2014 and 2018 are used to investigate the effect of OOP health expenditure on household welfare in India. Three aspects of catastrophic expenditure were analyzed in this paper: (i) incidence and intensity of 'catastrophic' health expenditure, (ii) socioeconomic inequality in catastrophic health expenditures, and (iii) factors affecting catastrophic health expenditures. The odds of incidence and intensity of CHE were higher for the poorer households. Using the logistic regression model, it was observed that the odds of incidence of CHE was higher among the households with at least one child aged less than 5 years, one elderly person, one secondary educated female member, and if at least one member in the household used a private healthcare facility for treatment. The multiple regression model showed that the intensity of CHE was higher among households with members having chronic illness, and if members had higher duration of stay in the hospital. Subsidizing healthcare to the households having elderly members and children is necessary to reduce CHE. Expanding health insurance coverage, increasing coverage limits, and inclusion of coverage for outpatient and preventive services are vital to protect households. Strengthening public primary health infrastructure and setting up a regulatory organization to establish policies and conduct regular audits to ensure that private hospitals do not increase hospitalizations and the duration of stay is necessary.
印度正在采取措施提供全民健康覆盖。自付（OOP）医疗保健支付是印度医疗保健支付的最重要机制。本研究旨在调查 OOP 医疗保健支付对灾难性医疗支出（CHE）的影响。本研究使用了来自国家抽样调查组织、2014 年和 2018 年社会卫生消费的数据，调查了 OOP 医疗支出对印度家庭福利的影响。本文分析了灾难性支出的三个方面：（i）“灾难性”医疗支出的发生率和强度，（ii）灾难性医疗支出的社会经济不平等，以及（iii）影响灾难性医疗支出的因素。较贫困家庭发生和强度 CHE 的可能性更高。使用逻辑回归模型，观察到 CHE 发生率较高的家庭中至少有一个 5 岁以下的孩子、一个老年人、一个受过中等教育的女性成员，以及如果家庭中至少有一个成员因治疗而使用私人医疗保健设施。多元回归模型表明，有慢性病成员和住院时间较长的家庭 CHE 强度更高。有必要向有老年成员和儿童的家庭提供医疗保健补贴，以减少 CHE。扩大医疗保险覆盖范围，提高覆盖范围上限，并将门诊和预防服务纳入覆盖范围，对于保护家庭至关重要。加强公共初级卫生基础设施，并建立一个监管组织，制定政策并进行定期审计，以确保私立医院不会增加住院时间和住院时间，这是必要的。
