University School of Management and Entrepreneurship, Delhi Technological University, Vivek Vihar Phase 2, Delhi 110095, India.
Health Policy Plan. 2023 Sep 18;38(8):926-938. doi: 10.1093/heapol/czad050.
More than 50% of health expenditure is financed through out-of-pocket payments in India, imposing a colossal financial burden on households. Amidst the rising incidence of non-communicable diseases, injuries, and an unfinished agenda of infectious diseases, this study examines comprehensively the economic impact of out-of-pocket health expenditure (OOPE) across 17 disease categories in India. Data from the latest round of the National Sample Survey (2017-18), titled 'Household Social Consumption: Health', were employed. Outcomes, namely, catastrophic health expenditure (CHE), poverty headcount ratio, distressed financing, foregone care, and loss of household earnings, were estimated. Results showed that 49% of households that sought hospitalization and/or outpatient care experienced CHE and 15% of households fell below the poverty line due to OOPE. Notably, outpatient care was more burdensome (CHE: 47.8% and impoverishment: 15.0%) than hospitalization (CHE: 43.1% and impoverishment: 10.7%). Nearly 16% of households used distressed sources to finance hospitalization-related OOPE. Cancer, genitourinary disorders, psychiatric and neurological disorders, obstetric conditions, and injuries imposed a substantial economic burden on households. OOPE and associated financial burden were higher among households where members sought care in private healthcare facilities compared with those treated in public facilities across most disease categories. The high burden of OOPE necessitates the need to increase health insurance uptake and consider outpatient services under the purview of health insurance. Concerted efforts to strengthen the public health sector, improved regulation of private healthcare providers, and prioritizing health promotion and disease prevention strategies are crucial to augment financial risk protection.
印度超过 50%的卫生支出是通过自费支付的，这给家庭带来了巨大的经济负担。在非传染性疾病、伤害发病率不断上升和传染病未完成议程的背景下，本研究全面考察了印度 17 种疾病类别中自费卫生支出（OOPE）的经济影响。使用了最新一轮国家抽样调查（2017-18 年）的数据，名为“家庭社会消费：健康”。评估了结果，即灾难性卫生支出（CHE）、贫困发生率、贫困融资、放弃护理和家庭收入损失。结果表明，49%寻求住院和/或门诊治疗的家庭经历了 CHE，15%的家庭因 OOPE 而陷入贫困线以下。值得注意的是，门诊治疗比住院治疗更具负担（CHE：47.8%和贫困发生率：15.0%）（CHE：43.1%和贫困发生率：10.7%）。近 16%的家庭使用贫困融资来支付与住院相关的 OOPE。癌症、泌尿生殖系统疾病、精神和神经疾病、产科疾病和伤害给家庭带来了巨大的经济负担。在大多数疾病类别中，与在公共医疗机构接受治疗的家庭相比，在私立医疗机构寻求治疗的家庭的 OOPE 及其相关经济负担更高。自费支付的高负担要求增加医疗保险的普及率，并考虑将门诊服务纳入医疗保险范围。需要协同努力，加强公共卫生部门，改善对私立医疗机构提供者的监管，并优先考虑健康促进和疾病预防战略，以增加财务风险保护。
