Krishnamoorthy Yuvaraj, Rajaa Sathish, Sinha Isha, Krishnan Murali, Samuel Gerald, Kanth Krishna
Department of Community Medicine, ESIC Medical College and PGIMSR, K.K. Nagar, Chennai, India.
Heliyon. 2023 Aug 3;9(8):e18902. doi: 10.1016/j.heliyon.2023.e18902. eCollection 2023 Aug.
Catastrophic health expenditure [CHE] in India is on a rise. This situation would worsen even further when resources are disproportionately distributed across various socioeconomic classes. Hence, we conducted this study to determine the equity and extent of out-of-pocket [OOP] payments, Catastrophic health expenditure and impoverishment among rural households during COVID-19 pandemic in Tamil Nadu, India. A cross-sectional survey covering 2409 households was conducted during November 2021 across six districts in rural part of Tamil Nadu. Information on out-of-pocket payments, Catastrophic health expenditure (based on 40% capacity-to-pay [CTP] method) and impoverishment was obtained through World Health Organization standard criteria. Point estimates were reported as proportions with 95% Confidence Interval [CI]. Our results showed that the proportion of households with out-of-pocket payments on health and Catastrophic health expenditure in the month preceding the survey was 82.8% (95%CI: 81.2%-84.3%) and 26.9% (95%CI: 25.1%-28.7%) respectively. Nuclear (couple with dependent children only) and joint family type (extended family), presence of under-five children and lower socioeconomic status were significant determinants of Catastrophic health expenditure. The prevalence of impoverishment was 6.4% (95%CI: 5.4%-7.5%). To conclude, more than three fourth of the rural households in Tamil Nadu has out-of-pocket payments for health with one-fourth having Catastrophic health expenditure. Almost one in fourteen non-poor households faced impoverishment during the COVID-19 pandemic. This shows the disproportionate distribution of health expenses especially in the rural areas. Hence, appropriate financial risk protection measures should be taken in order to progress towards universal healthcare in our country.
印度灾难性卫生支出[CHE]呈上升趋势。当资源在不同社会经济阶层中分配不均时，这种情况将进一步恶化。因此，我们开展了这项研究，以确定印度泰米尔纳德邦农村家庭在新冠疫情期间自付费用、灾难性卫生支出和贫困的公平性及程度。2021年11月，在泰米尔纳德邦农村地区的六个区开展了一项涵盖2409户家庭的横断面调查。通过世界卫生组织的标准准则获取了自付费用、灾难性卫生支出（基于40%支付能力[CTP]方法）和贫困方面的信息。点估计值以比例形式报告，并给出95%置信区间[CI]。我们的结果显示，在调查前一个月有卫生自付费用和灾难性卫生支出的家庭比例分别为82.8%（95%CI：81.2%-84.3%）和26.9%（95%CI：25.1%-28.7%）。核心家庭（仅夫妻及受抚养子女）和联合家庭类型（大家庭）、五岁以下儿童的存在以及较低的社会经济地位是灾难性卫生支出的重要决定因素。贫困发生率为6.4%（95%CI：5.4%-7.5%）。总之，泰米尔纳德邦超过四分之三的农村家庭有卫生自付费用，其中四分之一有灾难性卫生支出。在新冠疫情期间，几乎每十四户非贫困家庭中就有一户面临贫困。这表明卫生费用分配不均，尤其是在农村地区。因此，应采取适当的金融风险保护措施，以推动我国实现全民医疗保健。
