Department of Humanities and Social Sciences, Indian Institute of Technology (IIT), Madras, Chennai, Tamil Nadu, 600036, India.
Department of Family and Generations, International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India.
Sci Rep. 2024 Mar 26;14(1):7164. doi: 10.1038/s41598-024-57984-1.
In India, the rising double burden of diseases and the low fiscal capacity of the government forces people to resort to hardship financing. This study aimed to examine the factors contributing to the reduction in hardship financing among inpatient households in India. The study relies on two rounds of National Sample Surveys with a sample of 34,478 households from the 71st round (2014) and 56,681 households from the 75th round (2018). We employed multivariable logistic regression and multivariate decomposition analyses to explore the factors associated with hardship financing in Indian households with hospitalized member(s) and assess the contributing factors to the reduction in hardship financing between 2014 and 2018. Notably, though hardship financing for inpatient households has decreased between 2014 and 2018, households with catastrophic health expenditure (CHE) had higher odds of hardship financing than those without CHE. While factors such as CHE, prolonged hospitalization, and private hospitals had impoverishing effects on hardship financing in 2014 and 2018, the decomposition model showed the potential of CHE (32%), length of hospitalization (32%), and private hospitals (24%) to slow down this negative impact over time. The findings showed the potential for further improvements in financial health protection for inpatient care over time, and underscore the need for continuing efforts to strengthen the implementation of public programs and schemes in India such as Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY).
在印度，疾病负担的双重增加和政府财政能力的低下迫使人们不得不进行艰难的融资。本研究旨在探讨导致印度住院家庭艰难融资减少的因素。该研究依赖于两轮全国抽样调查，样本来自第 71 轮（2014 年）的 34478 户家庭和第 75 轮（2018 年）的 56681 户家庭。我们采用多变量逻辑回归和多变量分解分析来探讨与住院家庭成员的印度家庭的艰难融资相关的因素，并评估 2014 年至 2018 年艰难融资减少的促成因素。值得注意的是，尽管住院家庭的艰难融资在 2014 年至 2018 年间有所减少，但有灾难性医疗支出（CHE）的家庭比没有 CHE 的家庭更有可能进行艰难融资。虽然 CHE、住院时间延长和私立医院等因素对 2014 年和 2018 年的艰难融资产生了贫困化影响，但分解模型显示 CHE（32%）、住院时间（32%）和私立医院（24%）有潜力随着时间的推移减缓这种负面影响。研究结果表明，随着时间的推移，住院治疗的财务健康保护有可能进一步改善，并强调印度需要继续努力加强公共计划和方案的实施，如 Ayushman Bharat Pradhan Mantri Jan Arogya Yojana（PMJAY）。
