Addressing Data and Methodological Limitations in Estimating Catastrophic Health Spending and Impoverishment in India, 2004-18 [post]

Sanjay Mohanty, Laxmikant Dwivedi
2020 unpublished
BackgroundEstimates of catastrophic health expenditure (CHE) are counterintuitive to researchers, policy makers, and developmental partners due to data and methodological limitation. While inferences drawn from use of capacity-to-pay (CTP) and budget share (BS) approaches are inconsistent, the non-availability of data on food expenditure in the health survey in India is an added limitation. MethodsUsing data from the health and consumption surveys of National Sample Surveys over 15 years, we
more » ... ver 15 years, we have overcome these limitations and estimated the incidence and intensity of CHE and impoverishment using the CTP approach. ResultsThe incidence of CHE for health services in India has declined from 12.5% in 2004 to 9.1% by 2018 and that of intensity of CHE has increased from 1.25 to 1.31 during the same period. The impoverishment due to health spending was 4.8% in 2004, 5.1% in 2014 and 3.3% in 2018. The state variations in incidence and intensity of CHE and incidence of impoverishment is large. The odds of incurring CHE were lowest among the richest households [OR 0.22; 95% CI: 0.21,0.24], households with elderly members [OR 1.20; 95% CI :1.12,1.18] and households using both inpatient and outpatient services [OR 2.80, 95% CI 2.66, 2.95]. Access to health insurance reduced the chance of CHE and impoverishment among the richest households. The pattern of impoverishment was similar to that of CHE. ConclusionWe recommend the CTP approach when estimating CHE and impoverishment in low and middle-income countries.
doi:10.21203/ fatcat:w3pwksyeura6bcdtmykxvlkvxq