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Socio-Economic Differentials in Impoverishment Effects of Out-of-Pocket Health Expenditure in China and India: Evidence from WHO SAGE

Author

Listed:
  • Kaushalendra Kumar
  • Ashish Singh
  • Santosh Kumar
  • Faujdar Ram
  • Abhishek Singh
  • Usha Ram
  • Joel Negin
  • Paul R Kowal

Abstract

Background and Objectives: The provision of affordable health care is generally considered a fundamental goal of a welfare state. In addition to its role in maintaining and improving the health status of individuals and households, it impacts the economic prosperity of a society through its positive effects on labor productivity. Given this context, this paper assesses socioeconomic-differentials in the impact of out-of-pocket-health-expenditure (OOPHE) on impoverishment in China and India, two of the fastest growing economies of the world. Data and Methods: The paper uses data from the World Health Organisation’s Study on Global Ageing and Adult Health (WHO SAGE), and Bivariate as well as Multivariate analyses for investigating the socioeconomic-differentials in the impact of out-of-pocket-health-expenditure (OOPHE) on impoverishment in China and India. Results and Conclusions: Annually, about 7% and 8% of the population in China and India, respectively, fall in poverty due to OOPHE. Also, the percentage shortfall in income for the population from poverty line due to OOPHE is 2% in China and 1.3% in India. Further, findings from the multivariate analysis indicate that lower wealth status and inpatient as well as outpatient care increase the odds of falling below poverty line significantly (with the extent much higher in the case of in-patient care) due to OOPHE in both China and India. In addition, having at least an under-5 child in the household, living in rural areas and having a household head with no formal education increases the odds of falling below poverty line significantly (compared to a head with college level education) due to OOPHE in China; whereas having at least an under-5 child, not having health insurance and residing in rural areas increases the odds of becoming poor significantly due to OOPHE in India.

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  • Kaushalendra Kumar & Ashish Singh & Santosh Kumar & Faujdar Ram & Abhishek Singh & Usha Ram & Joel Negin & Paul R Kowal, 2015. "Socio-Economic Differentials in Impoverishment Effects of Out-of-Pocket Health Expenditure in China and India: Evidence from WHO SAGE," PLOS ONE, Public Library of Science, vol. 10(8), pages 1-19, August.
    • Handle: RePEc:plo:pone00:0135051
    DOI: 10.1371/journal.pone.0135051
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    References listed on IDEAS

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    1. Shivendra Sangar & Varun Dutt & Ramna Thakur, 2019. "Economic burden, impoverishment, and coping mechanisms associated with out‐of‐pocket health expenditure in India: A disaggregated analysis at the state level," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(1), pages 301-313, January.
    2. Kumar, Kaushalendra & Shukla, Ankita & Singh, Abhishek & Ram, Faujdar & Kowal, Paul, 2016. "Association between wealth and health among older adults in rural China and India," The Journal of the Economics of Ageing, Elsevier, vol. 7(C), pages 43-52.
    3. Mónica Pinilla‐Roncancio & Jeannette Liliana Amaya‐Lara & Gustavo Cedeño‐Ocampo & Paul Rodríguez‐Lesmes & Carlos Sepúlveda, 2023. "Catastrophic health‐care payments and multidimensional poverty: Are they related?," Health Economics, John Wiley & Sons, Ltd., vol. 32(8), pages 1689-1709, August.
    4. Xiaochen Ma & Ziyue Wang & Xiaoyun Liu, 2019. "Progress on Catastrophic Health Expenditure in China: Evidence from China Family Panel Studies (CFPS) 2010 to 2016," IJERPH, MDPI, vol. 16(23), pages 1-11, November.
    5. Rahman, Md Mizanur & Jung, Jenny & Islam, Md Rashedul & Rahman, Md Mahfuzur & Nakamura, Ryota & Akter, Shamima & Sato, Motohiro, 2022. "Global, regional, and national progress in financial risk protection towards universal health coverage, 2000–2030," Social Science & Medicine, Elsevier, vol. 312(C).
    6. A. Akhtar & Nadeem Ahmad & Indrani Roy Chowdhury, 2020. "Socio-economic inequality in catastrophic health expenditure among households in India: A decomposition analysis," Indian Economic Review, Springer, vol. 55(2), pages 339-369, December.
    7. Anshul Kastor & Sanjay K Mohanty, 2018. "Disease-specific out-of-pocket and catastrophic health expenditure on hospitalization in India: Do Indian households face distress health financing?," PLOS ONE, Public Library of Science, vol. 13(5), pages 1-18, May.
    8. Haiyan Jia & Xiaoyu Sai & Yangyue Su & Ying Huang, 2022. "Measurement and Decomposition of the Health Poverty of Rural Residents in China," IJERPH, MDPI, vol. 19(19), pages 1-20, October.
    9. Dunfu Zhang & K. M. Atikur Rahman, 2020. "Government health expenditure, out‐of‐pocket payment and social inequality: A cross‐national analysis of China and OECD countries," International Journal of Health Planning and Management, Wiley Blackwell, vol. 35(5), pages 1111-1126, September.
    10. Mohd Zuhair & Fuli Zhou & Saurabh Pratap & Ram Babu Roy, 2022. "Eliciting key attributes of health insurance in rural India: a qualitative analysis," SN Business & Economics, Springer, vol. 2(3), pages 1-28, March.
    11. Kumar, Kaushalendra & Singh, Abhishek & James, K.S. & McDougal, Lotus & Raj, Anita, 2020. "Gender bias in hospitalization financing from borrowings, selling of assets, contribution from relatives or friends in India," Social Science & Medicine, Elsevier, vol. 260(C).
    12. Roopali Goyanka & Charu C. Garg & Sheela Prasad, 2019. "Impoverishment Due to Out-of-pocket Health Expenditures: Measurement and Comparison Across Different Surveys in India," Indian Journal of Human Development, , vol. 13(2), pages 121-134, August.
    13. Subhalaxmi Mohapatra, 2022. "Health Expenditures, Health Infrastructure and Health Status in SAARC Countries: A Panel Data Analysis," Vikalpa: The Journal for Decision Makers, , vol. 47(3), pages 205-216, September.
    14. Jay Dev Dubey, 2021. "Measuring Income Elasticity of Healthcare-Seeking Behavior in India: A Conditional Quantile Regression Approach," Journal of Quantitative Economics, Springer;The Indian Econometric Society (TIES), vol. 19(4), pages 767-793, December.
    15. Raj Panda & Pradeep Guin & Kumar Gaurav, 2020. "Governance in Public Purchasing of Tertiary-Level Health Care: Lessons From Madhya Pradesh, India," SAGE Open, , vol. 10(3), pages 21582440209, July.
    16. Jeetendra Yadav & Geetha R. Menon & Denny John, 2021. "Disease-Specific Out-of-Pocket Payments, Catastrophic Health Expenditure and Impoverishment Effects in India: An Analysis of National Health Survey Data," Applied Health Economics and Health Policy, Springer, vol. 19(5), pages 769-782, September.

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