IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0205510.html
   My bibliography  Save this article

Variations in catastrophic health expenditure across the states of India: 2004 to 2014

Author

Listed:
  • Anamika Pandey
  • G Anil Kumar
  • Rakhi Dandona
  • Lalit Dandona

Abstract

Background: Financial protection is a key dimension of universal health coverage. Catastrophic health expenditure (CHE) has increased in India over time. The overall figures mask the subnational heterogeneity crucial for designing insurance coverage for 1.3 billion population across India. We estimated CHE in every state of India and the changes over a decade. Methods: We used National Sample Survey data on health care utilisation in 2004 and 2014. The states were placed in four groups based on epidemiological transition level (ETL), defined on the basis of ratio of disability-adjusted life-years from communicable diseases to those from non-communicable diseases and injuries combined, with a low ratio denoting high ETL state group. CHE was defined as the proportion of households that had out-of-pocket payments for health care equalling or exceeding 10% of the household expenditure. We assessed variation in the magnitude and distribution of CHE between ETL state groups and between states of India. Results: In 2014, CHE was higher in the high (30.3%, 95% confidence interval: 28.5 to 32.1) and higher-middle (27.4%, 26.3 to 28.6) ETL state groups than the low (21.8%, 20.8 to 22.8) and lower-middle (19.0%, 17.1 to 21.0) groups. From 2004 to 2014, CHE increased only in the high and higher-middle ETL groups (1.19 and 1.34 times, respectively). However, the individual states with substantial increase in CHE were spread across all ETL groups. The gap between the highest CHE of an individual state and the lowest was 8-fold in 2014. CHE was disproportionately concentrated among the rich in 2004 for most of India, but in 2014 CHE was distributed equally among the rich and poor because of the substantial increase in CHE among the poor over time. Conclusions: Better provision of quality health care should be accompanied by financial protection measures to safeguard the poor from increasing CHE in India. The state-specific CHE trends can provide useful input for the planning of the recently launched National Health Protection Mission such that it meets the requirement of each state.

Suggested Citation

  • Anamika Pandey & G Anil Kumar & Rakhi Dandona & Lalit Dandona, 2018. "Variations in catastrophic health expenditure across the states of India: 2004 to 2014," PLOS ONE, Public Library of Science, vol. 13(10), pages 1-15, October.
    • Handle: RePEc:plo:pone00:0205510
    DOI: 10.1371/journal.pone.0205510
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0205510
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0205510&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0205510?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Owen O'Donnell & Eddy van Doorslaer & Adam Wagstaff & Magnus Lindelow, 2008. "Analyzing Health Equity Using Household Survey Data : A Guide to Techniques and Their Implementation," World Bank Publications - Books, The World Bank Group, number 6896, December.
    2. 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.
    3. Wagstaff, Adam & Paci, Pierella & van Doorslaer, Eddy, 1991. "On the measurement of inequalities in health," Social Science & Medicine, Elsevier, vol. 33(5), pages 545-557, January.
    4. Government of India, 2017. "National Health Policy 2017," Working Papers id:11664, eSocialSciences.
    5. Jelena Arsenijevic & Milena Pavlova & Bernd Rechel & Wim Groot, 2016. "Catastrophic Health Care Expenditure among Older People with Chronic Diseases in 15 European Countries," PLOS ONE, Public Library of Science, vol. 11(7), pages 1-18, July.
    6. Shankar Prinja & Pankaj Bahuguna & Andrew D Pinto & Atul Sharma & Gursimer Bharaj & Vishal Kumar & Jaya Prasad Tripathy & Manmeet Kaur & Rajesh Kumar, 2012. "The Cost of Universal Health Care in India: A Model Based Estimate," PLOS ONE, Public Library of Science, vol. 7(1), pages 1-9, January.
    7. Karan, Anup & Yip, Winnie & Mahal, Ajay, 2017. "Extending health insurance to the poor in India: An impact evaluation of Rashtriya Swasthya Bima Yojana on out of pocket spending for healthcare," Social Science & Medicine, Elsevier, vol. 181(C), pages 83-92.
    8. Kakwani, Nanak & Wagstaff, Adam & van Doorslaer, Eddy, 1997. "Socioeconomic inequalities in health: Measurement, computation, and statistical inference," Journal of Econometrics, Elsevier, vol. 77(1), pages 87-103, March.
    9. Xander Koolman & Eddy van Doorslaer, 2004. "On the interpretation of a concentration index of inequality," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 649-656, July.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Hajizadeh, Mohammad & Pandey, Sujita & Pulok, Mohammad Habibullah, 2023. "Decomposition of socioeconomic inequalities in catastrophic out-of-pocket expenditure for healthcare in Canada," Health Policy, Elsevier, vol. 127(C), pages 51-59.
    2. Hajizadeh, Mohammad & Nandi, Arijit & Heymann, Jody, 2014. "Social inequality in infant mortality: What explains variation across low and middle income countries?," Social Science & Medicine, Elsevier, vol. 101(C), pages 36-46.
    3. Hajizadeh, Mohammad & Hu, Min & Bombay, Amy & Asada, Yukiko, 2018. "Socioeconomic inequalities in health among Indigenous peoples living off-reserve in Canada: Trends and determinants," Health Policy, Elsevier, vol. 122(8), pages 854-865.
    4. Tavares, Lara Patrício & Zantomio, Francesca, 2017. "Inequity in healthcare use among older people after 2008: The case of southern European countries," Health Policy, Elsevier, vol. 121(10), pages 1063-1071.
    5. Ziebarth, Nicolas, 2010. "Measurement of health, health inequality, and reporting heterogeneity," Social Science & Medicine, Elsevier, vol. 71(1), pages 116-124, July.
    6. H. Eme Ichoku & William Fonta & Michael Thiede, 2011. "Socioeconomic gradients in self-rated health: a developing country case study of Enugu State, Nigeria," Economic Change and Restructuring, Springer, vol. 44(3), pages 179-202, August.
    7. Razzolini, Tiziano & Leombruni, Roberto & Mastrobuoni, Giovanni & Pagliero, Mario, 2014. "Beneath the surface: The decline in gender injury gap," Labour Economics, Elsevier, vol. 30(C), pages 282-288.
    8. Lu, Jui-fen R. & Leung, Gabriel M. & Kwon, Soonman & Tin, Keith Y.K. & Van Doorslaer, Eddy & O'Donnell, Owen, 2007. "Horizontal equity in health care utilization evidence from three high-income Asian economies," Social Science & Medicine, Elsevier, vol. 64(1), pages 199-212, January.
    9. Lumme, Sonja & Sund, Reijo & Leyland, Alastair H. & Keskimäki, Ilmo, 2012. "Socioeconomic equity in amenable mortality in Finland 1992–2008," Social Science & Medicine, Elsevier, vol. 75(5), pages 905-913.
    10. McGovern, Mark E., 2014. "Comparing the relationship between stature and later life health in six low and middle income countries," The Journal of the Economics of Ageing, Elsevier, vol. 4(C), pages 128-148.
    11. Olufunke Alaba & Lumbwe Chola, 2014. "Socioeconomic Inequalities in Adult Obesity Prevalence in South Africa: A Decomposition Analysis," IJERPH, MDPI, vol. 11(3), pages 1-20, March.
    12. Mototsugu Fukushige & Noriko Ishikawa & Satoko Maekawa, 2012. "A modified Kakwani measure for health inequality," Health Economics Review, Springer, vol. 2(1), pages 1-7, December.
    13. Sato, Azusa, 2012. "Do Inequalities in Health Care Utilization in Developing Countries Change When We Take into Account Traditional Medicines?," World Development, Elsevier, vol. 40(11), pages 2275-2289.
    14. N. N., 2015. "WIFO-Monatsberichte, Heft 8/2015," WIFO Monatsberichte (monthly reports), WIFO, vol. 88(8), August.
    15. Eibhlin Hudson & David Madden & Irene Mosca, 2015. "A Formal Investigation of Inequalities in Health Behaviours After Age 50 on the Island of Ireland," The Economic and Social Review, Economic and Social Studies, vol. 46(2), pages 233-265.
    16. Lahiri, Kajal & Pulungan, Zulkarnain, 2007. "Income-related health disparity and its determinants in New York state: racial/ethnic and geographical comparisons," MPRA Paper 21694, University Library of Munich, Germany.
    17. Hosung Shin & Han-A Cho & Bo-Ra Kim, 2021. "Dental Expenditure by Household Income in Korea over the Period 2008–2017: A Review of the National Dental Insurance Reform," IJERPH, MDPI, vol. 18(8), pages 1-11, April.
    18. Philip Clarke & Tom Van Ourti, 2009. "Correcting the Bias in the Concentration Index when Income is Grouped," CEPR Discussion Papers 599, Centre for Economic Policy Research, Research School of Economics, Australian National University.
    19. John E. Ataguba, 2022. "A short note revisiting the concentration index: Does the normalization of the concentration index matter?," Health Economics, John Wiley & Sons, Ltd., vol. 31(7), pages 1506-1512, July.
    20. Baltica Cabieses & Richard Cookson & Manuel Espinoza & Gillian Santorelli & Iris Delgado, 2015. "Did Socioeconomic Inequality in Self-Reported Health in Chile Fall after the Equity-Based Healthcare Reform of 2005? A Concentration Index Decomposition Analysis," PLOS ONE, Public Library of Science, vol. 10(9), pages 1-21, September.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0205510. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.