Catastrophic out-of-pocket payment for healthcare and implications for household coping strategies: evidence from West Bengal, India

Purpose: To identify the relative risks of catastrophic healthcare expenditures for different types of health need, and the impact of such expenditure on household coping strategies. Methods: Using data from a household survey in West Bengal, the risks of incurring ‘catastrophic' healthcare expenditures relating to hospitalization, ambulatory care, chronic illness and delivery were estimated using a logistic regression. A regression model was then used to estimate the relationship between the incidence of catastrophic expenditures at different threshold levels and an ‘Aggregate Coping Index', constructed using principle components analysis. Results: The proportion of households in which a member required hospitalization who experienced catastrophic healthcare expenditure was more than three times that for those where a member had a chronic illness but was not hospitalized. However, in the logistic regression model the likelihood of catastrophic expenditure relating to chronic care was around twice that for hospitalization. Catastrophic expenditure on care, irrespective of the precise threshold we adopt, was significantly correlated with our coping strategy index. Conclusions: Catastrophic health spending is an important problem for the population in West Bengal. More attention is needed on the poverty-inducing effects of long-term expenditures on chronic illness, given that existing schemes only address hospitalization.