Assessing the magnitude, distribution and determinants of catastrophic health expenditure in urban Lucknow, North India

Abstract

Available online xxxKeywords: Catastrophic health expenditure Determinants Out of pocket payment Hospitalization India a b s t r a c t Introduction: To assess the magnitude, distribution, and determinants of catastrophic health expenditures (CHE) of households in urban Lucknow, North India.Methods: A cohort of 400 households was selected by 2-step cluster sampling and baseline demographic survey was done followed by two six-monthly health surveys. CHE was defined as health expenditures !10% of household's capacity to pay, measured by nonsubsistence spending.Results: From December 2011 to June 2012, 157/400 (39.25%) households reported !1 episodes of illness, with households suffering sickness in the first survey at increased risk for it in the second (Crude Odd's Ratio ¼ 3.33, 95% CI: 2.02e5.45; p value <0.0001). Mean sickness days without hospitalization were 13.13 AE 36 per household. In 24 (6%) households, there was !1 hospitalization. Health expenditure was entirely met through out of pocket payments (OOP). CHE occurred in 45 (11.25%) households, with statistically significant differences across per capita income quintiles (p ¼ 0.036) and 60% falling in the lower two. On logistic regression model, adjusting for per capital income quintile, CHE was associated with hospitalization (Adjusted OR ¼ 100, 95% CI: 25.00e333.33; p < 0.0001) and >13 sickness days without hospitalization (Adjusted OR ¼ 4.21, 95% CI: 1.862e9.524;Conclusions: Since not only hospitalization but also prolonged sickness days without hospitalization was associated with increased risk of CHE, and since almost half the households have sickness, steps should be taken to protect all households from financial hardship through tax based health financing, social health insurance or other forms of prepayment, as currently all health expenses were met through OOP payments.

Determinants of Household Catastrophic Health Expenditure: A Systematic Review

“…A total of 25 studies investigated the relationship between family size and incurring CHE ( 15 , 16 , 18 – 22 , 24 – 28 , 31 – 43 ). Five studies found that the relationship is not significant ( 16 , 19 , 36 , 38 , 41 ), ten studies found that a large family size is a risk factor ( 18 , 20 , 22 , 24 , 26 , 31 , 32 , 34 , 35 , 40 ) and ten found that a small family size is associated with a higher risk ( 15 , 21 , 25 , 27 , 28 , 33 , 37 , 39 , 42 , 43 ).…”

Assessing the economic burden of illness for tuberculosis patients in Benin: determinants and consequences of catastrophic health expenditures and inequities

“…Targeted protection interventions are highly expected (Pal ; Misra et al . ). Even if universal coverage is a promising development, the specific disease programme should continue to be subsidised.…”

“…; Misra et al . ), and indirect and coping costs (Laokri et al ., ) must be addressed. Further analysis of the long‐term consequences of potentially irreversible coping strategies is needed to comprehensively apprehend illness poverty gap.…”

Mapping healthcare systems: a policy relevant analytic tool

“…The low level of public spending and high cost-sharing, result in very high rates of catastrophic expenditures for the Indian people. 39 , 46 – 50 …”