Catastrophic household expenditure on health in an urban slum: a cross-sectional survey

Abstract

INTRODUCTIONThe World Health Report 2000 identified financial protection against the costs of ill health as a fundamental objective of health systems, on the premise that a fair health system ensures households make health care payments according to their ability to pay rather than the risk of illness.1 Out-of-pocket expenditures are nonreimbursable fees which a patient or family is responsible for paying directly to health practitioners or suppliers, without intervention of a third party.It often occurs, when publicly funded facilities are unable to provide the required health services and supplies for free or through insurance. Health policies are concerned not only with improving health status of population but also with protecting households from financial catastrophe of illness.2 Out-of-pocket spending on health in the previous 30 days that exceeded 10% of the household's total expenditure over the same period was considered to be catastrophic. India was ranked as having the 42 nd highest average out of pocket expenditure with 74.4% of private expenditure being paid as out of pocket. ABSTRACT Background:The World Health Report 2000 identified financial protection against the costs of ill health as a fundamental objective of health systems. Out-of-pocket expenditure accounts for an average increase in poverty by 2.9 percent for urban India. Therefore, this study aims at evaluating the out-of-pocket health expenditures as well as assessing the predictors of catastrophic health costs care in urban slums. The objectives was to find the prevalence of catastrophic household expenditures on health and to assess the determinants and illnesses commonly associated with catastrophic household expenditure on health. Methods: The study was conducted in a notified urban slum of Shivamogga district which was selected randomly and all the households were included in the study. Data was collected after informed consent using pre-tested semistructured questionnaire and analyzed in SPSS vs18. Results: Out of 197 households, 94 (47.7%) households experienced catastrophic health expenditure in past one month. Most common conditions associated with catastrophic expenditure were respiratory infections (cough, cold and fever; p-0.034), arthritis (p-0.001), hypertension (p<0.01) and diabetes (p-0.015). Conclusions: We conclude that almost half of the community incurred catastrophic health expenses. Findings have important policy implications and can be used to ensure higher degree of financial protection against the economic impact of illnesses.