Economic burden, impoverishment, and coping mechanisms associated with out-of-pocket health expenditure in India: A disaggregated analysis at the state level

Abstract

Introduction: The high share of out-of-pocket (OOP) health expenditure imposes an extreme financial burden on households, and they have to incur a substantial amount of expenditure to avail health care services. This study analyses the inter-state differentials in the economic burden of OOP health expenditure, resultant impoverishment impact, and sources of finance used as coping mechanisms. Materials and methods: The study is based on health expenditure survey, namely the 71 st Round on “Key Indicators of Social Consumption in India: Health,” (2014) conducted in India by the National Sample Survey Organisation. The study uses headcount, payment gap, and concentration index to measure the economic burden, impoverishment impact of OOP health expenditure, and the level of inequality. Results: On the basis of results, the states can be divided into four distinct categories: (1) States with low economic burden and low poverty impact of OOP health expenditure, (2) low economic burden and high poverty impact of OOP health expenditure, (3) high economic burden and low poverty impact of OOP health expenditure, and (4) high economic burden and high poverty impact of OOP health expenditure. Conclusions: Inter-state differentials in OOP health expenditure and impoverishment need proper attention of the government especially the policy makers.