Exploring the determinants of catastrophic health expenditure and socioeconomic horizontal equity in relation to it: a rural community based longitudinal study in West Bengal

Authors

  • Abhishek Paul Department of Community Medicine, Burdwan Medical College, Burdwan, West Bengal
  • Suresh Chandra Malick Department of Community Medicine, Calcutta National Medical College, Kolkata, Kolkata, West Bengal
  • Shatanik Mondal Department of Community Medicine, Malda Medical College, Malda, West Bengal
  • Saibendu Kumar Lahiri Department of Community Medicine, R.G. Kar Medical College, Kolkata, West Bengal

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20182189

Keywords:

Catastrophic health expenditure, Concentration index, Equity

Abstract

Background:Equity in health care is defined as equal access to available care for equal need. Out-of-pocket expenditures are the most inequitable means of health care financing. These payments become catastrophic health expenditure (CHE) if it exceeds the household’s ‘Capacity to Pay’. As fairness is one of the fundamental objectives of the health system, identification of the factors responsible for these expenditures is important. Hence this study was conducted to find out the determinants of CHE and to explore the socioeconomic horizontal equity in relation to it.

Methods:Total 352 households from 9 villages of Amdanga block, North 24 Parganas, were studied for 12 months. Annual out-of-pocket healthcare expenditure exceeding 40% of annual household non-food expenditure was classified as CHE and determinants of the same were identified using logit-model. Equity was measured by Concentration index and modified Kakwani measure (MDK).

Results:Overall prevalence of CHE was 20.7% and highest (39.3%) in the second income quintile. The odds of incurring CHE were highest (35.43) for the households with member/s requiring inpatient treatment followed by households having more than five members (12.81). Negative value of concentration index and MDK indicated that the probability of incurring CHE was disproportionately concentrated among the poor and the financing system was degressive, however some amount of equity was noted in the poorest quintile.

Conclusions:Apart from the poorest section in the community the poorer and middle income sections are still exposed to healthcare expenditure shocks and the health care spending was diverse and less equitable.

Author Biography

Abhishek Paul, Department of Community Medicine, Burdwan Medical College, Burdwan, West Bengal

Department of Community Medicine; Contractual Medical Officer (Specialist)

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Published

2018-05-22

How to Cite

Paul, A., Malick, S. C., Mondal, S., & Lahiri, S. K. (2018). Exploring the determinants of catastrophic health expenditure and socioeconomic horizontal equity in relation to it: a rural community based longitudinal study in West Bengal. International Journal Of Community Medicine And Public Health, 5(6), 2522–2528. https://doi.org/10.18203/2394-6040.ijcmph20182189

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Original Research Articles