Scourge of out-of-pocket expenditure on health: A study on its burden and predictors in a rural community of West Bengal
Authors
Pritam Ghosh
NTEP Consultant, World Health Organization, India
Sanjoy Sadhukhan
Department of Epidemiology, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India
Aparajita Dasgupta
Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India
Bobby Paul
Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India
Sauryadripta Ghose
Department of Community Medicine, ESI MC, Kolkata, West Bengal, India
Aloke Biswas
Department of Community Medicine, AIIMS, Kalyani, West Bengal, India
Keywords:
Catastrophic expenditure, cost for illness, health cost, health insurance, out-of-pocket expenses
Abstract
ABSTRACT
Introduction:
Globally, one-third of current health expenditure had been out-of-pocket expenditure (OOPE). The health system financing of almost all low- and middle-income countries including India rely heavily on out-of-pocket (OOP) payments for health care. OOPE on health payments is particularly hard on any community, especially the poor leading to incomplete or even no treatment during their ill health. This study estimated OOPE among residents of a rural community in West Bengal and explored the associated factors with high OOP expenses.
Methods:
A community-based cross-sectional study was conducted in a rural community in Singur, West Bengal from June 2019 to February 2020. The study was done among 398 villagers selected from 15 clusters or villages. Households were randomly selected in each village. All members of the selected households were interviewed. SPSS was used for data analysis both for descriptive and inferential statistics.
Results:
Only 14.6% of morbid persons had catastrophic expenditure. The incidence of catastrophic expenditure was higher among those who opted for private practitioners and or ayurveda, yoga and naturopathy, unani, siddha, and homeopathy (AYUSH) facilities. There was zero catastrophic expenditure for the unqualified sector. There was an increasing trend of OOP payments among the lower socioeconomic groups. Again, low-income individuals had a higher share in cumulative expenditure (Gini coefficient of 0.35). Most of the participants (78.4%) had no health insurance coverage.
Conclusion:
Promotion for higher utilization of public health facilities may reduce the burden of OOP expenses. Government health insurance schemes must be widened with the inclusion of coverage of outpatient services. Integrating AYUSH services in the public sector is another option to reduce OOP expenses.
Keywords: Catastrophic expenditure, cost for illness, health cost, health insurance, out-of-pocket expenses
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