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Trends in catastrophic health expenditure in India: 1993 to 2014

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Pandey, Anamika, Ploubidis, George B, Clarke, Lynda, Dandona, Lalit·2018·Bulletin of the World Health Organization
DOI 10.2471/blt.17.191759PMC PMC5791868
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Abstract

OBJECTIVE: To investigate trends in out-of-pocket health-care payments and catastrophic health expenditure in India by household age composition. METHODS: We obtained data from four national consumer expenditure surveys and three health-care utilization surveys conducted between 1993 and 2014. Households were divided into five groups by age composition. We defined catastrophic health expenditure as out-of-pocket payments equalling or exceeding 10% of household expenditure. Factors associated with catastrophic expenditure were identified by multivariable analysis. FINDINGS: Overall, the proportion of catastrophic health expenditure increased 1.47-fold between the 1993-1994 expenditure survey (12.4%) and the 2011-2012 expenditure survey (18.2%) and 2.24-fold between the 1995-1996 utilization survey (11.1%) and the 2014 utilization survey (24.9%). The proportion increased more in the poorest than the richest quintile: 3.00-fold versus 1.74-fold, respectively, across the utilization surveys. Catastrophic expenditure was commonest among households comprising only people aged 60 years or older: the adjusted odds ratio (aOR) was 3.26 (95% confidence interval, CI: 2.76-3.84) compared with households with no older people or children younger than 5 years. The risk was also increased among households with both older people and children (aOR: 2.58; 95% CI: 2.31-2.89), with a female head (aOR: 1.32; 95% CI: 1.19-1.47) and with a rural location (aOR: 1.27; 95% CI: 1.20-1.35). CONCLUSION: The proportion of households experiencing catastrophic health expenditure in India increased over the past two decades. Such expenditure was highest among households with older people. Financial protection mechanisms are needed for population groups at risk for catastrophic health expenditure.

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  • The review's findings are consistent with findings in comparable regions such as Southeast Asia and South America.

    “Our findings are consistent with findings in comparable regions such as Southeast Asia [105, 106] and South America [107, 108].”

    From Factors associated with catastrophic health expenditure in sub-Saharan Africa: A systematic review (2022) · cites this paper as [106]

    The Methods and Results describe surveys of Indian households, not findings from Southeast Asia or South America. The Discussion mentions studies in other countries, and the References list work on Thailand and Brazil, but our copy does not establish that the citing review’s findings are consistent with findings in both regions (searched: Southeast Asia, South America, and country-specific comparisons). (LLM, conf=0.76)

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Research works printed but not linked: 33

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Metadata

Authors
Pandey, A., Ploubidis, G. B., Clarke, L., & Dandona, L.
Affiliations
  • Public Health Foundation of India (IN)
  • University College London (GB)
  • London School of Hygiene & Tropical Medicine (GB)
Corresponding author
Pandey, Anamika
ORCID
Venue
Bulletin of the World Health Organization
Publisher
WHO Press
Published
2017-11-30
Volume
96
Issue
1
Pages
18-28
ISSN
0042-9686 (ISSN-L)
DOI
10.2471/blt.17.191759
PMC
PMC5791868
OpenAlex
W2780496980
Cited by
238
References
2
Citations by year
2026: 14 · 2025: 20 · 2024: 27 · 2023: 42 · 2022: 41 · 2021: 40 · 2020: 32 · 2019: 16 · 2018: 6
FWCI
21.44
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Bulletin of the World Health Organization (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Funders
  • University of Washington
  • London School of Hygiene and Tropical Medicine
  • Wellcome Trust
  • Institute for Health Metrics and Evaluation
  • Public Health Foundation of India
  • Economic and Social Research Council (ES/G040923/1, ES/M001660/1)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Reforms
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Financial Impacts of Cancer
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Global Health Care Issues
Keywords
catastrophic health expenditure, out-of-pocket health payments, older adults, financial protection, poverty, urban-rural differences, female-headed households, India, health care financing
MeSH terms
Adolescent, Adult, Catastrophic Illness, Child, Health Expenditures, Family Characteristics, Female, Financing, Personal, Health Services, Humans, India, Middle Aged, Poverty, Social Class

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