ArticleInternational journal for equity in health2021
Addressing data and methodological limitations in estimating catastrophic health spending and impoverishment in India, 2004-18.
Article in International journal for equity in health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
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20 citing papers in PubMed, 64 citations in OpenAlex.
- Effect of kangaroo mother care initiated in community settings on financial risk protection of low-income households: a randomised controlled trial in Haryana, India.BMJ global health · 2022Trial
- Economic gradients of health insurance coverage in India.Frontiers in public health · 2026Article
- Catastrophic and impoverishing impacts of health expenditures: a focus on non-communicable diseases in Pokhara Metropolitan City, Nepal.BMC public health · 2025Article
- District-level monitoring of universal health coverage, India.Bulletin of the World Health Organization · 2024Article
- The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) after four years of implementation - is it making an impact on quality of inpatient care and financial protection in India?BMC health services research · 2024Article
- Incidence and intensity of catastrophic health expenditure and impoverishment among the elderly: an empirical evidence from India.Scientific reports · 2024Article
- Hospitalisation expenditure on tuberculosis among tribal populations in India: A repeated cross-sectional analysis of national sample survey data, 2004 to 2018.Public health in practice (Oxford, England) · 2024Article
- Rural‒urban disparities in household catastrophic health expenditure in Bangladesh: a multivariate decomposition analysis.International journal for equity in health · 2024Article
- Prevalence and predictors of insomnia and its treatment-seeking among older adults in India.Journal of activity, sedentary and sleep behaviors · 2024Article
- Are institutional deliveries equitable in the southern states of India? A benefit incidence analysis.International journal for equity in health · 2024Article
- Catastrophic health expenditure associated with non-inpatient costs among middle-aged and older individuals in China.Frontiers in public health · 2024Article
- Cancer care and economic burden-A narrative review.Journal of family medicine and primary care · 2023Review
- Catastrophic health expenditure and its association with socioeconomic status in China: evidence from the 2011-2018 China Health and Retirement Longitudinal Study.International journal for equity in health · 2023Article
- Evolution of Government-funded health insurance for universal health coverage in India.The Lancet regional health. Southeast Asia · 2023Review
- Financial risk protection from out-of-pocket health spending in low- and middle-income countries: a scoping review of the literature.Health research policy and systems · 2022Article
- What fragile factors hinder the pace of China's alleviation efforts of the poverty-stricken population? A study from the perspective of impoverishment caused by medical expenses.BMC health services research · 2022Article
- Components of Out-of-Pocket Expenditure and Their Relative Contribution to Economic Burden of Diseases in India.JAMA network open · 2022Article
- Financial risk protection in health care in Bangladesh in the era of Universal Health Coverage.PloS one · 2022Article
- Out-of-pocket expenditure on medicines in Bangladesh: An analysis of the national household income and expenditure survey 2016-17.PloS one · 2022Article
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Authors and funding
2 authors at 1 institution in 1 country.
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Abstract
backgroundEstimates of catastrophic health expenditure (CHE) are counterintuitive to researchers, policy makers, and developmental partners due to data and methodological limitation. While inferences drawn from use of capacity-to-pay (CTP) and budget share (BS) approaches are inconsistent, the non-availability of data on food expenditure in the health survey in India is an added limitation.
methodsUsing data from the health and consumption surveys of National Sample Surveys over 14 years, we have overcome these limitations and estimated the incidence and intensity of CHE and impoverishment using the CTP approach.
resultsThe incidence of CHE for health services in India was 12.5% in 2004, 13.4% in 2014 and 9.1% by 2018. Among those households incurring CHE, they spent 1.25 times of their capacity to pay in 2004 (intensity of CHE), 1.71 times in 2014 and 1.31 times by 2018. The impoverishment due to health spending was 4.8% in 2004, 5.1% in 2014 and 3.3% in 2018. The state variations in incidence and intensity of CHE and incidence of impoverishment is large. The concentration index (CI) of CHE was - 0.16 in 2004, - 0.18 in 2014 and - 0.22 in 2018 suggesting increasing inequality over time. The concentration curves based on CTP approach suggests that the CHE was concentrated among poor. The odds of incurring CHE were lowest among the richest households [OR 0.22; 95% CI: 0.21, 0.24], households with elderly members [OR 1.20; 95% CI:1.12, 1.18] and households using both inpatient and outpatient services [OR 2.80, 95% CI 2.66, 2.95]. Access to health insurance reduced the chance of CHE and impoverishment among the richest households. The pattern of impoverishment was similar to that of CHE.
conclusionIn the last 14 years, the CHE and impoverishment in India has declined while inequality in CHE has increased.
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