Variations in catastrophic health expenditure across the states of India: 2004 to 2014
Financial protection is a key dimension of universal health coverage. Catastrophic health expenditure (CHE) has increased in India over time. The overall figures mask the subnational heterogeneity crucial for designing insurance coverage for 1.3 billion population across India. We estimated CHE in e...
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| description | Financial protection is a key dimension of universal health coverage. Catastrophic health expenditure (CHE) has increased in India over time. The overall figures mask the subnational heterogeneity crucial for designing insurance coverage for 1.3 billion population across India. We estimated CHE in every state of India and the changes over a decade.
We used National Sample Survey data on health care utilisation in 2004 and 2014. The states were placed in four groups based on epidemiological transition level (ETL), defined on the basis of ratio of disability-adjusted life-years from communicable diseases to those from non-communicable diseases and injuries combined, with a low ratio denoting high ETL state group. CHE was defined as the proportion of households that had out-of-pocket payments for health care equalling or exceeding 10% of the household expenditure. We assessed variation in the magnitude and distribution of CHE between ETL state groups and between states of India.
In 2014, CHE was higher in the high (30.3%, 95% confidence interval: 28.5 to 32.1) and higher-middle (27.4%, 26.3 to 28.6) ETL state groups than the low (21.8%, 20.8 to 22.8) and lower-middle (19.0%, 17.1 to 21.0) groups. From 2004 to 2014, CHE increased only in the high and higher-middle ETL groups (1.19 and 1.34 times, respectively). However, the individual states with substantial increase in CHE were spread across all ETL groups. The gap between the highest CHE of an individual state and the lowest was 8-fold in 2014. CHE was disproportionately concentrated among the rich in 2004 for most of India, but in 2014 CHE was distributed equally among the rich and poor because of the substantial increase in CHE among the poor over time.
Better provision of quality health care should be accompanied by financial protection measures to safeguard the poor from increasing CHE in India. The state-specific CHE trends can provide useful input for the planning of the recently launched National Health Protection Mission such that it meets the requirement of each state. |
| doi_str_mv | 10.1371/journal.pone.0205510 |
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We used National Sample Survey data on health care utilisation in 2004 and 2014. The states were placed in four groups based on epidemiological transition level (ETL), defined on the basis of ratio of disability-adjusted life-years from communicable diseases to those from non-communicable diseases and injuries combined, with a low ratio denoting high ETL state group. CHE was defined as the proportion of households that had out-of-pocket payments for health care equalling or exceeding 10% of the household expenditure. We assessed variation in the magnitude and distribution of CHE between ETL state groups and between states of India.
In 2014, CHE was higher in the high (30.3%, 95% confidence interval: 28.5 to 32.1) and higher-middle (27.4%, 26.3 to 28.6) ETL state groups than the low (21.8%, 20.8 to 22.8) and lower-middle (19.0%, 17.1 to 21.0) groups. From 2004 to 2014, CHE increased only in the high and higher-middle ETL groups (1.19 and 1.34 times, respectively). However, the individual states with substantial increase in CHE were spread across all ETL groups. The gap between the highest CHE of an individual state and the lowest was 8-fold in 2014. CHE was disproportionately concentrated among the rich in 2004 for most of India, but in 2014 CHE was distributed equally among the rich and poor because of the substantial increase in CHE among the poor over time.
Better provision of quality health care should be accompanied by financial protection measures to safeguard the poor from increasing CHE in India. The state-specific CHE trends can provide useful input for the planning of the recently launched National Health Protection Mission such that it meets the requirement of each state.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0205510</identifier><identifier>PMID: 30346971</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Catastrophic Illness - economics ; Communicable diseases ; Confidence intervals ; Economic aspects ; Epidemiology ; Expenditures ; Geography, Medical ; Health care ; Health care costs ; Health care industry ; Health care policy ; Health Expenditures - trends ; Health insurance ; Healthcare Disparities - economics ; Healthcare Disparities - trends ; Heterogeneity ; Households ; Humans ; India ; Insurance coverage ; Medicine and Health Sciences ; National health insurance ; People and Places ; Planning ; Public health ; Quality management ; Research and Analysis Methods ; Sampling methods ; Social Sciences ; Socioeconomic Factors ; Surveys ; Sustainable development</subject><ispartof>PloS one, 2018-10, Vol.13 (10), p.e0205510-e0205510</ispartof><rights>COPYRIGHT 2018 Public Library of Science</rights><rights>2018 Pandey et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2018 Pandey et al 2018 Pandey et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c758t-340bccef322c2583291f779923efd4d2004e6f26d3cb0f67556c4750fca41f8c3</citedby><cites>FETCH-LOGICAL-c758t-340bccef322c2583291f779923efd4d2004e6f26d3cb0f67556c4750fca41f8c3</cites><orcidid>0000-0001-5063-9898</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6197636/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6197636/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30346971$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pandey, Anamika</creatorcontrib><creatorcontrib>Kumar, G Anil</creatorcontrib><creatorcontrib>Dandona, Rakhi</creatorcontrib><creatorcontrib>Dandona, Lalit</creatorcontrib><title>Variations in catastrophic health expenditure across the states of India: 2004 to 2014</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Financial protection is a key dimension of universal health coverage. Catastrophic health expenditure (CHE) has increased in India over time. The overall figures mask the subnational heterogeneity crucial for designing insurance coverage for 1.3 billion population across India. We estimated CHE in every state of India and the changes over a decade.
We used National Sample Survey data on health care utilisation in 2004 and 2014. The states were placed in four groups based on epidemiological transition level (ETL), defined on the basis of ratio of disability-adjusted life-years from communicable diseases to those from non-communicable diseases and injuries combined, with a low ratio denoting high ETL state group. CHE was defined as the proportion of households that had out-of-pocket payments for health care equalling or exceeding 10% of the household expenditure. We assessed variation in the magnitude and distribution of CHE between ETL state groups and between states of India.
In 2014, CHE was higher in the high (30.3%, 95% confidence interval: 28.5 to 32.1) and higher-middle (27.4%, 26.3 to 28.6) ETL state groups than the low (21.8%, 20.8 to 22.8) and lower-middle (19.0%, 17.1 to 21.0) groups. From 2004 to 2014, CHE increased only in the high and higher-middle ETL groups (1.19 and 1.34 times, respectively). However, the individual states with substantial increase in CHE were spread across all ETL groups. The gap between the highest CHE of an individual state and the lowest was 8-fold in 2014. CHE was disproportionately concentrated among the rich in 2004 for most of India, but in 2014 CHE was distributed equally among the rich and poor because of the substantial increase in CHE among the poor over time.
Better provision of quality health care should be accompanied by financial protection measures to safeguard the poor from increasing CHE in India. The state-specific CHE trends can provide useful input for the planning of the recently launched National Health Protection Mission such that it meets the requirement of each state.</description><subject>Catastrophic Illness - economics</subject><subject>Communicable diseases</subject><subject>Confidence intervals</subject><subject>Economic aspects</subject><subject>Epidemiology</subject><subject>Expenditures</subject><subject>Geography, Medical</subject><subject>Health care</subject><subject>Health care costs</subject><subject>Health care industry</subject><subject>Health care policy</subject><subject>Health Expenditures - trends</subject><subject>Health insurance</subject><subject>Healthcare Disparities - economics</subject><subject>Healthcare Disparities - trends</subject><subject>Heterogeneity</subject><subject>Households</subject><subject>Humans</subject><subject>India</subject><subject>Insurance coverage</subject><subject>Medicine and Health Sciences</subject><subject>National health insurance</subject><subject>People and Places</subject><subject>Planning</subject><subject>Public health</subject><subject>Quality management</subject><subject>Research and Analysis Methods</subject><subject>Sampling methods</subject><subject>Social Sciences</subject><subject>Socioeconomic Factors</subject><subject>Surveys</subject><subject>Sustainable development</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNkluLGyEUx4fS0r2036C0QmFpH5J6G830obAsvQQWFnrJqxjnmBgmY1adsv32dZLZJVP2oYgox9_5Hz3-i-IVwVPCJPmw8V1odTPd-RammOKyJPhJcUoqRieCYvb0aH9SnMW4wbhkMyGeFycMMy4qSU6LxUIHp5PzbUSuRUYnHVPwu7UzaA26SWsEdztoa5e6AEib4GNEaQ0oJp0gIm_RPJ_qj4hizFHyeSX8RfHM6ibCy2E9L359-fzz6tvk-ubr_OryemJkOUsTxvHSGLCMUkPLGaMVsVJWFWVga173iiAsFTUzS2yFLEthuCyxNZoTOzPsvHhz0N01PqqhJVFRQjnJc0YyMT8QtdcbtQtuq8Mf5bVT-4APK6VDcqYBZYGDpIKArZZcmlrTvgy1DBOS6_dan4Zq3XILtYE2Bd2MRMcnrVurlf-tBKmkYCILvBsEgr_tICa1ddFA0-gWfNffmwksSrpH3_6DPv66gVrp_ADXWp_rml5UXZZlJYjkjGVq-giVRw1bZ7J_rMvxUcL7UUJmEtylle5iVPMf3_-fvVmM2Ysj9uCv6Jtu778xyA_g3m8B7EOTCVa9_e-7oXr7q8H-Oe318Qc9JN37nf0Fet79Tw</recordid><startdate>20181022</startdate><enddate>20181022</enddate><creator>Pandey, Anamika</creator><creator>Kumar, G Anil</creator><creator>Dandona, Rakhi</creator><creator>Dandona, Lalit</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0001-5063-9898</orcidid></search><sort><creationdate>20181022</creationdate><title>Variations in catastrophic health expenditure across the states of India: 2004 to 2014</title><author>Pandey, Anamika ; Kumar, G Anil ; Dandona, Rakhi ; Dandona, Lalit</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c758t-340bccef322c2583291f779923efd4d2004e6f26d3cb0f67556c4750fca41f8c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Catastrophic Illness - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pandey, Anamika</au><au>Kumar, G Anil</au><au>Dandona, Rakhi</au><au>Dandona, Lalit</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Variations in catastrophic health expenditure across the states of India: 2004 to 2014</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2018-10-22</date><risdate>2018</risdate><volume>13</volume><issue>10</issue><spage>e0205510</spage><epage>e0205510</epage><pages>e0205510-e0205510</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Financial protection is a key dimension of universal health coverage. Catastrophic health expenditure (CHE) has increased in India over time. The overall figures mask the subnational heterogeneity crucial for designing insurance coverage for 1.3 billion population across India. We estimated CHE in every state of India and the changes over a decade.
We used National Sample Survey data on health care utilisation in 2004 and 2014. The states were placed in four groups based on epidemiological transition level (ETL), defined on the basis of ratio of disability-adjusted life-years from communicable diseases to those from non-communicable diseases and injuries combined, with a low ratio denoting high ETL state group. CHE was defined as the proportion of households that had out-of-pocket payments for health care equalling or exceeding 10% of the household expenditure. We assessed variation in the magnitude and distribution of CHE between ETL state groups and between states of India.
In 2014, CHE was higher in the high (30.3%, 95% confidence interval: 28.5 to 32.1) and higher-middle (27.4%, 26.3 to 28.6) ETL state groups than the low (21.8%, 20.8 to 22.8) and lower-middle (19.0%, 17.1 to 21.0) groups. From 2004 to 2014, CHE increased only in the high and higher-middle ETL groups (1.19 and 1.34 times, respectively). However, the individual states with substantial increase in CHE were spread across all ETL groups. The gap between the highest CHE of an individual state and the lowest was 8-fold in 2014. CHE was disproportionately concentrated among the rich in 2004 for most of India, but in 2014 CHE was distributed equally among the rich and poor because of the substantial increase in CHE among the poor over time.
Better provision of quality health care should be accompanied by financial protection measures to safeguard the poor from increasing CHE in India. The state-specific CHE trends can provide useful input for the planning of the recently launched National Health Protection Mission such that it meets the requirement of each state.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>30346971</pmid><doi>10.1371/journal.pone.0205510</doi><tpages>e0205510</tpages><orcidid>https://orcid.org/0000-0001-5063-9898</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Catastrophic Illness - economics Communicable diseases Confidence intervals Economic aspects Epidemiology Expenditures Geography, Medical Health care Health care costs Health care industry Health care policy Health Expenditures - trends Health insurance Healthcare Disparities - economics Healthcare Disparities - trends Heterogeneity Households Humans India Insurance coverage Medicine and Health Sciences National health insurance People and Places Planning Public health Quality management Research and Analysis Methods Sampling methods Social Sciences Socioeconomic Factors Surveys Sustainable development |
| title | Variations in catastrophic health expenditure across the states of India: 2004 to 2014 |
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