Academic journal article Bulletin of the World Health Organization

Variations in Catastrophic Health Expenditure Estimates from Household Surveys in India/ Estimation Des Variations Des Depenses De Sante Catastrophiques a Partir D'enquetes Menees Aupres Des Menages En Inde/Variaciones En Las Estimaciones De Los Gastos Sanitarios Catastroficos En la India

Academic journal article Bulletin of the World Health Organization

Variations in Catastrophic Health Expenditure Estimates from Household Surveys in India/ Estimation Des Variations Des Depenses De Sante Catastrophiques a Partir D'enquetes Menees Aupres Des Menages En Inde/Variaciones En Las Estimaciones De Los Gastos Sanitarios Catastroficos En la India

Article excerpt

Introduction

Out-of-pocket (OOP) payments are the primary source of health-care financing in many countries. (1) In 2004-05, OOP payments in India were estimated to account for approximately two thirds of total health expenditure (2) and fewer than 10% of households had health insurance for at least one member. (3) OOP payments are considered "catastrophic" when they drive households into having to reduce expenditure on basic necessities. (4) The proportion of households that incur catastrophic health expenditure (CHE) in a country is widely used as an indicator of the extent to which the health system protects households needing health care against financial hardship. Offering such protection is a major goal of health systems and is the purpose behind universal health coverage. (4-10)

In many countries, household surveys--some focused on consumer expenditure and others on health--are the main sources of data on households' OOP payments for health care. (1) The estimates of OOP payments vary substantially between surveys depending on survey type, type of respondents and the survey methods used, such as the length of the recall period or the number of items included in the survey questionnaire. (1,11-17) In India, data on household expenditure are routinely available from National Sample Survey Organisation surveys on consumer expenditure and from special survey rounds on health. (18,19) All of these surveys exert an important influence on health policy because they are the sources of data for programme and policy assessment (9,10,20,21) and for the preparation of the national health accounts. (2,22) Other health-focused household surveys have also recently collected information on household expenditure (23,24) Although these surveys have all been used to estimate CHE and OOP payments in India, no one has ever assessed whether the estimates obtained from them are comparable.

For this paper, we generated household OOP payments and CHE estimates using data from five national and multi-state household surveys conducted in India since the year 2000 and we compared the results. We also examined and compared the number and type of household expenditure items included in each survey questionnaire to try to explain the variability in OOP payment and CHE estimates across surveys. This exercise may prove useful in standardizing survey methods to obtain CHE estimates that are valid and consistent.

Methods

Data sources

Table 1 shows the characteristics of the five surveys that have collected data on health expenditure and other expenditure in India since the year 2000. The surveys are of two types: consumer expenditure surveys and health-focused surveys.

Consumer expenditure surveys

We obtained data from the National Sample Survey on Household Consumer Expenditure, which was conducted in all Indian states in 2004-05 (NSS 2004-05) (25) and 2009-10 (18) (NSS 2009-10). These surveys collected data on expenditure for any health service, whether or not the household paid for the service. The expenditure data thus collected is considered an approximation of OOP payments, since most private payments for health care in India are made out of pocket. NSS 2009-10 was conducted in two parts--Type I and Type II--with a different questionnaire for each one. The Type I survey used the same questionnaire as NSS 2004-05 and hence was used for all analyses; in the Type II survey, the recall period for food expenditure differed from the one that was used in the Type I survey.

Health-focused surveys

We analysed data on OOP payments from the World Health Survey conducted in 2003 (WHS 2003); (23) the National Sample Survey on Morbidity, Health Care and the Condition of the Aged conducted in 2004 (NSS 2004), (19) and the Study on Global Ageing and Adult Health conducted in 2007-08 (SAGE 2007-08). (24) The WHS 2003 and SAGE 2007-08 were conducted in six states that were selected to be representative of India geographically and in level of development; (23) the NSS 2004 was conducted in all Indian states. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.