Deprecated (16384): The ArrayAccess methods will be removed in 4.0.0.Use getParam(), getData() and getQuery() instead. - /home/brlfuser/public_html/src/Controller/ArtileDetailController.php, line: 150
 You can disable deprecation warnings by setting `Error.errorLevel` to `E_ALL & ~E_USER_DEPRECATED` in your config/app.php. [CORE/src/Core/functions.php, line 311]
Code Context


        trigger_error($message, E_USER_DEPRECATED);

    }
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 You can disable deprecation warnings by setting `Error.errorLevel` to `E_ALL & ~E_USER_DEPRECATED` in your config/app.php.'
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deprecationWarning - CORE/src/Core/functions.php, line 311
Cake\Http\ServerRequest::offsetGet() - CORE/src/Http/ServerRequest.php, line 2421
App\Controller\ArtileDetailController::index() - APP/Controller/ArtileDetailController.php, line 150
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Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
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Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Http\Runner::run() - CORE/src/Http/Runner.php, line 51
Cake\Http\Server::run() - CORE/src/Http/Server.php, line 98

Deprecated (16384): The ArrayAccess methods will be removed in 4.0.0.Use getParam(), getData() and getQuery() instead. - /home/brlfuser/public_html/src/Controller/ArtileDetailController.php, line: 151
 You can disable deprecation warnings by setting `Error.errorLevel` to `E_ALL & ~E_USER_DEPRECATED` in your config/app.php. [CORE/src/Core/functions.php, line 311]
Code Context


        trigger_error($message, E_USER_DEPRECATED);

    }
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 You can disable deprecation warnings by setting `Error.errorLevel` to `E_ALL & ~E_USER_DEPRECATED` in your config/app.php.'
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deprecationWarning - CORE/src/Core/functions.php, line 311
Cake\Http\ServerRequest::offsetGet() - CORE/src/Http/ServerRequest.php, line 2421
App\Controller\ArtileDetailController::index() - APP/Controller/ArtileDetailController.php, line 151
Cake\Controller\Controller::invokeAction() - CORE/src/Controller/Controller.php, line 610
Cake\Http\ActionDispatcher::_invoke() - CORE/src/Http/ActionDispatcher.php, line 120
Cake\Http\ActionDispatcher::dispatch() - CORE/src/Http/ActionDispatcher.php, line 94
Cake\Http\BaseApplication::__invoke() - CORE/src/Http/BaseApplication.php, line 235
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Routing\Middleware\RoutingMiddleware::__invoke() - CORE/src/Routing/Middleware/RoutingMiddleware.php, line 162
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Routing\Middleware\AssetMiddleware::__invoke() - CORE/src/Routing/Middleware/AssetMiddleware.php, line 97
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Error\Middleware\ErrorHandlerMiddleware::__invoke() - CORE/src/Error/Middleware/ErrorHandlerMiddleware.php, line 96
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Http\Runner::run() - CORE/src/Http/Runner.php, line 51
Cake\Http\Server::run() - CORE/src/Http/Server.php, line 98

Warning (512): Unable to emit headers. Headers sent in file=/home/brlfuser/public_html/vendor/cakephp/cakephp/src/Error/Debugger.php line=853 [CORE/src/Http/ResponseEmitter.php, line 48]
Code Context
            if (Configure::read('debug')) {

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        NEWS ALERTS | Rising burden of out-of-pocket health expenditure    </title>
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A recent study published in the prestigious science journal 'PLOS One' (August 2014) shows that Central programmes like National Rural Health Mission (NRHM) and Rashtriya Swasthya Bima Yojana (RSBY), and state-level initiatives like Yeshasvini health insurance scheme (Karnataka), Vajpayee Aarogyasri..."/>
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A recent study published in the prestigious science journal 'PLOS One' (August 2014) shows that Central programmes like National Rural Health Mission (NRHM) and Rashtriya Swasthya Bima Yojana (RSBY), and state-level initiatives like Yeshasvini health insurance scheme (Karnataka), Vajpayee Aarogyasri..." />
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                            <p align="justify">A recent study published in the prestigious science journal 'PLOS One' (August 2014) shows that Central programmes like National Rural Health Mission (NRHM) and Rashtriya Swasthya Bima Yojana (RSBY), and state-level initiatives like Yeshasvini health insurance scheme (Karnataka), Vajpayee Aarogyasri health insurance scheme (Karnataka), Rajiv Aarogyasri scheme (Andhra Pradesh), Chief Minister's Insurance Scheme for Life Saving Treatment (Tamil Nadu) etc. did little to reduce the financial burden arising out of personal expenses on healthcare, especially for India's poorest and underprivileged social and religious groups. </p><p align="justify">The study has found rising share of out-of-pocket health expenditure in total household spending among disadvantaged households (SC/ST/Muslim/Poorest 20%), relative to their better-off counterparts, thus, indicating serious gaps in existing programmes with regard to access to affordable outpatient care and drugs.</p><p align="justify">It has been noticed that the proportion of out-of-pocket (OOP) expenditure on <a href="https://im4change.in/hunger-hdi/public-health-51.html" title="https://im4change.in/hunger-hdi/public-health-51.html">healthcare</a> in total household spending increased faster among Muslim households relative to non-Muslim households by 0.9% during 2000-12. Similarly, the proportion of out-of-pocket expenditure on health in total household spending grew faster among SC/ST households relative to non SC/ST households by 0.6% during the same period. This means that despite large government investments in NRHM (during the period 2005-2012) that was intended to make healthcare available in rural India mostly in outpatient settings, one could see sharper increases in out-of-pocket expenses among Muslims and SC/ST compared to their better-off counterparts.</p><p align="justify">While the rise in the share of households reporting &quot;any OOP for outpatient care&quot; among the poorest 20% households exceeded that for the richest 20% substantially (by 8.4% points, given a baseline shares of 51.3% and 68.2% respectively in 2000) during the period 2000-2012, the opposite was true for &quot;any OOP for inpatient care&quot;. Despite the rapid expansion of publicly financed insurance schemes for hospital-based services, such as RSBY and Aarogyasri, poor utilization of inpatient care (relative to the top 20% of households) among the poorest 20% as well as the SC/ST households could be observed. </p><p align="justify">According to the authors Anup Karan, Sakthivel Selvaraj and Ajay Mahal, the following factors could have triggered rising personal health expenses: </p><p align="justify">a. Instead of strengthening existing public health facilities and facilitating the provision of free or highly subsidized health care services, the focus of the NRHM has shifted to reproductive and child health (RCH) interventions. Thus, relative neglect of primary care translated into increased financial burden on poor and other less advantaged population groups. </p><p align="justify">b. Only a handful of state governments provided access to subsidized drugs as a result of which households have been forced to pay for medicines from their own pocket. Due to rising drug prices in the open market, the overall OOP burden has increased. </p><p align="justify">c. Publicly financed insurance schemes may facilitate healthcare use, but they may also facilitate additional (out-of-pocket) contributions due to the limited financial cover, especially if the demand for health service use exceeds the approved upper limit for coverage and also because coverage of post-hospitalization care is limited.</p><p align="justify">d. Healthcare provision and financing innovations are possibly poorly targeted. The BPL list prepared by various states suffers from a high degree of &lsquo;exclusion' and &lsquo;inclusion errors'. Existing literature suggests that SC/ST populations tend to benefit less from public programmes than other population sub-groups. </p><p align="justify">The econometric study has used data generated from consumer expenditure surveys (CES) by the National Sample Survey Organisation (NSSO) in 3 quinquennial (five yearly) rounds: 1999-2000, 2004-05 and 2011-12. The study has used data on out-of-pocket (OOP) health spending on outpatient care using a 30-day recall period and on inpatient care using a 365-day recall period in the three surveys. </p><p align="justify">In the present study, the multiple indicators of the financial burden of ill-health (using information on out-of-pocket spending on healthcare incurred by households) mentioned are: (a) monthly out-of-pocket spending (at constant 1999-2000 prices) per household member, (b) share of out-of-pocket in total household spending, and (c) the proportion of households incurring catastrophic levels of out-of-pocket spending by: i) out-of-pocket being more than 10% of total household expenditure; and ii) out-of-pocket being more than 25% of the total non-food expenditure. In addition, Anup Karan et al have used indicators for whether a household incurred any OOP spending, separately for inpatient care, outpatient care and all types of care. Although the survey data used in the analysis did not include any information on healthcare use, these indicators served as proxies for utilization of healthcare services.</p><p align="justify">The key findings of the study are:</p><p align="justify">* In both rural and urban areas, there has been a fall in the percentage of households reporting any out-of-pocket expenditure on inpatient care between 2000 and 2005 and then a rise between 2005 and 2012 for the same. </p><p align="justify">* In both rural (61.4% in 2005 versus 78.8% in 2012) and urban areas (62.9% in 2005 versus 75.9% in 2012), there has been a rise in the percentage of households reporting any out-of-pocket expenditure on outpatient care between 2005 and 2012. </p><p align="justify">* Among rural households, monthly out-of-pocket spending per member was almost 60% higher in 2012 compared to 2000 (INR 29.59 in 2000 versus INR 47.05 in 2012) and nearly 68% higher among urban households (INR 43.28 in 2000 versus INR 72.36 in 2012) over the same period (constant 1999-2000 prices). While household out-of-pocket expenses (per member) rose both for inpatient and outpatient care, inpatient OOP spending saw faster increases than outpatient OOP spending from 2000 to 2012 (constant 1999-2000 prices).</p><p align="justify">* The share of households reporting out-of-pocket spending in excess of 10% of their total expenditure increased from 15% in 2000 to 18.9% in 2012 among rural households and from 12.4% in 2000 to 15.9% in 2012 among urban households.</p><p align="justify">* Overall, the share of out-of-pocket healthcare expenses in total household spending increased from 5.8% in 2000 to 6.7% in 2012.</p><p align="justify">* Among the poorest 20% households, the percentage of households reporting any out-of-pocket healthcare expenses on inpatient care reduced from 14.6% in 2000 to 9.4% in 2012 but in case of outpatient care, there was a rise from 51.3% in 2000 to 73.3% in 2012.    </p><p align="justify">* Among the richest 20% households, the percentage of households reporting any out-of-pocket healthcare expenses on inpatient care reduced marginally from 24.6% in 2000 to 22.0% in 2012 but in case of outpatient care, there was a rise from 68.2% in 2000 to 79.6% in 2012. </p><p align="justify">* The poorest 20% of the households registered a faster increase in the indicator &quot;reporting any OOP payment&quot; compared to the richest 20% during 2000-2012.</p><p align="justify">* Among the SC/ST households, the percentage of households reporting any out-of-pocket healthcare expenses on inpatient care reduced from 18.2% in 2000 to 12.6% in 2012 but in case of outpatient care, there was a rise from 58.0% in 2000 to 75.1% in 2012. </p><p align="justify">* Out-of-pocket healthcare expenses rose as a share of total household spending faster for SC/ST households relative to non-SC/ST households, irrespective of whether one considers overall OOP, OOP for inpatient care, or OOP for outpatient care (the coefficients for indicators of catastrophic spending were also mostly positive, but all statistically indistinguishable from zero).</p><p align="justify">* Over the same period, the proportion reporting &quot;any OOP&quot; grew more slowly for SC/ST household (relative to non-SC/ST household) (a difference of 21.2% points, relative to a baseline of 66.7% in 2000).</p><p align="justify">* Among the Muslim households, the percentage of households reporting any out-of-pocket healthcare expenses on inpatient care reduced from 18.6% in 2000 to 14.7% in 2012 but in case of outpatient care, there was a rise from 66.49% in 2000 to 82.76% in 2012. </p><p align="justify">* Among the poorest 20% households, proportion of out-of-pocket healthcare expenses in the total expenditure rose from 3.21% in 2000 to 4.12% in 2012 while among the richest 20% households, the same increased from 7.18% in 2000 to 8.52% in 2012.</p><p align="justify">* The share of out-of-pocket in total household spending increased sharply among Muslims (relative to non-Muslims) during 2000-2012 in all three of the indicators of OOP shares - outpatient care, inpatient care and overall - so their OOP spending burden also increased.</p><p align="justify">* Among the SC/ST households, proportion of out-of-pocket healthcare expenses in the total expenditure rose from 5.23% in 2000 to 6.57% in 2012 while among the Muslim households, the same increased from 5.49% in 2000 to 7.02% in 2012.</p><p align="justify">* Over the period 2000 to 2012, the share of households reporting catastrophic payments increased by roughly 3% when a 10% threshold ratio of out-of-pocket spending to total household spending was used, and by roughly 1% when a threshold ratio of 25% for out-of-pocket spending to non-food spending was used.</p><p align="justify">* Results for SC/ST households versus non-SC/ST households show no differences in rates of change in the population share incurring catastrophic spending during 2000-2012. Finally, over the period 2000-2012, the growth in the share of Muslim households reporting catastrophic spending exceeded that of non-Muslims by 0.8% points using the 10% threshold, and by 0.4% points using the 25% catastrophic threshold, although the results did not attain statistical significance.</p><p align="justify"><strong>References:</strong></p><p align="justify">Moving to Universal Coverage? Trends in the Burden of Out-Of-Pocket Payments for Health Care across Social Groups in India, 1999-2000 to 2011-12 by Anup Karan, Sakthivel Selvaraj and Ajay Mahal, Plos One Journal, August 15, 2014, DOI: 10.1371/journal.pone.0105162 (Please <a href="https://im4change.in/siteadmin/tinymce/uploaded/Out%20of%20pocket%20expenditure%20on%20health%20by%20various%20social%20groups.pdf" title="OOP expenditure on health" title="https://im4change.in/siteadmin/tinymce/uploaded/Out%20of%20pocket%20expenditure%20on%20health%20by%20various%20social%20groups.pdf" title="OOP expenditure on health">click here</a> to access)   </p><p align="justify">Health expense is a major burden on rural citizenry (Please <a href="https://im4change.in/news-alerts/health-expense-is-a-major-burden-on-rural-citizenry-24650.html" title="https://im4change.in/news-alerts/health-expense-is-a-major-burden-on-rural-citizenry-24650.html">click here</a> to access) </p><p align="justify">Neediest gain least from health care drive -GS Mudur, The Telegraph, 18 August, 2014 (Please <a href="https://im4change.in/latest-news-updates/neediest-gain-least-from-health-care-drive-gs-mudur-4673736.html" title="https://im4change.in/latest-news-updates/neediest-gain-least-from-health-care-drive-gs-mudur-4673736.html">click here</a> to access)</p><p align="justify">Universal Health Coverage, United Nations (India) (Please <a href="http://in.one.un.org/task-teams/universal-health-coverage" title="http://in.one.un.org/task-teams/universal-health-coverage">click here</a> to access)&nbsp; </p><p align="justify">Level and Pattern of Consumer Expenditure 2011-12, National Sample Survey 68th Round (July 2011-June 2012), released in February, 2014 (Please <a href="http://mospi.nic.in/Mospi_New/upload/nss_rep_555.pdf" title="http://mospi.nic.in/Mospi_New/upload/nss_rep_555.pdf">click here</a> to access)&nbsp; </p><p align="justify">Conference on Universal Health Coverage held at Institute of Economic Growth, University of Delhi, 21 March, 2014 (Please <a href="https://www.youtube.com/watch?v=BqlrD0cBhBM" title="https://www.youtube.com/watch?v=BqlrD0cBhBM">click here</a> to access) </p><p align="justify">Health Financing in India: A tale of political apathy, plunder and catastrophe -Indranil (2013), Vikalp (Please <a href="http://www.vikalp.ind.in/2013/11/health-financing-in-india-indranil.html" title="http://www.vikalp.ind.in/2013/11/health-financing-in-india-indranil.html">click here</a> to access) </p><p align="justify">An Estimate of Public Expenditure on Health in India (2012) by Mita Choudhury and HK Amar Nath, National Institute of Public Finance and Policy (NIPFP), May (Please <a href="https://im4change.in/siteadmin/tinymce/uploaded/NIPFP%20health_estimates_report.pdf" title="https://im4change.in/siteadmin/tinymce/uploaded/NIPFP%20health_estimates_report.pdf">click here</a> to access)&nbsp; </p><p align="justify">Chapter No. 20: Health, Twelfth Five Year Plan (2012-2017), Social Sectors, Volume III (Please <a href="http://planningcommission.nic.in/plans/planrel/fiveyr/12th/pdf/12fyp_vol3.pdf" title="http://planningcommission.nic.in/plans/planrel/fiveyr/12th/pdf/12fyp_vol3.pdf">click here</a> to access)&nbsp; </p><p align="justify">Rural Health Statistics in India 2012, Ministry of Health and Family Welfare (Please <a href="https://im4change.in/siteadmin/tinymce/uploaded/Rural%20Health%20Statistics%20of%20India%202012.pdf" title="https://im4change.in/siteadmin/tinymce/uploaded/Rural%20Health%20Statistics%20of%20India%202012.pdf">click here</a> to access)&nbsp; </p><p align="justify">Spending won't make it better -Meeta Rajivlochan, The Indian Express, 19 March, 2014 (Please <a href="https://im4change.in/latest-news-updates/spending-wont-make-it-better-meeta-rajivlochan-24547.html" title="https://im4change.in/latest-news-updates/spending-wont-make-it-better-meeta-rajivlochan-24547.html">click here</a> to access)&nbsp; </p><p align="justify">India's right to health-Nitin Desai, The Business Standard, 18 March, 2014 (Please <a href="https://im4change.in/latest-news-updates/india039s-right-to-health-nitin-desai-24546.html" title="https://im4change.in/latest-news-updates/india039s-right-to-health-nitin-desai-24546.html">click here</a> to access)&nbsp; </p><p align="justify"><strong>Image Courtesy: UNDP India</strong><br /></p>                                                           
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A recent study published in the prestigious science journal 'PLOS One' (August 2014) shows that Central programmes like National Rural Health Mission (NRHM) and Rashtriya Swasthya Bima Yojana (RSBY), and state-level initiatives like Yeshasvini health insurance scheme (Karnataka), Vajpayee Aarogyasri..."/>
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A recent study published in the prestigious science journal 'PLOS One' (August 2014) shows that Central programmes like National Rural Health Mission (NRHM) and Rashtriya Swasthya Bima Yojana (RSBY), and state-level initiatives like Yeshasvini health insurance scheme (Karnataka), Vajpayee Aarogyasri..." />
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    <h1 class="cat-box-title">Rising burden of out-of-pocket health expenditure</h1>
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		 Published on</span><span class="text-date"> Aug 19, 2014</span>
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                            <p align="justify">A recent study published in the prestigious science journal 'PLOS One' (August 2014) shows that Central programmes like National Rural Health Mission (NRHM) and Rashtriya Swasthya Bima Yojana (RSBY), and state-level initiatives like Yeshasvini health insurance scheme (Karnataka), Vajpayee Aarogyasri health insurance scheme (Karnataka), Rajiv Aarogyasri scheme (Andhra Pradesh), Chief Minister's Insurance Scheme for Life Saving Treatment (Tamil Nadu) etc. did little to reduce the financial burden arising out of personal expenses on healthcare, especially for India's poorest and underprivileged social and religious groups. </p><p align="justify">The study has found rising share of out-of-pocket health expenditure in total household spending among disadvantaged households (SC/ST/Muslim/Poorest 20%), relative to their better-off counterparts, thus, indicating serious gaps in existing programmes with regard to access to affordable outpatient care and drugs.</p><p align="justify">It has been noticed that the proportion of out-of-pocket (OOP) expenditure on <a href="https://im4change.in/hunger-hdi/public-health-51.html" title="https://im4change.in/hunger-hdi/public-health-51.html">healthcare</a> in total household spending increased faster among Muslim households relative to non-Muslim households by 0.9% during 2000-12. Similarly, the proportion of out-of-pocket expenditure on health in total household spending grew faster among SC/ST households relative to non SC/ST households by 0.6% during the same period. This means that despite large government investments in NRHM (during the period 2005-2012) that was intended to make healthcare available in rural India mostly in outpatient settings, one could see sharper increases in out-of-pocket expenses among Muslims and SC/ST compared to their better-off counterparts.</p><p align="justify">While the rise in the share of households reporting &quot;any OOP for outpatient care&quot; among the poorest 20% households exceeded that for the richest 20% substantially (by 8.4% points, given a baseline shares of 51.3% and 68.2% respectively in 2000) during the period 2000-2012, the opposite was true for &quot;any OOP for inpatient care&quot;. Despite the rapid expansion of publicly financed insurance schemes for hospital-based services, such as RSBY and Aarogyasri, poor utilization of inpatient care (relative to the top 20% of households) among the poorest 20% as well as the SC/ST households could be observed. </p><p align="justify">According to the authors Anup Karan, Sakthivel Selvaraj and Ajay Mahal, the following factors could have triggered rising personal health expenses: </p><p align="justify">a. Instead of strengthening existing public health facilities and facilitating the provision of free or highly subsidized health care services, the focus of the NRHM has shifted to reproductive and child health (RCH) interventions. Thus, relative neglect of primary care translated into increased financial burden on poor and other less advantaged population groups. </p><p align="justify">b. Only a handful of state governments provided access to subsidized drugs as a result of which households have been forced to pay for medicines from their own pocket. Due to rising drug prices in the open market, the overall OOP burden has increased. </p><p align="justify">c. Publicly financed insurance schemes may facilitate healthcare use, but they may also facilitate additional (out-of-pocket) contributions due to the limited financial cover, especially if the demand for health service use exceeds the approved upper limit for coverage and also because coverage of post-hospitalization care is limited.</p><p align="justify">d. Healthcare provision and financing innovations are possibly poorly targeted. The BPL list prepared by various states suffers from a high degree of &lsquo;exclusion' and &lsquo;inclusion errors'. Existing literature suggests that SC/ST populations tend to benefit less from public programmes than other population sub-groups. </p><p align="justify">The econometric study has used data generated from consumer expenditure surveys (CES) by the National Sample Survey Organisation (NSSO) in 3 quinquennial (five yearly) rounds: 1999-2000, 2004-05 and 2011-12. The study has used data on out-of-pocket (OOP) health spending on outpatient care using a 30-day recall period and on inpatient care using a 365-day recall period in the three surveys. </p><p align="justify">In the present study, the multiple indicators of the financial burden of ill-health (using information on out-of-pocket spending on healthcare incurred by households) mentioned are: (a) monthly out-of-pocket spending (at constant 1999-2000 prices) per household member, (b) share of out-of-pocket in total household spending, and (c) the proportion of households incurring catastrophic levels of out-of-pocket spending by: i) out-of-pocket being more than 10% of total household expenditure; and ii) out-of-pocket being more than 25% of the total non-food expenditure. In addition, Anup Karan et al have used indicators for whether a household incurred any OOP spending, separately for inpatient care, outpatient care and all types of care. Although the survey data used in the analysis did not include any information on healthcare use, these indicators served as proxies for utilization of healthcare services.</p><p align="justify">The key findings of the study are:</p><p align="justify">* In both rural and urban areas, there has been a fall in the percentage of households reporting any out-of-pocket expenditure on inpatient care between 2000 and 2005 and then a rise between 2005 and 2012 for the same. </p><p align="justify">* In both rural (61.4% in 2005 versus 78.8% in 2012) and urban areas (62.9% in 2005 versus 75.9% in 2012), there has been a rise in the percentage of households reporting any out-of-pocket expenditure on outpatient care between 2005 and 2012. </p><p align="justify">* Among rural households, monthly out-of-pocket spending per member was almost 60% higher in 2012 compared to 2000 (INR 29.59 in 2000 versus INR 47.05 in 2012) and nearly 68% higher among urban households (INR 43.28 in 2000 versus INR 72.36 in 2012) over the same period (constant 1999-2000 prices). While household out-of-pocket expenses (per member) rose both for inpatient and outpatient care, inpatient OOP spending saw faster increases than outpatient OOP spending from 2000 to 2012 (constant 1999-2000 prices).</p><p align="justify">* The share of households reporting out-of-pocket spending in excess of 10% of their total expenditure increased from 15% in 2000 to 18.9% in 2012 among rural households and from 12.4% in 2000 to 15.9% in 2012 among urban households.</p><p align="justify">* Overall, the share of out-of-pocket healthcare expenses in total household spending increased from 5.8% in 2000 to 6.7% in 2012.</p><p align="justify">* Among the poorest 20% households, the percentage of households reporting any out-of-pocket healthcare expenses on inpatient care reduced from 14.6% in 2000 to 9.4% in 2012 but in case of outpatient care, there was a rise from 51.3% in 2000 to 73.3% in 2012.    </p><p align="justify">* Among the richest 20% households, the percentage of households reporting any out-of-pocket healthcare expenses on inpatient care reduced marginally from 24.6% in 2000 to 22.0% in 2012 but in case of outpatient care, there was a rise from 68.2% in 2000 to 79.6% in 2012. </p><p align="justify">* The poorest 20% of the households registered a faster increase in the indicator &quot;reporting any OOP payment&quot; compared to the richest 20% during 2000-2012.</p><p align="justify">* Among the SC/ST households, the percentage of households reporting any out-of-pocket healthcare expenses on inpatient care reduced from 18.2% in 2000 to 12.6% in 2012 but in case of outpatient care, there was a rise from 58.0% in 2000 to 75.1% in 2012. </p><p align="justify">* Out-of-pocket healthcare expenses rose as a share of total household spending faster for SC/ST households relative to non-SC/ST households, irrespective of whether one considers overall OOP, OOP for inpatient care, or OOP for outpatient care (the coefficients for indicators of catastrophic spending were also mostly positive, but all statistically indistinguishable from zero).</p><p align="justify">* Over the same period, the proportion reporting &quot;any OOP&quot; grew more slowly for SC/ST household (relative to non-SC/ST household) (a difference of 21.2% points, relative to a baseline of 66.7% in 2000).</p><p align="justify">* Among the Muslim households, the percentage of households reporting any out-of-pocket healthcare expenses on inpatient care reduced from 18.6% in 2000 to 14.7% in 2012 but in case of outpatient care, there was a rise from 66.49% in 2000 to 82.76% in 2012. </p><p align="justify">* Among the poorest 20% households, proportion of out-of-pocket healthcare expenses in the total expenditure rose from 3.21% in 2000 to 4.12% in 2012 while among the richest 20% households, the same increased from 7.18% in 2000 to 8.52% in 2012.</p><p align="justify">* The share of out-of-pocket in total household spending increased sharply among Muslims (relative to non-Muslims) during 2000-2012 in all three of the indicators of OOP shares - outpatient care, inpatient care and overall - so their OOP spending burden also increased.</p><p align="justify">* Among the SC/ST households, proportion of out-of-pocket healthcare expenses in the total expenditure rose from 5.23% in 2000 to 6.57% in 2012 while among the Muslim households, the same increased from 5.49% in 2000 to 7.02% in 2012.</p><p align="justify">* Over the period 2000 to 2012, the share of households reporting catastrophic payments increased by roughly 3% when a 10% threshold ratio of out-of-pocket spending to total household spending was used, and by roughly 1% when a threshold ratio of 25% for out-of-pocket spending to non-food spending was used.</p><p align="justify">* Results for SC/ST households versus non-SC/ST households show no differences in rates of change in the population share incurring catastrophic spending during 2000-2012. Finally, over the period 2000-2012, the growth in the share of Muslim households reporting catastrophic spending exceeded that of non-Muslims by 0.8% points using the 10% threshold, and by 0.4% points using the 25% catastrophic threshold, although the results did not attain statistical significance.</p><p align="justify"><strong>References:</strong></p><p align="justify">Moving to Universal Coverage? Trends in the Burden of Out-Of-Pocket Payments for Health Care across Social Groups in India, 1999-2000 to 2011-12 by Anup Karan, Sakthivel Selvaraj and Ajay Mahal, Plos One Journal, August 15, 2014, DOI: 10.1371/journal.pone.0105162 (Please <a href="https://im4change.in/siteadmin/tinymce/uploaded/Out%20of%20pocket%20expenditure%20on%20health%20by%20various%20social%20groups.pdf" title="OOP expenditure on health" title="https://im4change.in/siteadmin/tinymce/uploaded/Out%20of%20pocket%20expenditure%20on%20health%20by%20various%20social%20groups.pdf" title="OOP expenditure on health">click here</a> to access)   </p><p align="justify">Health expense is a major burden on rural citizenry (Please <a href="https://im4change.in/news-alerts/health-expense-is-a-major-burden-on-rural-citizenry-24650.html" title="https://im4change.in/news-alerts/health-expense-is-a-major-burden-on-rural-citizenry-24650.html">click here</a> to access) </p><p align="justify">Neediest gain least from health care drive -GS Mudur, The Telegraph, 18 August, 2014 (Please <a href="https://im4change.in/latest-news-updates/neediest-gain-least-from-health-care-drive-gs-mudur-4673736.html" title="https://im4change.in/latest-news-updates/neediest-gain-least-from-health-care-drive-gs-mudur-4673736.html">click here</a> to access)</p><p align="justify">Universal Health Coverage, United Nations (India) (Please <a href="http://in.one.un.org/task-teams/universal-health-coverage" title="http://in.one.un.org/task-teams/universal-health-coverage">click here</a> to access)&nbsp; </p><p align="justify">Level and Pattern of Consumer Expenditure 2011-12, National Sample Survey 68th Round (July 2011-June 2012), released in February, 2014 (Please <a href="http://mospi.nic.in/Mospi_New/upload/nss_rep_555.pdf" title="http://mospi.nic.in/Mospi_New/upload/nss_rep_555.pdf">click here</a> to access)&nbsp; </p><p align="justify">Conference on Universal Health Coverage held at Institute of Economic Growth, University of Delhi, 21 March, 2014 (Please <a href="https://www.youtube.com/watch?v=BqlrD0cBhBM" title="https://www.youtube.com/watch?v=BqlrD0cBhBM">click here</a> to access) </p><p align="justify">Health Financing in India: A tale of political apathy, plunder and catastrophe -Indranil (2013), Vikalp (Please <a href="http://www.vikalp.ind.in/2013/11/health-financing-in-india-indranil.html" title="http://www.vikalp.ind.in/2013/11/health-financing-in-india-indranil.html">click here</a> to access) </p><p align="justify">An Estimate of Public Expenditure on Health in India (2012) by Mita Choudhury and HK Amar Nath, National Institute of Public Finance and Policy (NIPFP), May (Please <a href="https://im4change.in/siteadmin/tinymce/uploaded/NIPFP%20health_estimates_report.pdf" title="https://im4change.in/siteadmin/tinymce/uploaded/NIPFP%20health_estimates_report.pdf">click here</a> to access)&nbsp; </p><p align="justify">Chapter No. 20: Health, Twelfth Five Year Plan (2012-2017), Social Sectors, Volume III (Please <a href="http://planningcommission.nic.in/plans/planrel/fiveyr/12th/pdf/12fyp_vol3.pdf" title="http://planningcommission.nic.in/plans/planrel/fiveyr/12th/pdf/12fyp_vol3.pdf">click here</a> to access)&nbsp; </p><p align="justify">Rural Health Statistics in India 2012, Ministry of Health and Family Welfare (Please <a href="https://im4change.in/siteadmin/tinymce/uploaded/Rural%20Health%20Statistics%20of%20India%202012.pdf" title="https://im4change.in/siteadmin/tinymce/uploaded/Rural%20Health%20Statistics%20of%20India%202012.pdf">click here</a> to access)&nbsp; </p><p align="justify">Spending won't make it better -Meeta Rajivlochan, The Indian Express, 19 March, 2014 (Please <a href="https://im4change.in/latest-news-updates/spending-wont-make-it-better-meeta-rajivlochan-24547.html" title="https://im4change.in/latest-news-updates/spending-wont-make-it-better-meeta-rajivlochan-24547.html">click here</a> to access)&nbsp; </p><p align="justify">India's right to health-Nitin Desai, The Business Standard, 18 March, 2014 (Please <a href="https://im4change.in/latest-news-updates/india039s-right-to-health-nitin-desai-24546.html" title="https://im4change.in/latest-news-updates/india039s-right-to-health-nitin-desai-24546.html">click here</a> to access)&nbsp; </p><p align="justify"><strong>Image Courtesy: UNDP India</strong><br /></p>                                                           
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        NEWS ALERTS | Rising burden of out-of-pocket health expenditure    </title>
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A recent study published in the prestigious science journal 'PLOS One' (August 2014) shows that Central programmes like National Rural Health Mission (NRHM) and Rashtriya Swasthya Bima Yojana (RSBY), and state-level initiatives like Yeshasvini health insurance scheme (Karnataka), Vajpayee Aarogyasri..."/>
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A recent study published in the prestigious science journal 'PLOS One' (August 2014) shows that Central programmes like National Rural Health Mission (NRHM) and Rashtriya Swasthya Bima Yojana (RSBY), and state-level initiatives like Yeshasvini health insurance scheme (Karnataka), Vajpayee Aarogyasri..." />
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    <h1 class="cat-box-title">Rising burden of out-of-pocket health expenditure</h1>
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                            <p align="justify">A recent study published in the prestigious science journal 'PLOS One' (August 2014) shows that Central programmes like National Rural Health Mission (NRHM) and Rashtriya Swasthya Bima Yojana (RSBY), and state-level initiatives like Yeshasvini health insurance scheme (Karnataka), Vajpayee Aarogyasri health insurance scheme (Karnataka), Rajiv Aarogyasri scheme (Andhra Pradesh), Chief Minister's Insurance Scheme for Life Saving Treatment (Tamil Nadu) etc. did little to reduce the financial burden arising out of personal expenses on healthcare, especially for India's poorest and underprivileged social and religious groups. </p><p align="justify">The study has found rising share of out-of-pocket health expenditure in total household spending among disadvantaged households (SC/ST/Muslim/Poorest 20%), relative to their better-off counterparts, thus, indicating serious gaps in existing programmes with regard to access to affordable outpatient care and drugs.</p><p align="justify">It has been noticed that the proportion of out-of-pocket (OOP) expenditure on <a href="https://im4change.in/hunger-hdi/public-health-51.html" title="https://im4change.in/hunger-hdi/public-health-51.html">healthcare</a> in total household spending increased faster among Muslim households relative to non-Muslim households by 0.9% during 2000-12. Similarly, the proportion of out-of-pocket expenditure on health in total household spending grew faster among SC/ST households relative to non SC/ST households by 0.6% during the same period. This means that despite large government investments in NRHM (during the period 2005-2012) that was intended to make healthcare available in rural India mostly in outpatient settings, one could see sharper increases in out-of-pocket expenses among Muslims and SC/ST compared to their better-off counterparts.</p><p align="justify">While the rise in the share of households reporting &quot;any OOP for outpatient care&quot; among the poorest 20% households exceeded that for the richest 20% substantially (by 8.4% points, given a baseline shares of 51.3% and 68.2% respectively in 2000) during the period 2000-2012, the opposite was true for &quot;any OOP for inpatient care&quot;. Despite the rapid expansion of publicly financed insurance schemes for hospital-based services, such as RSBY and Aarogyasri, poor utilization of inpatient care (relative to the top 20% of households) among the poorest 20% as well as the SC/ST households could be observed. </p><p align="justify">According to the authors Anup Karan, Sakthivel Selvaraj and Ajay Mahal, the following factors could have triggered rising personal health expenses: </p><p align="justify">a. Instead of strengthening existing public health facilities and facilitating the provision of free or highly subsidized health care services, the focus of the NRHM has shifted to reproductive and child health (RCH) interventions. Thus, relative neglect of primary care translated into increased financial burden on poor and other less advantaged population groups. </p><p align="justify">b. Only a handful of state governments provided access to subsidized drugs as a result of which households have been forced to pay for medicines from their own pocket. Due to rising drug prices in the open market, the overall OOP burden has increased. </p><p align="justify">c. Publicly financed insurance schemes may facilitate healthcare use, but they may also facilitate additional (out-of-pocket) contributions due to the limited financial cover, especially if the demand for health service use exceeds the approved upper limit for coverage and also because coverage of post-hospitalization care is limited.</p><p align="justify">d. Healthcare provision and financing innovations are possibly poorly targeted. The BPL list prepared by various states suffers from a high degree of &lsquo;exclusion' and &lsquo;inclusion errors'. Existing literature suggests that SC/ST populations tend to benefit less from public programmes than other population sub-groups. </p><p align="justify">The econometric study has used data generated from consumer expenditure surveys (CES) by the National Sample Survey Organisation (NSSO) in 3 quinquennial (five yearly) rounds: 1999-2000, 2004-05 and 2011-12. The study has used data on out-of-pocket (OOP) health spending on outpatient care using a 30-day recall period and on inpatient care using a 365-day recall period in the three surveys. </p><p align="justify">In the present study, the multiple indicators of the financial burden of ill-health (using information on out-of-pocket spending on healthcare incurred by households) mentioned are: (a) monthly out-of-pocket spending (at constant 1999-2000 prices) per household member, (b) share of out-of-pocket in total household spending, and (c) the proportion of households incurring catastrophic levels of out-of-pocket spending by: i) out-of-pocket being more than 10% of total household expenditure; and ii) out-of-pocket being more than 25% of the total non-food expenditure. In addition, Anup Karan et al have used indicators for whether a household incurred any OOP spending, separately for inpatient care, outpatient care and all types of care. Although the survey data used in the analysis did not include any information on healthcare use, these indicators served as proxies for utilization of healthcare services.</p><p align="justify">The key findings of the study are:</p><p align="justify">* In both rural and urban areas, there has been a fall in the percentage of households reporting any out-of-pocket expenditure on inpatient care between 2000 and 2005 and then a rise between 2005 and 2012 for the same. </p><p align="justify">* In both rural (61.4% in 2005 versus 78.8% in 2012) and urban areas (62.9% in 2005 versus 75.9% in 2012), there has been a rise in the percentage of households reporting any out-of-pocket expenditure on outpatient care between 2005 and 2012. </p><p align="justify">* Among rural households, monthly out-of-pocket spending per member was almost 60% higher in 2012 compared to 2000 (INR 29.59 in 2000 versus INR 47.05 in 2012) and nearly 68% higher among urban households (INR 43.28 in 2000 versus INR 72.36 in 2012) over the same period (constant 1999-2000 prices). While household out-of-pocket expenses (per member) rose both for inpatient and outpatient care, inpatient OOP spending saw faster increases than outpatient OOP spending from 2000 to 2012 (constant 1999-2000 prices).</p><p align="justify">* The share of households reporting out-of-pocket spending in excess of 10% of their total expenditure increased from 15% in 2000 to 18.9% in 2012 among rural households and from 12.4% in 2000 to 15.9% in 2012 among urban households.</p><p align="justify">* Overall, the share of out-of-pocket healthcare expenses in total household spending increased from 5.8% in 2000 to 6.7% in 2012.</p><p align="justify">* Among the poorest 20% households, the percentage of households reporting any out-of-pocket healthcare expenses on inpatient care reduced from 14.6% in 2000 to 9.4% in 2012 but in case of outpatient care, there was a rise from 51.3% in 2000 to 73.3% in 2012.    </p><p align="justify">* Among the richest 20% households, the percentage of households reporting any out-of-pocket healthcare expenses on inpatient care reduced marginally from 24.6% in 2000 to 22.0% in 2012 but in case of outpatient care, there was a rise from 68.2% in 2000 to 79.6% in 2012. </p><p align="justify">* The poorest 20% of the households registered a faster increase in the indicator &quot;reporting any OOP payment&quot; compared to the richest 20% during 2000-2012.</p><p align="justify">* Among the SC/ST households, the percentage of households reporting any out-of-pocket healthcare expenses on inpatient care reduced from 18.2% in 2000 to 12.6% in 2012 but in case of outpatient care, there was a rise from 58.0% in 2000 to 75.1% in 2012. </p><p align="justify">* Out-of-pocket healthcare expenses rose as a share of total household spending faster for SC/ST households relative to non-SC/ST households, irrespective of whether one considers overall OOP, OOP for inpatient care, or OOP for outpatient care (the coefficients for indicators of catastrophic spending were also mostly positive, but all statistically indistinguishable from zero).</p><p align="justify">* Over the same period, the proportion reporting &quot;any OOP&quot; grew more slowly for SC/ST household (relative to non-SC/ST household) (a difference of 21.2% points, relative to a baseline of 66.7% in 2000).</p><p align="justify">* Among the Muslim households, the percentage of households reporting any out-of-pocket healthcare expenses on inpatient care reduced from 18.6% in 2000 to 14.7% in 2012 but in case of outpatient care, there was a rise from 66.49% in 2000 to 82.76% in 2012. </p><p align="justify">* Among the poorest 20% households, proportion of out-of-pocket healthcare expenses in the total expenditure rose from 3.21% in 2000 to 4.12% in 2012 while among the richest 20% households, the same increased from 7.18% in 2000 to 8.52% in 2012.</p><p align="justify">* The share of out-of-pocket in total household spending increased sharply among Muslims (relative to non-Muslims) during 2000-2012 in all three of the indicators of OOP shares - outpatient care, inpatient care and overall - so their OOP spending burden also increased.</p><p align="justify">* Among the SC/ST households, proportion of out-of-pocket healthcare expenses in the total expenditure rose from 5.23% in 2000 to 6.57% in 2012 while among the Muslim households, the same increased from 5.49% in 2000 to 7.02% in 2012.</p><p align="justify">* Over the period 2000 to 2012, the share of households reporting catastrophic payments increased by roughly 3% when a 10% threshold ratio of out-of-pocket spending to total household spending was used, and by roughly 1% when a threshold ratio of 25% for out-of-pocket spending to non-food spending was used.</p><p align="justify">* Results for SC/ST households versus non-SC/ST households show no differences in rates of change in the population share incurring catastrophic spending during 2000-2012. Finally, over the period 2000-2012, the growth in the share of Muslim households reporting catastrophic spending exceeded that of non-Muslims by 0.8% points using the 10% threshold, and by 0.4% points using the 25% catastrophic threshold, although the results did not attain statistical significance.</p><p align="justify"><strong>References:</strong></p><p align="justify">Moving to Universal Coverage? Trends in the Burden of Out-Of-Pocket Payments for Health Care across Social Groups in India, 1999-2000 to 2011-12 by Anup Karan, Sakthivel Selvaraj and Ajay Mahal, Plos One Journal, August 15, 2014, DOI: 10.1371/journal.pone.0105162 (Please <a href="https://im4change.in/siteadmin/tinymce/uploaded/Out%20of%20pocket%20expenditure%20on%20health%20by%20various%20social%20groups.pdf" title="OOP expenditure on health" title="https://im4change.in/siteadmin/tinymce/uploaded/Out%20of%20pocket%20expenditure%20on%20health%20by%20various%20social%20groups.pdf" title="OOP expenditure on health">click here</a> to access)   </p><p align="justify">Health expense is a major burden on rural citizenry (Please <a href="https://im4change.in/news-alerts/health-expense-is-a-major-burden-on-rural-citizenry-24650.html" title="https://im4change.in/news-alerts/health-expense-is-a-major-burden-on-rural-citizenry-24650.html">click here</a> to access) </p><p align="justify">Neediest gain least from health care drive -GS Mudur, The Telegraph, 18 August, 2014 (Please <a href="https://im4change.in/latest-news-updates/neediest-gain-least-from-health-care-drive-gs-mudur-4673736.html" title="https://im4change.in/latest-news-updates/neediest-gain-least-from-health-care-drive-gs-mudur-4673736.html">click here</a> to access)</p><p align="justify">Universal Health Coverage, United Nations (India) (Please <a href="http://in.one.un.org/task-teams/universal-health-coverage" title="http://in.one.un.org/task-teams/universal-health-coverage">click here</a> to access)&nbsp; </p><p align="justify">Level and Pattern of Consumer Expenditure 2011-12, National Sample Survey 68th Round (July 2011-June 2012), released in February, 2014 (Please <a href="http://mospi.nic.in/Mospi_New/upload/nss_rep_555.pdf" title="http://mospi.nic.in/Mospi_New/upload/nss_rep_555.pdf">click here</a> to access)&nbsp; </p><p align="justify">Conference on Universal Health Coverage held at Institute of Economic Growth, University of Delhi, 21 March, 2014 (Please <a href="https://www.youtube.com/watch?v=BqlrD0cBhBM" title="https://www.youtube.com/watch?v=BqlrD0cBhBM">click here</a> to access) </p><p align="justify">Health Financing in India: A tale of political apathy, plunder and catastrophe -Indranil (2013), Vikalp (Please <a href="http://www.vikalp.ind.in/2013/11/health-financing-in-india-indranil.html" title="http://www.vikalp.ind.in/2013/11/health-financing-in-india-indranil.html">click here</a> to access) </p><p align="justify">An Estimate of Public Expenditure on Health in India (2012) by Mita Choudhury and HK Amar Nath, National Institute of Public Finance and Policy (NIPFP), May (Please <a href="https://im4change.in/siteadmin/tinymce/uploaded/NIPFP%20health_estimates_report.pdf" title="https://im4change.in/siteadmin/tinymce/uploaded/NIPFP%20health_estimates_report.pdf">click here</a> to access)&nbsp; </p><p align="justify">Chapter No. 20: Health, Twelfth Five Year Plan (2012-2017), Social Sectors, Volume III (Please <a href="http://planningcommission.nic.in/plans/planrel/fiveyr/12th/pdf/12fyp_vol3.pdf" title="http://planningcommission.nic.in/plans/planrel/fiveyr/12th/pdf/12fyp_vol3.pdf">click here</a> to access)&nbsp; </p><p align="justify">Rural Health Statistics in India 2012, Ministry of Health and Family Welfare (Please <a href="https://im4change.in/siteadmin/tinymce/uploaded/Rural%20Health%20Statistics%20of%20India%202012.pdf" title="https://im4change.in/siteadmin/tinymce/uploaded/Rural%20Health%20Statistics%20of%20India%202012.pdf">click here</a> to access)&nbsp; </p><p align="justify">Spending won't make it better -Meeta Rajivlochan, The Indian Express, 19 March, 2014 (Please <a href="https://im4change.in/latest-news-updates/spending-wont-make-it-better-meeta-rajivlochan-24547.html" title="https://im4change.in/latest-news-updates/spending-wont-make-it-better-meeta-rajivlochan-24547.html">click here</a> to access)&nbsp; </p><p align="justify">India's right to health-Nitin Desai, The Business Standard, 18 March, 2014 (Please <a href="https://im4change.in/latest-news-updates/india039s-right-to-health-nitin-desai-24546.html" title="https://im4change.in/latest-news-updates/india039s-right-to-health-nitin-desai-24546.html">click here</a> to access)&nbsp; </p><p align="justify"><strong>Image Courtesy: UNDP India</strong><br /></p>                                                           
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Home हिन्दी

Rising burden of out-of-pocket health expenditure

Published on Aug 19, 2014   Modified on Aug 19, 2014

A recent study published in the prestigious science journal 'PLOS One' (August 2014) shows that Central programmes like National Rural Health Mission (NRHM) and Rashtriya Swasthya Bima Yojana (RSBY), and state-level initiatives like Yeshasvini health insurance scheme (Karnataka), Vajpayee Aarogyasri health insurance scheme (Karnataka), Rajiv Aarogyasri scheme (Andhra Pradesh), Chief Minister's Insurance Scheme for Life Saving Treatment (Tamil Nadu) etc. did little to reduce the financial burden arising out of personal expenses on healthcare, especially for India's poorest and underprivileged social and religious groups. The study has found rising share of out-of-pocket health expenditure in total household spending among disadvantaged households (SC/ST/Muslim/Poorest 20%), relative to their better-off counterparts, thus, indicating serious gaps in existing programmes with regard to access to affordable outpatient care and drugs. It has been noticed that the proportion of out-of-pocket (OOP) expenditure on healthcare in total household spending increased faster among Muslim households relative to non-Muslim households by 0.9% during 2000-12. Similarly, the proportion of out-of-pocket expenditure on health in total household spending grew faster among SC/ST households relative to non SC/ST households by 0.6% during the same period. This means that despite large government investments in NRHM (during the period 2005-2012) that was intended to make healthcare available in rural India mostly in outpatient settings, one could see sharper increases in out-of-pocket expenses among Muslims and SC/ST compared to their better-off counterparts. While the rise in the share of households reporting "any OOP for outpatient care" among the poorest 20% households exceeded that for the richest 20% substantially (by 8.4% points, given a baseline shares of 51.3% and 68.2% respectively in 2000) during the period 2000-2012, the opposite was true for "any OOP for inpatient care". Despite the rapid expansion of publicly financed insurance schemes for hospital-based services, such as RSBY and Aarogyasri, poor utilization of inpatient care (relative to the top 20% of households) among the poorest 20% as well as the SC/ST households could be observed. According to the authors Anup Karan, Sakthivel Selvaraj and Ajay Mahal, the following factors could have triggered rising personal health expenses: a. Instead of strengthening existing public health facilities and facilitating the provision of free or highly subsidized health care services, the focus of the NRHM has shifted to reproductive and child health (RCH) interventions. Thus, relative neglect of primary care translated into increased financial burden on poor and other less advantaged population groups. b. Only a handful of state governments provided access to subsidized drugs as a result of which households have been forced to pay for medicines from their own pocket. Due to rising drug prices in the open market, the overall OOP burden has increased. c. Publicly financed insurance schemes may facilitate healthcare use, but they may also facilitate additional (out-of-pocket) contributions due to the limited financial cover, especially if the demand for health service use exceeds the approved upper limit for coverage and also because coverage of post-hospitalization care is limited. d. Healthcare provision and financing innovations are possibly poorly targeted. The BPL list prepared by various states suffers from a high degree of ‘exclusion' and ‘inclusion errors'. Existing literature suggests that SC/ST populations tend to benefit less from public programmes than other population sub-groups. The econometric study has used data generated from consumer expenditure surveys (CES) by the National Sample Survey Organisation (NSSO) in 3 quinquennial (five yearly) rounds: 1999-2000, 2004-05 and 2011-12. The study has used data on out-of-pocket (OOP) health spending on outpatient care using a 30-day recall period and on inpatient care using a 365-day recall period in the three surveys. In the present study, the multiple indicators of the financial burden of ill-health (using information on out-of-pocket spending on healthcare incurred by households) mentioned are: (a) monthly out-of-pocket spending (at constant 1999-2000 prices) per household member, (b) share of out-of-pocket in total household spending, and (c) the proportion of households incurring catastrophic levels of out-of-pocket spending by: i) out-of-pocket being more than 10% of total household expenditure; and ii) out-of-pocket being more than 25% of the total non-food expenditure. In addition, Anup Karan et al have used indicators for whether a household incurred any OOP spending, separately for inpatient care, outpatient care and all types of care. Although the survey data used in the analysis did not include any information on healthcare use, these indicators served as proxies for utilization of healthcare services. The key findings of the study are: * In both rural and urban areas, there has been a fall in the percentage of households reporting any out-of-pocket expenditure on inpatient care between 2000 and 2005 and then a rise between 2005 and 2012 for the same. * In both rural (61.4% in 2005 versus 78.8% in 2012) and urban areas (62.9% in 2005 versus 75.9% in 2012), there has been a rise in the percentage of households reporting any out-of-pocket expenditure on outpatient care between 2005 and 2012. * Among rural households, monthly out-of-pocket spending per member was almost 60% higher in 2012 compared to 2000 (INR 29.59 in 2000 versus INR 47.05 in 2012) and nearly 68% higher among urban households (INR 43.28 in 2000 versus INR 72.36 in 2012) over the same period (constant 1999-2000 prices). While household out-of-pocket expenses (per member) rose both for inpatient and outpatient care, inpatient OOP spending saw faster increases than outpatient OOP spending from 2000 to 2012 (constant 1999-2000 prices). * The share of households reporting out-of-pocket spending in excess of 10% of their total expenditure increased from 15% in 2000 to 18.9% in 2012 among rural households and from 12.4% in 2000 to 15.9% in 2012 among urban households. * Overall, the share of out-of-pocket healthcare expenses in total household spending increased from 5.8% in 2000 to 6.7% in 2012. * Among the poorest 20% households, the percentage of households reporting any out-of-pocket healthcare expenses on inpatient care reduced from 14.6% in 2000 to 9.4% in 2012 but in case of outpatient care, there was a rise from 51.3% in 2000 to 73.3% in 2012. * Among the richest 20% households, the percentage of households reporting any out-of-pocket healthcare expenses on inpatient care reduced marginally from 24.6% in 2000 to 22.0% in 2012 but in case of outpatient care, there was a rise from 68.2% in 2000 to 79.6% in 2012. * The poorest 20% of the households registered a faster increase in the indicator "reporting any OOP payment" compared to the richest 20% during 2000-2012. * Among the SC/ST households, the percentage of households reporting any out-of-pocket healthcare expenses on inpatient care reduced from 18.2% in 2000 to 12.6% in 2012 but in case of outpatient care, there was a rise from 58.0% in 2000 to 75.1% in 2012. * Out-of-pocket healthcare expenses rose as a share of total household spending faster for SC/ST households relative to non-SC/ST households, irrespective of whether one considers overall OOP, OOP for inpatient care, or OOP for outpatient care (the coefficients for indicators of catastrophic spending were also mostly positive, but all statistically indistinguishable from zero). * Over the same period, the proportion reporting "any OOP" grew more slowly for SC/ST household (relative to non-SC/ST household) (a difference of 21.2% points, relative to a baseline of 66.7% in 2000). * Among the Muslim households, the percentage of households reporting any out-of-pocket healthcare expenses on inpatient care reduced from 18.6% in 2000 to 14.7% in 2012 but in case of outpatient care, there was a rise from 66.49% in 2000 to 82.76% in 2012. * Among the poorest 20% households, proportion of out-of-pocket healthcare expenses in the total expenditure rose from 3.21% in 2000 to 4.12% in 2012 while among the richest 20% households, the same increased from 7.18% in 2000 to 8.52% in 2012. * The share of out-of-pocket in total household spending increased sharply among Muslims (relative to non-Muslims) during 2000-2012 in all three of the indicators of OOP shares - outpatient care, inpatient care and overall - so their OOP spending burden also increased. * Among the SC/ST households, proportion of out-of-pocket healthcare expenses in the total expenditure rose from 5.23% in 2000 to 6.57% in 2012 while among the Muslim households, the same increased from 5.49% in 2000 to 7.02% in 2012. * Over the period 2000 to 2012, the share of households reporting catastrophic payments increased by roughly 3% when a 10% threshold ratio of out-of-pocket spending to total household spending was used, and by roughly 1% when a threshold ratio of 25% for out-of-pocket spending to non-food spending was used. * Results for SC/ST households versus non-SC/ST households show no differences in rates of change in the population share incurring catastrophic spending during 2000-2012. Finally, over the period 2000-2012, the growth in the share of Muslim households reporting catastrophic spending exceeded that of non-Muslims by 0.8% points using the 10% threshold, and by 0.4% points using the 25% catastrophic threshold, although the results did not attain statistical significance. References: Moving to Universal Coverage? Trends in the Burden of Out-Of-Pocket Payments for Health Care across Social Groups in India, 1999-2000 to 2011-12 by Anup Karan, Sakthivel Selvaraj and Ajay Mahal, Plos One Journal, August 15, 2014, DOI: 10.1371/journal.pone.0105162 (Please click here to access) Health expense is a major burden on rural citizenry (Please click here to access) Neediest gain least from health care drive -GS Mudur, The Telegraph, 18 August, 2014 (Please click here to access) Universal Health Coverage, United Nations (India) (Please click here to access)  Level and Pattern of Consumer Expenditure 2011-12, National Sample Survey 68th Round (July 2011-June 2012), released in February, 2014 (Please click here to access)  Conference on Universal Health Coverage held at Institute of Economic Growth, University of Delhi, 21 March, 2014 (Please click here to access) Health Financing in India: A tale of political apathy, plunder and catastrophe -Indranil (2013), Vikalp (Please click here to access) An Estimate of Public Expenditure on Health in India (2012) by Mita Choudhury and HK Amar Nath, National Institute of Public Finance and Policy (NIPFP), May (Please click here to access)  Chapter No. 20: Health, Twelfth Five Year Plan (2012-2017), Social Sectors, Volume III (Please click here to access)  Rural Health Statistics in India 2012, Ministry of Health and Family Welfare (Please click here to access)  Spending won't make it better -Meeta Rajivlochan, The Indian Express, 19 March, 2014 (Please click here to access)  India's right to health-Nitin Desai, The Business Standard, 18 March, 2014 (Please click here to access)  Image Courtesy: UNDP India

Tagged with: nss national sample survey hospitals Access to Healthcare Public Health Health healthcare out of pocket NRHM National Health Mission National Rural Health Mission Access to Medicines medicines

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