Catastrophic health expenditure and its determinants among households in Rural Puducherry

Abstract

Background: Health care expenditures exacerbate poverty, with additional 25 million households or more than 100 million individuals globally pushed into poverty every year because of such expenditures. The Government expenditure on healthcare in India is only 1.04% of GDP which is and less than 30% of total health spending. Aim: To assess the proportion of catastrophic health expenditure and the factors influencing among households in rural Puducherry. Materials and Methods: A community based cross-sectional analytical study was conducted in selected villages within 5 kms of a Medical College Hospital in Puducherry from September 2016 to June 2017. Socio-demographic details and health expenditure of the households were obtained using epicollect5 software from 817 households with 3459 individuals. Data were exported to Microsoft excel and analysed using STATA(v14). Multivariate analysis using binary logistic regression analysis was done to identify the independent effect of various factors on catastrophic health expenditure. Results: The mean per-capita expenditure on health care among the households was INR 226.5.  About 27% of the households incurred catastrophic health expenditure. Multivariate analysis revealed that households with lower socio-economic status [11.21 (95%CI:5.07-24.82)], presence of vulnerable individuals at home [2.94 (95%CI:1.82-4.01)], alcohol-tobacco consumption [2.37 (95%CI:1.31-3.19)] and no health insurance schemes [6.89 (95%CI:4.74-10.41)] were the factors independently associated with catastrophic health expenditure. Conclusion: Catastrophic health expenditure was found in about one-fourth (27.2%) of the households. The household factors influencing catastrophic health expenditure were also identified. Strengthening the ability of health-care systems to provide comprehensive care is essential for reducing the burden of catastrophic health expenditure. Special focus must be given to financing the health care needs of the disadvantaged sections of the population.