Addressing data and methodological limitations in estimating catastrophic health spending and impoverishment in India, 2004–18

Abstract Background Estimates of catastrophic health expenditure (CHE) are counterintuitive to researchers, policy makers, and developmental partners due data methodological limitation. While inferences drawn from use capacity-to-pay (CTP) budget share (BS) approaches inconsistent, the non-availability on food in survey India is an added Methods Using consumption surveys National Sample Surveys over 14 years, we have overcome these limitations estimated incidence intensity CHE impoverishment using CTP approach. Results The for services was 12.5% 2004, 13.4% 2014 9.1% by 2018. Among those households incurring CHE, they spent 1.25 times their capacity pay 2004 (intensity CHE), 1.71 1.31 spending 4.8% 5.1% 3.3% state variations large. concentration index (CI) ? 0.16 0.18 0.22 2018 suggesting increasing inequality time. curves based approach suggests that concentrated among poor. odds were lowest richest [OR 0.22; 95% CI: 0.21, 0.24], with elderly members 1.20; CI:1.12, 1.18] both inpatient outpatient 2.80, CI 2.66, 2.95]. Access insurance reduced chance households. pattern similar CHE. Conclusion In last has declined while increased.