Catastrophic out-of-pocket payment for health care and its impact on households: Experience from West Bengal, India

The present paper attempts to find out the major determining factors of catastrophic payment in health care, and the impact of such expenditure on household economic status. A survey of 3150 households in West Bengal, India, was analyzed using multivariate logistic regression models to identify factors associated with catastrophic health expenditures, defined as household spending on health greater than 40% of non-food expenditure. The factors associates with catastrophic medical expenditures are: multiple spells of illnesses in the households, prevalence of chronic morbidity among the household members (Odds ratio 3.0, 95% CI), inpatient care (Odds ratio 1.4, 95% CI) and childbirth (Odds ratio 1.0, 95% CI). Other household characteristics, such as household size (Odds ratio 1.0, 95% CI) and rural/urban location (Odds ratio 2.1, 95% CI) are also important determinants of catastrophic spending. The analysis shows a common pattern of expenditure due to the treatment of minor illness on increasing the burden of catastrophe on the households, which overshadows the effects of one-time expenditures incurred for hospitalization. The cumulative amount incurred for minor ailments effects household’s current food consumption, children’s education, medical treatment of the other member, social recreation in a greater extent as compared to the hospitalization care or birth delivery. This study addressed the key findings to the policy maker to ensure better access and high degree of financial protection against the impact of illness.