Inpatient Hospital Admissions: Are There Inequities in Experiencing Catastrophic Health Expenditures Among the Hospitalized Patients in India?

OBJECTIVES: India is characterized by one of the highest OOPE on healthcare, in conjunction with the pervasive socio-economic disparities. This study was conducted to estimate the income-related inequalities in the incidence of CHE on hospitalization and glean the individual contributions of wider socio-economic determinants in influencing these inequalities in India.

METHODS: The study employed cross-sectional data from 75^th round of National Sample Survey Organization conducted during 2017-18 which circumscribed a sample size of 1,13,823 households and 5,57,887 individuals. The inequalities and need-adjusted inequities in the incidence of CHE on hospitalization care was assessed via Erreyger’s corrected concentration index. Need standardized concentration indices were further used to unravel the inter and intra-regional income related inequities in outcome of interest. Regression-based decomposition was performed to delineate the individual contributions of legitimate and illegitimate factors of CHE.

RESULTS: Our findings revealed pervasive wealth-related inequalities in the CHE for hospitalization care in India with a profound gap between the poorest and richest income quintile. The negative value of concentration index (EI: -0.19) indicated the inequalities to be significantly concentrated amongst the poor. Need-adjusted inequalities also demonstrated the pro-poor concentration (EI: -0.26), denoting the unfair systemic inequalities in the CHE which are disadvantageous to the poor. Multivariate logit results indicated that households with elderly, smaller size, vulnerable caste affiliation, poorest income quintile, no insurance cover, hospitalization in private facility, longer stay duration in the hospital and residence in the region at lower level of epidemiological transition level was associated with increased likelihood of incurring CHE on hospitalization.

CONCLUSIONS: Policy interventions such as increasing the awareness, enrollment, and utilization of Publicly Financed Health Insurance schemes, strengthening the public hospitals to provide improved quality of specialized care and referral mechanism and increasing the overall budgetary share of healthcare to improve the institutional capacities is suggested.