Abstract

BACKGROUND: The public health spending in India is below two percent of gross domestic product. Approximately 70 percent of Indian health care payments are out-of-pocket. However, this system of paying for health care is not sustainable in that it distorts the economic well being of the people, especially the poor ones. Households face catastrophic payments when health care payment is out-of-pocket. This catastrophic health spending can be an additional source of poverty. Therefore, in this study we set to examine the out-of-pocket spending on health care and the determinants of catastrophic payments. DATA AND METHODS: The analysis is based on cross-sectional primary data surveyed in the year 2015 for 576 households. The survey was done in the rural areas of Chirang district, Assam, India. The multivariate logistic regression analysis was done to examine the determinants of out of pocket health payments. RESULTS: Higher income and non-poor households are found to make higher out-of-pocket payments on health care compared to lower income groups. Nonetheless, the burden of out-of-pocket payments is higher on lower income groups than the higher income households due to the fact that the proportion of health payments to income is higher for the lower income households. The lowest income group households are 1.22 times higher chance to incur catastrophic health expenditure than the highest income group households OR=1.22, p<0.001). The middle income group households (Rs 75,001-2, 00,000) is also more likely to incur catastrophic households compared to the highest income group whose income is more than two lakhs (OR=75.38, p<0.05). Inpatient care for IPD, those households who utilized the private health care are more likely to incur catastrophic OOP payments compared to those households who made a visit to the public health centre for IPD (ORs=286.93, p<0.01). Households who made a visit to the registered private hospital for outpatient health care are more likely to face catastrophic health payments compared to those households who made visit to the public health centre (ORs=140.80, p<0.01). similarly, households who made OOP payments in the registered private doctor for outpatient treatment are also more likely to face catastrophic payments as compared to those who visited public health centre for the OPD treatment (ORs=36.19, p<0.05). CONCLUSION: Out-of-pocket health care payments is regressive in nature, the burden of out of pocket payment is more on the lower income groups. Households’ income, family size, private health care and disease type are important determinants of catastrophic out of pocket payments. Thus, the policy makers need to take cognizance of these factors in formulating health care policies for the rural areas of Assam in particular and the north eastern states in general.

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