Quantifying the burden of out-of-pocket health expenditure in India

This study aims at analyzing the dimensions of the burden of out-of-pocket (OOP) health expenditure in rural and urban India between 1999-2000 and 2011-2012.

Consumer Expenditure Survey data of the National Sample Survey for the period of 1999-2000 (55th round), 2004-2005 (61st round), and 2011-2012 (68th round) have been used in this study.

To analyze the dimension of OOP healthcare expenditure, this study has used headcount measure, which includes change in the percentage of population paying OOP health expenditure, concentration index of headcount, rank-weighted headcount, and gap measures, which includes average per capita gap (health expenditure), mean positive gap, concentration index, and rank-weighted gap for rural, urban, and all India level between 1999-2000 and 2011-2012.

The authors have found that a large percentage of the population in rural and urban India is still not reporting health expenditure. There is a huge difference between per capita health expenditure in rural and urban areas during the study period. The percentage of the population that reported OOP health expenditure has increased at the bottom level, but the expenditure got more concentrated toward better-off people in both rural and urban areas of the country in this time period. It is also clear from the results that the concentration of average per capita gap (Co) in rural areas leans towards better-off people more than in urban areas.

This study advocates for health sector reforms to protect households from the significant burden of expenditure on critical health care.