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Economic consequences of ill-health for households in northern rural India.

Quintussi M, Van de Poel E, Panda P, Rutten F - BMC Health Serv Res (2015)

Bottom Line: This paper describes the relative importance of ill-health compared to other adverse events, the conduits through which ill-health affects household welfare and the coping strategies used to finance these expenses.Few households reported having to reduce (food) consumption in response to ill-health.As most of the households' economic risk related to ill-health appears to depend on out of pocket spending, introducing health insurance may contribute significantly to alleviate economic hardship for families in rural India.

View Article: PubMed Central - PubMed

Affiliation: Cologne Graduate School in Management, Economics and Social Sciences, University of Cologne, Cologne, Germany. quintussi@wiso.uni-koeln.de.

ABSTRACT

Background: As compared to other countries in South East Asia, India's health care system is characterized by very high out of pocket payments, and consequently low financial protection and access to care. This paper describes the relative importance of ill-health compared to other adverse events, the conduits through which ill-health affects household welfare and the coping strategies used to finance these expenses.

Methods: Cross-sectional data are used from a survey conducted with 5241 households in Uttar Pradesh and Bihar in 2010 that included a household shocks module and detailed information about health care use and spending.

Results: Health-related adverse events were the second most common adverse events (34%), after natural disasters (51%). Crop and livestock disease and weddings each affected about 8% of households. Only a fourth of households reported to have recovered from illness and/or death in the family (by the time of the survey). Most of the households' economic burden related to ill-health was depending on direct medical costs, but indirect costs (such as lost earnings and transportation or food costs) were also not negligible. Close to half of the health expenditures were made for chronic conditions. Households tried to cope with health-related expenditures mostly by dissaving, borrowing and selling assets. Few households reported having to reduce (food) consumption in response to ill-health.

Conclusions: In the absence of pre-financing schemes, ill-health events pose a substantial threat to household welfare in rural India. While most households seem to be able to smooth consumption in the short term, coping strategies like selling assets and borrowing from moneylenders are likely to have severe long term consequences. As most of the households' economic risk related to ill-health appears to depend on out of pocket spending, introducing health insurance may contribute significantly to alleviate economic hardship for families in rural India. The importance of care for chronic diseases, however, represents a big challenge for the sustainability of community based health insurance schemes, since it is necessary to ensure a sufficient degree of risk pooling.

No MeSH data available.


Related in: MedlinePlus

Relative importance of coping strategies for financing health-related expenditures by type of care. Notes: Bars represent the proportion of households confronted with a specific type of health care use that have used a specific coping strategy. Households can employ more than one coping strategy.
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Fig2: Relative importance of coping strategies for financing health-related expenditures by type of care. Notes: Bars represent the proportion of households confronted with a specific type of health care use that have used a specific coping strategy. Households can employ more than one coping strategy.

Mentions: Having established the various costs associated with ill-health, we now want to investigate how households finance these costs in order to better understand the potential long-term consequences. FigureĀ 2 shows the relative importance of different coping strategies for different types of care and reveals that, particularly for hospitalizations, households resort to a combination of multiple financing mechanisms. Remarkably, over 80% of households that have been confronted with a hospitalization in the past year have borrowed money to cope with these expenditures. Other types of health care expenditures were typically financed through savings and loans, and to a lesser extent by selling assets and cutting/delaying payments. Those households that did sell assets mostly sold agricultural equipment and grain (58% of total cases), followed by household items (16%), livestock (11%) and jewelry (9%). Households that reported to cut back on spending mostly did this for food-related spending (68%).Figure 2


Economic consequences of ill-health for households in northern rural India.

Quintussi M, Van de Poel E, Panda P, Rutten F - BMC Health Serv Res (2015)

Relative importance of coping strategies for financing health-related expenditures by type of care. Notes: Bars represent the proportion of households confronted with a specific type of health care use that have used a specific coping strategy. Households can employ more than one coping strategy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4419476&req=5

Fig2: Relative importance of coping strategies for financing health-related expenditures by type of care. Notes: Bars represent the proportion of households confronted with a specific type of health care use that have used a specific coping strategy. Households can employ more than one coping strategy.
Mentions: Having established the various costs associated with ill-health, we now want to investigate how households finance these costs in order to better understand the potential long-term consequences. FigureĀ 2 shows the relative importance of different coping strategies for different types of care and reveals that, particularly for hospitalizations, households resort to a combination of multiple financing mechanisms. Remarkably, over 80% of households that have been confronted with a hospitalization in the past year have borrowed money to cope with these expenditures. Other types of health care expenditures were typically financed through savings and loans, and to a lesser extent by selling assets and cutting/delaying payments. Those households that did sell assets mostly sold agricultural equipment and grain (58% of total cases), followed by household items (16%), livestock (11%) and jewelry (9%). Households that reported to cut back on spending mostly did this for food-related spending (68%).Figure 2

Bottom Line: This paper describes the relative importance of ill-health compared to other adverse events, the conduits through which ill-health affects household welfare and the coping strategies used to finance these expenses.Few households reported having to reduce (food) consumption in response to ill-health.As most of the households' economic risk related to ill-health appears to depend on out of pocket spending, introducing health insurance may contribute significantly to alleviate economic hardship for families in rural India.

View Article: PubMed Central - PubMed

Affiliation: Cologne Graduate School in Management, Economics and Social Sciences, University of Cologne, Cologne, Germany. quintussi@wiso.uni-koeln.de.

ABSTRACT

Background: As compared to other countries in South East Asia, India's health care system is characterized by very high out of pocket payments, and consequently low financial protection and access to care. This paper describes the relative importance of ill-health compared to other adverse events, the conduits through which ill-health affects household welfare and the coping strategies used to finance these expenses.

Methods: Cross-sectional data are used from a survey conducted with 5241 households in Uttar Pradesh and Bihar in 2010 that included a household shocks module and detailed information about health care use and spending.

Results: Health-related adverse events were the second most common adverse events (34%), after natural disasters (51%). Crop and livestock disease and weddings each affected about 8% of households. Only a fourth of households reported to have recovered from illness and/or death in the family (by the time of the survey). Most of the households' economic burden related to ill-health was depending on direct medical costs, but indirect costs (such as lost earnings and transportation or food costs) were also not negligible. Close to half of the health expenditures were made for chronic conditions. Households tried to cope with health-related expenditures mostly by dissaving, borrowing and selling assets. Few households reported having to reduce (food) consumption in response to ill-health.

Conclusions: In the absence of pre-financing schemes, ill-health events pose a substantial threat to household welfare in rural India. While most households seem to be able to smooth consumption in the short term, coping strategies like selling assets and borrowing from moneylenders are likely to have severe long term consequences. As most of the households' economic risk related to ill-health appears to depend on out of pocket spending, introducing health insurance may contribute significantly to alleviate economic hardship for families in rural India. The importance of care for chronic diseases, however, represents a big challenge for the sustainability of community based health insurance schemes, since it is necessary to ensure a sufficient degree of risk pooling.

No MeSH data available.


Related in: MedlinePlus