Extent and determinants of catastrophic health expenditure in rural areas of Himachal Pradesh, India

In India, out-of-pocket (OOP) payments as a share of total health expenditures remain disproportionally high across population groups. When combined with poverty, poor access to healthcare and inadequate health insurance coverage, OOP expenses can have catastrophic consequences for rural households. In this context, the present study explored the levels of catastrophic health expenditures (CHE) and their determinants among rural households of a hilly state in India. Primary data were collected from 300 households in Himachal Pradesh. The focus of the study was to provide information on the distribution of CHE. In addition, various characteristics associated with the incidence of CHE were further studied using multiple logistic regression models. The results showed that households across Himachal Pradesh spend a significant proportion of their budget on healthcare. Among the characteristics associated with the likelihood of facing CHE, seeking outpatient care, having a chronic illness and location of the hospital showed significant associations. In conclusion, the financial risks emanating from OOP payments can be significantly reduced by covering outpatient care needs under social health insurance. Furthermore, strengthening rural health infrastructure to screen and treat chronic diseases locally, and minimizing the need to travel to distant places for treatment can also significantly reduce OOP payments.