Catastrophic Spending on Health by Sample Households: Some Results

As was noted in Chap. 1, a good amount of literature at the all India or by states now already exists to suggest that health expenditure in India and some other low-income countries in Asia is considerably large (Bonu et al. 2007; Gottret and Schieber 2006; O’Donnell et al. 2008; Xu et al. 2003, etc.). A great deal of this expenditure—almost three-quarters or in some cases even more—is borne privately by households in many of these countries, in particular those with inadequate health-care systems. In a large number of cases, OOP spending on health causes serious implications for low-income households and affects their sustained living by affecting their normal expenditure pattern, particularly on a host of important nonfood items. A number of these issues have begun to receive much wider attention in India over the past few years, particularly after the seminal report by the NCMH (Ministry of Health and Family Welfare 2005). There has also been a growing concern over these years regarding major policy failures on the part of the centre and state governments in providing adequate resources—physical, financial and human—to meet health-care needs of the people, in particular the poor and the needy. This Commission has also explicitly recognised in its report the prevalence of a very high OOP spending on health in several low-income states—in particular by the households in lowest income deciles—and its role in pushing a significant fraction of households to face poverty and debt trap (see Section 2 of the Commission’s Report, 2005). More or less, a similar inference was drawn in Chap. 3 of this study indicating a large fraction of households sliding below poverty level after incurring OOP expenses on health. Many of them had to borrow from private moneylenders with high repayment liabilities leading to asset divestments.