Using data from 60th round of the National Sample Survey, this study attempts to measure the incidence and intensity of ‘catastrophic’ maternal health care expenditure and examines its socio-economic correlates in u...Using data from 60th round of the National Sample Survey, this study attempts to measure the incidence and intensity of ‘catastrophic’ maternal health care expenditure and examines its socio-economic correlates in urban and rural areas separately. Additionally, it measures the effect of maternal health care expenditure on poverty incidence and examines the factors associated with such impoverishment due to maternal health care payments. We found that maternal health care expenditure in urban households was almost twice that of rural households. A little more than one third households suffered catastrophic payments in both urban and rural areas. Rural women from scheduled tribes (ST) had more catastrophic head counts than ST women from urban areas. On the other hand, the catastrophic head count was greater among illiterate women living in urban areas compared to those living in rural areas. After adjusting for out-of-pocket maternal health care expenditure, the poverty in urban and rural areas increased by almost equal percentage points (20% in urban areas versus 19% in rural areas). Increasing education level, higher consumption expenditure quintile and higher caste of women was associated with increasing odds of impoverishment due to maternal health care expenditure. To reduce maternal health care expenditure induced poverty, the demand-side maternal health care financing programs and policies in future should take into consideration all the costs incurred during prenatal, delivery and postnatal periods and focus not only on those women who suffered catastrophic expenditure and plunged into poverty but also those who forgo maternal health care due to their inability to pay.展开更多
The health inequities remain high in India with government and private health expenditures clearly favoring the rich, urban population and organized sector workers and the Out Of Pocket (OOP) spending as high as 80%, ...The health inequities remain high in India with government and private health expenditures clearly favoring the rich, urban population and organized sector workers and the Out Of Pocket (OOP) spending as high as 80%, afflicting the poor in the worst manner. The focus of the paper is to examine the potential Community Based Health Insurance (CBHI) offers to improve the healthcare access to rural, low-income population and the people in unorganized sector. This is done by drawing empirical evidence from various countries on their experiences of implementing CBHI schemes and its potential for applications to India, problems and challenges faced and the policy and management lessons that may be applicable to India. It can be concluded that CBHI schemes have proved to be effective in reducing the Catastrophic Health Expenditure (CHE) of people. But success of such schemes depends on its design, benefit package it offers, its management, economic and non-economic benefits perceived by enrollees and solidarity among community members. Collaboration of government, NGO’s and donor agencies is very crucial in extending coverage;similarly overcoming the mistrust that people have from such schemes and subsidizing the insurance for the many who cannot pay the premiums are important factors for success of CBHI in India. One of the biggest challenges for the health system is to address the piecemeal approach of CBHI schemes in extending health insurance and inability of such schemes to cover a large number of poor and the unorganized sector workers. Also, there is a need for a stronger policy research to demonstrate: 1) how such schemes can create a larger risk pool, 2) how such schemes can enroll a large number of people in the unorganized sector, 3) the interaction of CBHI schemes with other financing schemes and its link to the health system.展开更多
文摘Using data from 60th round of the National Sample Survey, this study attempts to measure the incidence and intensity of ‘catastrophic’ maternal health care expenditure and examines its socio-economic correlates in urban and rural areas separately. Additionally, it measures the effect of maternal health care expenditure on poverty incidence and examines the factors associated with such impoverishment due to maternal health care payments. We found that maternal health care expenditure in urban households was almost twice that of rural households. A little more than one third households suffered catastrophic payments in both urban and rural areas. Rural women from scheduled tribes (ST) had more catastrophic head counts than ST women from urban areas. On the other hand, the catastrophic head count was greater among illiterate women living in urban areas compared to those living in rural areas. After adjusting for out-of-pocket maternal health care expenditure, the poverty in urban and rural areas increased by almost equal percentage points (20% in urban areas versus 19% in rural areas). Increasing education level, higher consumption expenditure quintile and higher caste of women was associated with increasing odds of impoverishment due to maternal health care expenditure. To reduce maternal health care expenditure induced poverty, the demand-side maternal health care financing programs and policies in future should take into consideration all the costs incurred during prenatal, delivery and postnatal periods and focus not only on those women who suffered catastrophic expenditure and plunged into poverty but also those who forgo maternal health care due to their inability to pay.
文摘The health inequities remain high in India with government and private health expenditures clearly favoring the rich, urban population and organized sector workers and the Out Of Pocket (OOP) spending as high as 80%, afflicting the poor in the worst manner. The focus of the paper is to examine the potential Community Based Health Insurance (CBHI) offers to improve the healthcare access to rural, low-income population and the people in unorganized sector. This is done by drawing empirical evidence from various countries on their experiences of implementing CBHI schemes and its potential for applications to India, problems and challenges faced and the policy and management lessons that may be applicable to India. It can be concluded that CBHI schemes have proved to be effective in reducing the Catastrophic Health Expenditure (CHE) of people. But success of such schemes depends on its design, benefit package it offers, its management, economic and non-economic benefits perceived by enrollees and solidarity among community members. Collaboration of government, NGO’s and donor agencies is very crucial in extending coverage;similarly overcoming the mistrust that people have from such schemes and subsidizing the insurance for the many who cannot pay the premiums are important factors for success of CBHI in India. One of the biggest challenges for the health system is to address the piecemeal approach of CBHI schemes in extending health insurance and inability of such schemes to cover a large number of poor and the unorganized sector workers. Also, there is a need for a stronger policy research to demonstrate: 1) how such schemes can create a larger risk pool, 2) how such schemes can enroll a large number of people in the unorganized sector, 3) the interaction of CBHI schemes with other financing schemes and its link to the health system.
