Journal Article

Geographic Variation in Household and Catastrophic Health Spending in India: Assessing the Relative Importance of Villages, Districts, and States, 2011-2012

MOHANTY, SANJAY K., SUBRAMANIAN, S. V., KHAN, PIJUSH KANTI, KIM, ROCKLI

2018

Overview

Context: In India, health care is a local good, and households are the major source of financing it. Earlier studies have examined diverse determinants of health care spending, but no attempt has been made to understand the geographical variation in household and catastrophic health spending. We used multilevel modeling to assess the relative importance of villages, districts, and states to health spending in India. Methods: We used data on the health expenditures of 101,576 households collected in the consumption expenditure schedule (68th round) carried out by the National Sample Survey in 2011-2012. We examined 4 dependent variables: per-capita health spending (PHS), per-capita institutional health spending (PIHS), per-capita noninstitutional health spending (PNHS), and catastrophic health spending (CHS). CHS was defined as household health spending exceeding 40% of its capacity to pay. We used multilevel linear regression and logistic models to decompose the variation in each outcome by state, region, district, village, and household levels. Findings: The average PHS was 1,331 Indian rupees (INR), which varied by state-level economic development. About one-fourth of Indian households incurred CHS, which was equally high in both the economically developed and poorer states. After controlling for household level factors, 77.1% of the total variation in PHS was attributable to households, 10.1% to states, 9.5% to villages, 2.6% to districts, and 0.7% to regions. The pattern in variance partitioning was similar for PNHS. The largest interstate variation was found for CHS (15.9%), while the opposite was true for PIHS (3.2%). Conclusions: We observed substantial variations in household health spending at the state and village levels compared with India's districts and regions. The large variation in CHS attributable to states indicates interstate inequality in the accessibility to and cost of health care. Our findings suggest that contextual factors at the macro and micro political units are important to reduce India's household health spending and CHS.

• Publisher: Wiley Subscription Services, Inc,Blackwell Publishing Ltd,John Wiley and Sons Inc
• Subject: Ability to pay / Access / Accessibility / Adult / Aged / catastrophic health spending / Catastrophic Illness - economics / Consumer spending / Consumption / Context / Cost of Illness / Data collection / Dependent variables / Developed countries / Districts / Economic development / Economics / Expenditures / Family Characteristics / Female / Financing / Financing, Personal / Geographic regions / geographic variation / Geography, Medical / Government spending / Head of household / Health care / Health Care Costs / Health care economics / Health care expenditures / Health care policy / Health disparities / Health expenditures / Health Expenditures - statistics & numerical data / Health services / Health Services Accessibility - economics / household health spending / Households / Humans / India / Inequality / Male / Middle Aged / Modelling / Models, Economic / Multilevel / multilevel modeling / Multilevel models / National health insurance / Original Scholarship / Permanent income hypothesis / Regions / Regression analysis / Variables / Variation / Villages