Out of Pocket Expenditure in Health Care

1. Results of study in five states of India Out of Pocket Expenditure in Health Care Study Conducted by Study supported by Oxfam India Prayas, Rajasthan

2. Partner Organisations: Rashtriya Grameen Vikas Nidhi, Assam Child In Need Institute, Jharkhand Rural Women’s Social Education Centre, Tamilnadu Chirag, Uttarakhand

3. Out of Pocket Expenditure (Oope) in Health Care • OoPE are non-reimbursable fees which a patient or family is responsible for paying directly to health practitioners or suppliers, without intervention of a third party. It often occurs, when publicly funded facilities are unable to provide the required health services and supplies for free or through insurance. • India was ranked as having the 42nd highest average OoPE, with 74.4% of private expenditure being paid as out of pocket. (WHS 2011) • OoPE accounts for an average increase in poverty by as much as 3.6 and 2.9 percent for rural and urban India respectively (Gupta 2009)

4. Spending on Health in Different Economies of World WHO, World Health Report2008

5. Aim of the Study • Assess the nature of out of pocket payments of households in health care and examine its relationship with post 2004 new nation wide health initiatives viz. NRHM, RSBY and many state led programmes. Objectives of Study • Assess the change in out-of-pocket expenditure of households for health care between 2004-10. • Examine the change in OoP expenditure in various social and economic groups. • Analyse the pattern of OoP expenditure in relation to various parameters of new post 2004 national health initiatives viz. NRHM & RSBY

6. Research questions • Is there any reduction or increase in out-of-pocket expenditure for households on health care post 2004? • Is there any reduction or increase in out-of-pocket expenditure on health care in proportion to total consumption expenditure of households? • Is there any difference in the pattern of OoP across different (a) social and (b) economic categories? • Is there any effect of post 2004 new national health programmes on the pattern of out-of-pocket expenditure on health care?

7. Sampling strategy • Districts and village in states were selected through PPS technique (Probability Proportional to Size Sampling Technique). • Sample size was fixed to 200 HH per district. This was obtained by selecting 10 villages per district and 20 households per village. • Number of States : 5 • Number of Districts : 14 • Number of Villages: 140 • Number of Households surveyed : 2723

8. Sample design • Stratified multi-stage design • The first stage units (FSU) were the 2001 census villages. • The ultimate stage units (USU) were households in villages. In case of large villages requiring hamlet-group (hg) formation, one intermediate stage was the selection of two hg’s from each FSU. Formation of Second Stage Strata and allocation of households

9. Survey tool • Survey tool was adapted from NSSO 60th round. • There were two schedules – • for listing of households and • for in-depth interview of selected households • Field data of the study was collected in the months from March to May 2011

10. Profile of the sample group

11. Basic Household Amenities and Infrastructure

12. Basic Household Amenities and Infrastructure

13. Morbidity and Health Care(Non-hospitalised case)

14. Proportion of Ailing persons (per 1000) during last 15 days prior to the survey

15. Proportion of Ailing persons (per 1000) during last 15 days prior to the survey (Comparison with NSSO 60th round)

16. Proportion of Ailing Persons (per 1000) during last 15 days by sex and age group

17. Proportion of Ailing Persons (per 1000) during last 15 days by socio-economic characteristics

18. Proportion (Per 1000) of persons ailing and Proportion of persons reported commencement of ailment one day before the survey

19. Proportion (per 1000) of ailing persons treated in outpatient

20. Proportion (per 1000) of ailing persons treated in outpatient (Comparison with NSSO 60th round)

21. Proportion (per 1000) of untreated spells of ailment by reason for no treatment and comparison with NSSO 60th round

22. Per 1000 distribution of treated spells of ailments during 15 days by source of treatment for each MPCE class and social group

23. Per 1000 distribution of treated spells of ailments during 15 days by source of treatment (Comparison with NSSO 60th round)

24. Average total expenditure (Rs.) , Average total medical expenditure (Rs.) and expenditure on medicine (Rs.) for non-hospitalized treatment per ailing person during last 15 days

25. Average total expenditure (Rs.) for non hospitalized treatment for each MPCE class

26. Average total expenditure (Rs.) , Average total medical expenditure (Rs.) and other expenditure (Rs.) for non-hospitalized treatment per ailing person during last 15 days (Comparison with NSSO 60th round)

27. Proportion (per 1000) of household expenditure on treatment during last 15 days by source of finance for each MPCE class

28. Morbidity and Health Care(Hospitalised case)

29. Proportion (per 1000) of population hospitalized during last 365 days

30. Proportion (per 1000) of population hospitalized during last 365 days (Comparison with NSSO 60th round)

31. Proportion (per 1000) of population hospitalized by MPCE class

32. Per 1000 distribution of persons hospitalized by type of ailment

33. Proportion (per 1000) of hospitalized cases by type of hospital

34. Proportion (per 1000) of hospitalized cases by type of hospital (Comparison with NSSO 60th round)

35. Proportion (per 1000) of hospitalized cases by type of hospital in each MPCE class

36. Average Duration of Stay (in days) in Hospital by Type of Hospital

37. Average Medical Expenditure (Rs.) per hospitalization by sex and type of hospital

38. Average medical expenditure per hospitalization by type of hospital for each household MPCE class

39. Average total expenditure (Rs.) , Average total medical expenditure (Rs.) and expenditure on medicine (Rs.) for hospitalized case in last 365 days

40. Average total expenditure (Rs.) , Average total medical expenditure (Rs.) and other expenditure (Rs.) for per hospitalized case during last 365 days(Comparison with NSSO 60th round)

41. Proportion (per 1000) of household expenditure on treatment during last 15 days by source of finance for each MPCE class

42. Maternal and Child Health

43. Proportion of children Immunized (per 1000)

44. Expenditure incurred on Immunization (in Rs.)

45. Per 1000 distribution of childbirth by place of delivery for each broad age group

46. Average expenditure (in Rs.) per childbirth by place of delivery

47. Proportion (per 1000) of women who availed antenatal care services (PWANC) by source of institution for availing the facilities

48. Average expenditure (Rs.) on antenatal care services (ANC) by woman by source of service

49. Proportion (per 1000) of women who availed post-natal care services (PWPNC) by source of institution for availing the facilities

50. Average expenditure (Rs.) on post-natal care services (PNC) by woman by source of service