Out-of-Pocket Health Care Expenditure and Poverty Impact in a Fragile Indian State of Assam

Abstract

Out-of-Pocket (OOP) expenditure on health care is one of the debilitating factors in pushing households into poverty. Households, especially the lower income groups and which do not have security measures like medical insurance, are the worst sufferers when faced with health shocks. Conventional methods of poverty estimation do not take into account health care consumption expenditure, which might understate the poverty headcount. In this study, poverty headcount and impoverishing effects of OOP health care expenditure have been analysed. The data have been collected from Chirang district of Indian state of Assam. The state is a fragile state due to ethnic violence, militancy and natural calamities like flood that the region has been experiencing for decades. The recall period for the inpatient care is 365 days, and six months for outpatient care. The poverty headcount is the difference between post Hp and pre Hp. The pre-payment (i.e. pre-OOP) ‘poverty headcount’ is calculated by comparing household’s consumption expenditure gross of payments for health care with the poverty line defined by the planning commission of India (2001). The post-OOP payment ‘poverty headcount’ is computed by netting out health care payments from a household’s consumption expenditure and then comparing with the poverty line. The intensity of poverty has been estimated with the help of the methods introduced by Wagstaff and Doorslaer (2003). The higher income households make higher OOP expenditure than the lower income households. The burden of OOP is higher on the lower income households because the proportion of OOP expenditure to total income of households is higher amongst the poor households compared to higher income households. OOP expenditure pushed households into poverty. This is more serious with the inpatient care compared to the OOP expenditure on outpatient care. The poverty gap or the intensity of poverty of the overall OOP expenditure is Rs. 279.28, which varies between outpatient and inpatient OOP expenditure.