Description
Background: Lack of access to public facilities and qualified primary healthcare in urban areas results in a substantial proportion of out-patient care through private sector. While the Government of India has recently launched National Health Protection Mission (NHPM), to strengthen the primary health care and provide financial risk protection–its achievement however will significantly depend on its success to reach to the migrant urban poor. Focusing on health patterns and determinants of urban poor particularly the migrants are crucial to move towards universal health coverage. There have been a few studies from India which document the extent and determinants of morbidity profile, health seeking behavior, Out of Pocket (OOP) expenditures on health among urban poor migrant population, however the literature is scarce.
Objectives: The present study was undertaken to fulfil the existing gaps in evidence and literature on OOP expenditures on health especially among urban poor migrant population. Specifically, we tried to determine the extent of morbidity, healthcare utilization patterns, OOP expenditures and financial risk protection, and its determinants among the urban poor.
Methodology: A cross-sectional survey was conducted among 11,000 individuals from 2,400 urban households in 4 geographically diverse states of India. Along with socio-demographic and economic characteristics, information was collected on illness and hospitalization episodes, treatment seeking behavior, out-of-pocket expenditure and coping mechanisms utilized. The prevalence of CHE was computed, and logit models were used to identify the determinants of CHE for migrants and non-migrant.
Results: Average annual household healthcare OOPE was INR 6,689 (US $97). Mean Expenditure on hospitalization was INR 27,025 ($392), with 95% confidence interval ranging from INR 22,734 ($329) to INR 31,815 ($461). Households spent INR 26,850 (USD 350) per hospitalization, which was catastrophic for 10% of the households, further pushing 4.7% below the poverty line. Hospitalization rates were found to be significantly lower among males as compared to females (OR 0.75, p < 0.05). The CHE was higher among males (10.8%), non-Hindus (14.8%), those over 55 years of age (12%), illiterates (12.1%), non-enrolled in health insurance schemes (10.4%) and those belonging to poor tertiles (11.7%). Hospitalization rates were found to be significantly lower among males as compared to females (odds ratio 0.75, p <0.01) while the CHE rates were significantly higher among males (odds ratio 1.77, p < 0.05). Hospitalization rates were also observed to be higher among those above 55 years, Hindus, belonging to the general category, and poor patients. Our study results also indicated the inefficiency of health insurance enrolment to protect households from CHE, despite the higher hospitalization rates among the enrolled households.
Conclusion: The study not only indicates high OOP expenditure incurred by migrant urban poor, but also points to large socio-economic inequalities. Expected policy response should comprise of interventions aimed at reducing the OOP expenditures and improving access to health care.
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