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      Catastrophic Health Expenditure and Impoverishment Effects of Out-of-pocket Expenses: A Comparative Study of Tannery and Non-tannery Workers of Kanpur, India

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          Abstract

          Purpose:

          Treatment-seeking behaviors and economic burden because of health expenditure are widely discussed issues in India, and more so in recent times. The aim of this study is to identify health problems of tannery workers and their treatment-seeking behavior and their health expenditure.

          Data and Methods:

          The primary data used in this article were collected through a cross-sectional household survey of 284 male tannery workers in the Jajmau area of Kanpur city in the state of Uttar Pradesh, during January–June 2015.

          Results:

          Findings of the study revealed that around 36% of the tannery workers and 42% of non-tannery workers received treatment as outpatients in government/municipal hospital in the first spell of treatment. The secondary source of treatment was pharmacy/drug stores for 30% of the tannery workers and 24% of the non-tannery workers, an indication that a substantial proportion takes treatment without consulting a qualified medical practitioner; it also highlights that almost one-third of the tannery and non-tannery workers visited private health facility despite poor economic condition. It is evident that a substantial proportion of tannery and non-tannery workers are visiting private/non-governmental organization/trust hospital despite their poor financial situation.

          Conclusion:

          There is an urgent need to reinstate people's faith in public health facilities by developing professionalism, integrity, and accountability among different levels of health functionaries and frontline workers with the support of credible, transparent, and responsible regulatory environment.

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          Most cited references16

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          Social class related inequalities in household health expenditure and economic burden: evidence from Kerala, south India

          Background In the Indian context, a household's caste characteristics are most relevant for identifying its poverty and vulnerability status. Inadequate provision of public health care, the near-absence of health insurance and increasing dependence on the private health sector have impoverished the poor and the marginalised, especially the scheduled tribe population. This study examines caste-based inequalities in households' out-of-pocket health expenditure in the south Indian state of Kerala and provides evidence on the consequent financial burden inflicted upon households in different caste groups. Methods Using data from a 2003-2004 panel survey in Kottathara Panchayat that collected detailed information on health care consumption from 543 households, we analysed inequality in per capita out-of-pocket health expenditure across castes by considering households' health care needs and types of care utilised. We used multivariate regression to measure the caste-based inequality in health expenditure. To assess health expenditure burden, we analysed households incurring high health expenses and their sources of finance for meeting health expenses. Results The per capita health expenditures reported by four caste groups accord with their status in the caste hierarchy. This was confirmed by multivariate analysis after controlling for health care needs and influential confounders. Households with high health care needs are more disadvantaged in terms of spending on health care. Households with high health care needs are generally at higher risk of spending heavily on health care. Hospitalisation expenditure was found to have the most impoverishing impacts, especially on backward caste households. Conclusion Caste-based inequality in household health expenditure reflects unequal access to quality health care by different caste groups. Households with high health care needs and chronic health care needs are most affected by this inequality. Households in the most marginalised castes and with high health care need require protection against impoverishing health expenditures. Special emphasis must be given to funding hospitalisation, as this expenditure puts households most at risk in terms of mobilising monetary resources. However, designing protection instruments requires deeper understanding of how the uncovered financial burden of out-patient and hospitalisation expenditure creates negative consequences and of the relative magnitude of this burden on households.
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            Catastrophic health payments and health insurance: some counterintuitive evidence from one low-income country.

            The purpose of the study is to quantitatively analyze the role of health insurance in the determinants of catastrophic health payments in a low-income country setting. The study uses the most recent publicly available household level data from Zambia collected in 1998 containing detailed information on health care utilization and spending and on other key individual, household, and community factors. An econometric model is estimated by means of multivariate regression. The main results are counterintuitive in that health insurance is not found to provide financial protection against the risk of catastrophic payments; indeed, insurance is found to increase this risk. Reasons for the findings are discussed using additional available information focusing on the amount of care per illness episode and the type of care provided. The key conclusion is that the true impact of health insurance is an empirical issue depending on several key context factors, including quality assurance and service provision oversight.
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              The Economic impact of Non-communicable Diseases on households in India

              Background In India, Non Communicable Diseases (NCDs) and injuries account for an estimated 62% of the total age-standardized burden of forgone Disability Adjusted Life Years (DALYs). Public and private financing of clinical services to reduce the NCD burden is a major challenge. Methods We used National Sample Survey Organization (NSSO) survey data from 1995-96 and 2004 covering nearly 200 thousand households to assess healthcare utilization patterns and out of pocket health spending by disease category. For this purpose, self-reported diseases and conditions were categorized into NCDs and non-NCDs. Survey data were used to assess how households financed their overall health expenditures and related this pattern to specific health conditions. We measured catastrophic spending on NCD-related hospitalization, defined as occurring when health expenditures exceeded 40% of a household's ability to pay, that is, household consumption spending less combined survival consumption expenditure; and impoverishment when per capita expenditure within the household decreased to below the poverty line once health spending was netted out. Results The share of NCDs in out of pocket health expenses incurred by households increased over time, from 31.6 percent in 1995-96 to 47.3 percent in 2004. In both years, own savings and income were the most important source of financing for many health conditions, typically between 40-60 percent of all spending, whereas 30-35 percent was from borrowing. The odds of catastrophic hospitalization expenditures for cancer was nearly 170% greater and for CVD and injuries 22 percent greater than the odds due to communicable diseases. Impoverishment patterns were similar. Conclusions Out of pocket expenses for treating NCDs rose sharply over the period from 1995-96 to 2004. When NCDs are present, the financial risks to which Indians households are exposed are significant.
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                Author and article information

                Journal
                Indian J Occup Environ Med
                Indian J Occup Environ Med
                IJOEM
                Indian Journal of Occupational and Environmental Medicine
                Medknow Publications & Media Pvt Ltd (India )
                0973-2284
                1998-3670
                Jan-Apr 2018
                : 22
                : 1
                : 22-28
                Affiliations
                [1]Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Deonar, Mumbai, Maharashtra, India
                Author notes
                Address for correspondence: Santosh K. Sharma, International Institute for Population Sciences, Govandi Station Road, Deonor, Mumbai - 400 088, Maharashtra, India. E-mail: santoshiips88@ 123456gmail.com
                Article
                IJOEM-22-22
                10.4103/ijoem.IJOEM_168_17
                5932907
                29743781
                68d92b5d-dbb7-4b55-bf4c-a886b190dcc7
                Copyright: © 2018 Indian Journal of Occupational and Environmental Medicine

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Categories
                Original Article

                Occupational & Environmental medicine
                economic burden,kanpur,occupational hazard,treatment
                Occupational & Environmental medicine
                economic burden, kanpur, occupational hazard, treatment

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