Skip to main content
Erschienen in: Journal of Public Health 3/2016

25.02.2016 | Original Article

Pattern, growth and determinant of household health spending in India, 1993–2012

verfasst von: Sanjay K. Mohanty, L. Ladusingh, Anshul Kastor, Rajesh K. Chauhan, David E. Bloom

Erschienen in: Journal of Public Health | Ausgabe 3/2016

Einloggen, um Zugang zu erhalten

Abstract

Aim

This paper examines the pattern, growth and determinants of household health spending in India and compares the growth of per capita household health spending and per capita consumption expenditure over the last two decades.

Subject and methods

The unit data of various rounds of the National Sample Survey (consumption expenditure surveys 1993–1994, 2004–2005 and 2011–2012 and morbidity and health care surveys 1995–1996 and 2004) along with data from other secondary sources are used in the analyses. The patterns and growth of health spending are analyzed by demographic, social and economic attributes and economic well-being is measured using per capita consumption expenditure. Household health spending is subdivided into age structure, population growth, real cost of medical care and increased hospitalization. Descriptive statistics, fixed effect models and simple decomposition methods are used in the analyses.

Results

Results suggest that during 1993–2012, the annual growth rate of real per capita household health spending was twice (6.14 %) the real per capita consumption expenditure (2.60 %). On average, per capita household health spending among the richest consumption quintile was at least eight times higher than that of the poorest consumption quintile, linking household health spending to ability to pay. Household health spending was income inelastic. Though medicine accounts for a larger share of household health spending, household spending on medical tests is growing fast. We found a strong and positive gradient of age on per capita household health spending after controlling for income and other confounders. During 1995–2004, the age structure, hospitalization and real cost of hospitalization accounted for a 14, 42 and 26 % increase in the cost of hospitalization respectively.

Conclusion

Household health spending is growing faster than the consumption expenditure (economic well being) of household and changing age structure is significantly affecting health spending in India. Increased public spending on health, upgrading the public health system and increasing access to health insurance can reduce the household health spending in India.
Anhänge
Nur mit Berechtigung zugänglich
Fußnoten
1
Schedule type-1 was used as it is comparable with other rounds used in this analysis.
 
2
The term health spending and health expenditure are used interchangeably
 
Literatur
Zurück zum Zitat Arsenijevic J, Pavlova M, Groot W (2013) Measuring the catastrophic and impoverishing effect of household health care spending in Serbia. Soc Sci Med 78:17–25CrossRefPubMed Arsenijevic J, Pavlova M, Groot W (2013) Measuring the catastrophic and impoverishing effect of household health care spending in Serbia. Soc Sci Med 78:17–25CrossRefPubMed
Zurück zum Zitat Baltagi BH, Moscone F (2010) Health care expenditure and income in the OECD reconsidered: evidence from panel data. Econ Model 27:804–811CrossRef Baltagi BH, Moscone F (2010) Health care expenditure and income in the OECD reconsidered: evidence from panel data. Econ Model 27:804–811CrossRef
Zurück zum Zitat Bloom DE (2011) India’s baby boomers: dividend or disaster. Curr Hist 110:143–149 Bloom DE (2011) India’s baby boomers: dividend or disaster. Curr Hist 110:143–149
Zurück zum Zitat Bloom DE, Fonseca CET, Candeias V, Adashi E, Bloom L, Gurfein L, Llopis JE, Lubet A, Mitgang E, Carroll OJ, Saxena A (2014) Economics of non-communicable diseases in India. World Economic Forum, Harvard School of Public Health, Cambridge, MA Bloom DE, Fonseca CET, Candeias V, Adashi E, Bloom L, Gurfein L, Llopis JE, Lubet A, Mitgang E, Carroll OJ, Saxena A (2014) Economics of non-communicable diseases in India. World Economic Forum, Harvard School of Public Health, Cambridge, MA
Zurück zum Zitat Brinda EM, Kowal P, Attermann J, Enemark U (2015) Health service use, out-of-pocket payments and catastrophic health expenditure among older people in India: the WHO Study on global AGEing and adult health (SAGE). J Epidemiol Community Health 69:489–494CrossRefPubMed Brinda EM, Kowal P, Attermann J, Enemark U (2015) Health service use, out-of-pocket payments and catastrophic health expenditure among older people in India: the WHO Study on global AGEing and adult health (SAGE). J Epidemiol Community Health 69:489–494CrossRefPubMed
Zurück zum Zitat Cutler DM, Meera E (1998) The medical cost of the young and old: a forty-year perspective. In: Wise DA (ed) Frontiers in the economics of aging. University of Chicago Press, Chicago, IL, pp 215–246 Cutler DM, Meera E (1998) The medical cost of the young and old: a forty-year perspective. In: Wise DA (ed) Frontiers in the economics of aging. University of Chicago Press, Chicago, IL, pp 215–246
Zurück zum Zitat Deaton A (2003) Household surveys, consumption and the measurement of poverty. Econ Syst Res 15:135–159CrossRef Deaton A (2003) Household surveys, consumption and the measurement of poverty. Econ Syst Res 15:135–159CrossRef
Zurück zum Zitat Dhak B (2015) Demographic change and catastrophic health expenditure in India. Soc Indic Res 122:723–733CrossRef Dhak B (2015) Demographic change and catastrophic health expenditure in India. Soc Indic Res 122:723–733CrossRef
Zurück zum Zitat Dormont B, Grignon M, Huber H (2006) Health expenditure growth: reassessing the threat of ageing. Health Econ 15:947–963CrossRefPubMed Dormont B, Grignon M, Huber H (2006) Health expenditure growth: reassessing the threat of ageing. Health Econ 15:947–963CrossRefPubMed
Zurück zum Zitat Engelgau MM, Karan A, Mahal A (2012) The economic impact of non-communicable diseases on households in India. Glob Health 8:1–10CrossRef Engelgau MM, Karan A, Mahal A (2012) The economic impact of non-communicable diseases on households in India. Glob Health 8:1–10CrossRef
Zurück zum Zitat Fan VY, Savedoff WD (2014) The health financing transition: a conceptual framework and empirical evidence. Soc Sci Med 105:112–121CrossRefPubMed Fan VY, Savedoff WD (2014) The health financing transition: a conceptual framework and empirical evidence. Soc Sci Med 105:112–121CrossRefPubMed
Zurück zum Zitat Galbraith AA, Wong ST, Kim SE, Newacheck PW (2005) Out-of-pocket financial burden for low-income families with children: socioeconomic disparities and effects of insurance. Health Serv Res 40:1722–1736CrossRefPubMedPubMedCentral Galbraith AA, Wong ST, Kim SE, Newacheck PW (2005) Out-of-pocket financial burden for low-income families with children: socioeconomic disparities and effects of insurance. Health Serv Res 40:1722–1736CrossRefPubMedPubMedCentral
Zurück zum Zitat Garg CC, Karan AK (2009) Reducing out-of-pocket expenditures to reduce poverty: a disaggregated analysis at rural–urban and state level in India. Health Policy Plan 24:116–128CrossRefPubMed Garg CC, Karan AK (2009) Reducing out-of-pocket expenditures to reduce poverty: a disaggregated analysis at rural–urban and state level in India. Health Policy Plan 24:116–128CrossRefPubMed
Zurück zum Zitat Gerdtham UG, Sogaard J, Anderson F, Jonsson B (1992) An econometric analysis of health care expenditure: a cross sectional study of OECD countries. J Health Econ 11:63–84CrossRefPubMed Gerdtham UG, Sogaard J, Anderson F, Jonsson B (1992) An econometric analysis of health care expenditure: a cross sectional study of OECD countries. J Health Econ 11:63–84CrossRefPubMed
Zurück zum Zitat Getzen TE (1992) Population aging and the growth of health expenditures. J Gerontol 47:S98–S104CrossRefPubMed Getzen TE (1992) Population aging and the growth of health expenditures. J Gerontol 47:S98–S104CrossRefPubMed
Zurück zum Zitat Getzen TE (2000) Forecasting health expenditures: short, medium and long (long) term. J Health Care Finance 26:56–72 Getzen TE (2000) Forecasting health expenditures: short, medium and long (long) term. J Health Care Finance 26:56–72
Zurück zum Zitat Ghosh S (2011) Catastrophic payments and impoverishment due to out-of-pocket health spending: the effects of recent health sector reforms in India. Econ Polit Wkly 46:63–70 Ghosh S (2011) Catastrophic payments and impoverishment due to out-of-pocket health spending: the effects of recent health sector reforms in India. Econ Polit Wkly 46:63–70
Zurück zum Zitat Hitris T, Posnett J (1992) The determinants and effects of health expenditure in developed countries. J Health Econ 11:173–181CrossRef Hitris T, Posnett J (1992) The determinants and effects of health expenditure in developed countries. J Health Econ 11:173–181CrossRef
Zurück zum Zitat Holahan J, Blumberg LJ, McMorrow S, Zuckerman S, Waidmann T, Stockley K (2011) Containing the growth of spending in the US health system. The Urban Institute Health Policy Center, Washington, DC Holahan J, Blumberg LJ, McMorrow S, Zuckerman S, Waidmann T, Stockley K (2011) Containing the growth of spending in the US health system. The Urban Institute Health Policy Center, Washington, DC
Zurück zum Zitat Joe W (2015) Distressed financing of household out-of-pocket health care payments in India: incidence and correlates. Health Policy Plan 30:728–741CrossRefPubMed Joe W (2015) Distressed financing of household out-of-pocket health care payments in India: incidence and correlates. Health Policy Plan 30:728–741CrossRefPubMed
Zurück zum Zitat Kim Y, Yang B (2011) Relationship between catastrophic health expenditures and household incomes and expenditure patterns in South Korea. Health Policy 100:239–246CrossRefPubMed Kim Y, Yang B (2011) Relationship between catastrophic health expenditures and household incomes and expenditure patterns in South Korea. Health Policy 100:239–246CrossRefPubMed
Zurück zum Zitat Ladusingh L, Pandey A (2013a) Health expenditure and impoverishment in India. J Health Manag 15:57–74CrossRef Ladusingh L, Pandey A (2013a) Health expenditure and impoverishment in India. J Health Manag 15:57–74CrossRef
Zurück zum Zitat Ladusingh L, Pandey A (2013b) High inpatient care cost of dying in India. J Public Health 21:435–443CrossRef Ladusingh L, Pandey A (2013b) High inpatient care cost of dying in India. J Public Health 21:435–443CrossRef
Zurück zum Zitat Mahal A, Berman P (2001) Health expenditures and the elderly: a survey of issues in forecasting, methods used, and relevance for developing countries. Research paper no. 01.23, Harvard Burden of Disease Unit, Centre for Population and Development Studies, Boston, MA Mahal A, Berman P (2001) Health expenditures and the elderly: a survey of issues in forecasting, methods used, and relevance for developing countries. Research paper no. 01.23, Harvard Burden of Disease Unit, Centre for Population and Development Studies, Boston, MA
Zurück zum Zitat Mendelson DN, Schwartz WB (1993) The effects of aging and population growth on health care costs. Health Aff 12:119–125CrossRef Mendelson DN, Schwartz WB (1993) The effects of aging and population growth on health care costs. Health Aff 12:119–125CrossRef
Zurück zum Zitat Mohanty SK, Chauhan R, Mazumdar S, Srivastava A (2014) Out-of-pocket expenditure on health care among elderly and non-elderly households in India. Soc Indic Res 115:1137–1157CrossRef Mohanty SK, Chauhan R, Mazumdar S, Srivastava A (2014) Out-of-pocket expenditure on health care among elderly and non-elderly households in India. Soc Indic Res 115:1137–1157CrossRef
Zurück zum Zitat MoHFW (2009) National health accounts India 2004–05. Gov. of India, New Delhi MoHFW (2009) National health accounts India 2004–05. Gov. of India, New Delhi
Zurück zum Zitat Mukherjee S, Singh A, Chandra R (2013) Maternity or catastrophe: a study of household expenditure on maternal health care in India. Health 5:109–118CrossRef Mukherjee S, Singh A, Chandra R (2013) Maternity or catastrophe: a study of household expenditure on maternal health care in India. Health 5:109–118CrossRef
Zurück zum Zitat Musgrove P, Zeramdini R, Carrin G (2002) Basic patterns in national health expenditure. Bull World Health Organ 80:134–146PubMedPubMedCentral Musgrove P, Zeramdini R, Carrin G (2002) Basic patterns in national health expenditure. Bull World Health Organ 80:134–146PubMedPubMedCentral
Zurück zum Zitat Newhouse JP (1977) Medical-care expenditure: a cross-national survey. J Hum Resour 2:115–125CrossRef Newhouse JP (1977) Medical-care expenditure: a cross-national survey. J Hum Resour 2:115–125CrossRef
Zurück zum Zitat NSSO (1998a) Key results of household consumption expenditure. Report no. 401. Dept. of Statistics, Gov. of India, New Delhi NSSO (1998a) Key results of household consumption expenditure. Report no. 401. Dept. of Statistics, Gov. of India, New Delhi
Zurück zum Zitat NSSO (1998b) Morbidity and treatment of ailments. Report no. 441 (52/25.0/1). Dept. of Statistics, Gov. of India, New Delhi NSSO (1998b) Morbidity and treatment of ailments. Report no. 441 (52/25.0/1). Dept. of Statistics, Gov. of India, New Delhi
Zurück zum Zitat NSSO (2006a) Morbidity, health care and the condition of the aged. Report no. 507 (60/25.0/1). Ministry of Statistics and Programme Implementation, Gov. of India, New Delhi NSSO (2006a) Morbidity, health care and the condition of the aged. Report no. 507 (60/25.0/1). Ministry of Statistics and Programme Implementation, Gov. of India, New Delhi
Zurück zum Zitat NSSO (2006b) Level and pattern of consumer expenditure 2004–05. Report no. 508 (61/1.0/1). Ministry of Statistics and Programme Implementation, Gov. of India, New Delhi NSSO (2006b) Level and pattern of consumer expenditure 2004–05. Report no. 508 (61/1.0/1). Ministry of Statistics and Programme Implementation, Gov. of India, New Delhi
Zurück zum Zitat NSSO (2014) Level and pattern of consumer expenditure 2011–12. Report no. 555 (68/1.0/1), Ministry of Statistics and Programme Implementation, Gov. of India, New Delhi NSSO (2014) Level and pattern of consumer expenditure 2011–12. Report no. 555 (68/1.0/1), Ministry of Statistics and Programme Implementation, Gov. of India, New Delhi
Zurück zum Zitat NSSO (2015) Key indicators of social consumption in India: Health 2014. Report no. (71/25.0), Ministry of Statistics and Programme Implementation, Gov. of India, New Delhi NSSO (2015) Key indicators of social consumption in India: Health 2014. Report no. (71/25.0), Ministry of Statistics and Programme Implementation, Gov. of India, New Delhi
Zurück zum Zitat O’Connell JM (1996) The relationship between health expenditures and the age structure of the population in OECD countries. Health Econ 5:573–578CrossRefPubMed O’Connell JM (1996) The relationship between health expenditures and the age structure of the population in OECD countries. Health Econ 5:573–578CrossRefPubMed
Zurück zum Zitat O’Donnell O, Doorslaer EV, Rannan-Eliya RP, Somanathan A, Garg CC, Hanvoravongchai P, Huq MN, Karan A, Leung GM, Tin K, Vasavid C (2005) Explaining the incidence of catastrophic expenditures on health care: comparative evidence from Asia. EQUITAP 5 O’Donnell O, Doorslaer EV, Rannan-Eliya RP, Somanathan A, Garg CC, Hanvoravongchai P, Huq MN, Karan A, Leung GM, Tin K, Vasavid C (2005) Explaining the incidence of catastrophic expenditures on health care: comparative evidence from Asia. EQUITAP 5
Zurück zum Zitat OECD (2006) Projecting OECD health and long term care expenditure: what are the main drivers? Economic Department Working Paper no. 477, Organization for Economic Co-operation and Development, Paris OECD (2006) Projecting OECD health and long term care expenditure: what are the main drivers? Economic Department Working Paper no. 477, Organization for Economic Co-operation and Development, Paris
Zurück zum Zitat ORGI (2013) Sample registration system statistical report 2012. Ministry of Home Affairs, Gov. of India, New Delhi ORGI (2013) Sample registration system statistical report 2012. Ministry of Home Affairs, Gov. of India, New Delhi
Zurück zum Zitat ORGI and Center for Global Health Research (2009) Report on cause of death in India 2001–2003. Office of the Registrar General of India, New Delhi ORGI and Center for Global Health Research (2009) Report on cause of death in India 2001–2003. Office of the Registrar General of India, New Delhi
Zurück zum Zitat Planning Commission (2011) High level expert group report on universal health coverage for India. Gov. of India, New Delhi Planning Commission (2011) High level expert group report on universal health coverage for India. Gov. of India, New Delhi
Zurück zum Zitat Planning Commission (2013) Press notes on poverty estimates 2011–12. Gov. of India, New Delhi Planning Commission (2013) Press notes on poverty estimates 2011–12. Gov. of India, New Delhi
Zurück zum Zitat Romo VC (2003) Decomposition methods in demography. Rozenberg, Amsterdam Romo VC (2003) Decomposition methods in demography. Rozenberg, Amsterdam
Zurück zum Zitat Selvaraj S, Karan AK (2009) Deepening health insecurity in India: evidence from National Sample Surveys since 1980s. Econ Polit Wkly 44:55–60 Selvaraj S, Karan AK (2009) Deepening health insecurity in India: evidence from National Sample Surveys since 1980s. Econ Polit Wkly 44:55–60
Zurück zum Zitat Seshamani M, Gray AM (2004) A longitudinal study of the effects of age and time to death on hospital costs. J Health Econ 23:217–235CrossRefPubMed Seshamani M, Gray AM (2004) A longitudinal study of the effects of age and time to death on hospital costs. J Health Econ 23:217–235CrossRefPubMed
Zurück zum Zitat Smith S, Newhouse JP, Freeland MS (2009) Income, insurance, and technology: why does health spending outpace economic growth? Health Aff 28:1276–1284CrossRef Smith S, Newhouse JP, Freeland MS (2009) Income, insurance, and technology: why does health spending outpace economic growth? Health Aff 28:1276–1284CrossRef
Zurück zum Zitat Spann E, Mathijssen J, Tromp N, McBain F, Have AT, Baltussen R (2012) The impact of health insurance in Africa and Asia: a systematic review. Bull World Health Organ 90:685–692CrossRef Spann E, Mathijssen J, Tromp N, McBain F, Have AT, Baltussen R (2012) The impact of health insurance in Africa and Asia: a systematic review. Bull World Health Organ 90:685–692CrossRef
Zurück zum Zitat UN (1979) Manual IX: the methodology of measuring the impact of family planning programmes on fertility. United Nations, New York UN (1979) Manual IX: the methodology of measuring the impact of family planning programmes on fertility. United Nations, New York
Zurück zum Zitat Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJL (2003) Household catastrophic health expenditure: a multicountry analysis. Lancet 362:111–17CrossRefPubMed Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJL (2003) Household catastrophic health expenditure: a multicountry analysis. Lancet 362:111–17CrossRefPubMed
Zurück zum Zitat Xu K, Evans DB, Carrin G, Aguilar-Rivera AM, Musgrove P, Evans T (2007) Protecting households from catastrophic health spending. Health Aff 26:972–983CrossRef Xu K, Evans DB, Carrin G, Aguilar-Rivera AM, Musgrove P, Evans T (2007) Protecting households from catastrophic health spending. Health Aff 26:972–983CrossRef
Zurück zum Zitat Xu K, Saksena P, Holly A (2011) The determinants of health expenditure: a country level panel data analysis. Working Paper, Results for Development Institute, Washington, DC Xu K, Saksena P, Holly A (2011) The determinants of health expenditure: a country level panel data analysis. Working Paper, Results for Development Institute, Washington, DC
Zurück zum Zitat Yardim MS, Cilingiroglu N, Yardim N (2010) Catastrophic health expenditure and impoverishment in Turkey. Health Policy 94:26–33CrossRefPubMed Yardim MS, Cilingiroglu N, Yardim N (2010) Catastrophic health expenditure and impoverishment in Turkey. Health Policy 94:26–33CrossRefPubMed
Zurück zum Zitat Zweifel P, Felder S, Meiers M (1999) Ageing of population and health care expenditure: a red herring. Health Econ 8:485–496CrossRefPubMed Zweifel P, Felder S, Meiers M (1999) Ageing of population and health care expenditure: a red herring. Health Econ 8:485–496CrossRefPubMed
Metadaten
Titel
Pattern, growth and determinant of household health spending in India, 1993–2012
verfasst von
Sanjay K. Mohanty
L. Ladusingh
Anshul Kastor
Rajesh K. Chauhan
David E. Bloom
Publikationsdatum
25.02.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Journal of Public Health / Ausgabe 3/2016
Print ISSN: 2198-1833
Elektronische ISSN: 1613-2238
DOI
https://doi.org/10.1007/s10389-016-0712-0

Weitere Artikel der Ausgabe 3/2016

Journal of Public Health 3/2016 Zur Ausgabe