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In low- and middle-income countries like India, financing of health-care expenditure is predominantly characterized by out-of-pocket (OOP) spending. Given this context, the current study examined the economic burden of OOP health expenditure and resultant impoverishment in India. The study employed nationally representative survey on ‘Health and Morbidity’ conducted by National Sample Survey Organization (NSSO) in 2014 in India. Standard catastrophic, inequality and impoverishment measures were used to analyse the burden and impact of OOP health expenditure. Findings revealed that although the overall incidence and intensity of OOP health expenditure was concentrated among the richer consumption groups, in-depth study of the same in terms of inpatient and outpatient care showed that the incidence of outpatient care was highly concentrated towards the poorer consumption groups. Study also revealed that around 8% of the population fell below the poverty line due to OOP health expenditure in which outpatient care was the main contributing factor (5.8%). Among different socio-economic covariates, rural population, Muslims, Scheduled Castes and casual/agriculture labour were most affected and had higher impoverishment impact. Our findings suggest that there is a need to revisit the approach towards health-care financing in India. Abbreviations : OOP: Out-of-pocket; MPCE: Monthly per capita consumption expenditure; SCs: Scheduled Castes; STs: Scheduled Tribes; OBCs: Other Backward Castes; TCE: Total consumption expenditure; PFHI: Publicly financed health insurance; RSBY: Rashtriya Swasthya Bima Yojana; CMCHIS: Chief Minister’s Comprehensive Health Insurance Scheme; UHC: Universal health coverage

Burden of out-of-pocket health expenditure and its impoverishment impact in India: evidence from National Sample Survey