Determinants of out-of-pocket and catastrophic health expenditure in rural population: A community-based study in a block of Purba Barddhaman, West Bengal

Background: In India, health expenditure accounts for <5% of the Gross domestic product and the level of out-of-pocket (OOP) spending is 69.5% of total health expenditures. OOP expenditure (OOPE) has a negative impact on equity and can increase the risk of vulnerable groups slipping into poverty. Objectives: The study aimed to estimate the OOPE on health and catastrophic health expenditure (CHE) and their sociodemographic determinants in a rural area of Purba Barddhaman. Methods: A community-based cross-sectional study was conducted between July 2018 and February 2019 in Bhatar Block of Purba Bardhaman district, West Bengal. Required sample of 235 households, selected randomly were primary study units. One respondent from each household was interviewed with a predesigned, pretested schedule for sociodemographic and health-care expenditure-related variables. Mann-Whitney U test/Kruskal Wallis H test and multivariable logistic regression was applied. Results: The median OOP health expenditure was Rs. 3870 (inter quartile range: 2156-4952). Of 235 families, 38 (16.2%) had CHE over a period of 1 year. The significant correlates for CHE were type of village according to the presence of public health-care facility (adjusted odds ratio [AOR] = 4.748; 95% confidence interval [CI]: 1.886-11.956), presence of health insurance (AOR = 11.124; 95% CI: 3.690-33.535) and gender of the head of the family (AOR = 18.176; 95% CI: 3.353-98.534). Concentration curve suggested a higher concentration of CHE among poor households. Conclusion: CHE is substantially high in the area. The efforts are required to make the services available as close to the households as possible and to increase awareness about health facilities.