A BSTRACT Introduction: Achieving universal health coverage (UHC) remains a critical goal for nations worldwide, with a key focus on providing financial risk protection against high medical costs. Despite government and private health insurance coverage, rural populations often face substantial out-of-pocket health expenditure (OOPE) and catastrophic health expenditure (CHE), which is linked to increased financial strain, potential poverty, and delayed healthcare seeking. This study aims to estimate the healthcare OOPE and CHE in households in a rural area of West Bengal, and identify associated factors. Materials and Methods: A cross-sectional, community-based descriptive study was conducted in six Gram Panchayats of Barrackpore 2 Community Development Block, North 24 Parganas, West Bengal, between February and June 2024. Two hundred and fifteen households, selected through multi-stage random sampling, and a predesigned, pretested validated questionnaire, covering socio-demographic characteristics, health expenditure, and other related variables used to determine the OOPE and CHE and factors related to this. Mann–Whitney U /Kruskal–Wallis H test and multivariate logistic regression were applied as statistical tests. Results: Health-related median OOPE is 2245/-. IQR (500–3225) INR with a median direct expenditure of INR 2200 (IQR 500–3500) and indirect expenditure of INR 1200 (IQR 100–1500). Factors significantly associated with high OOPE included nuclear family structure, low educational status, above the poverty line, and use of private healthcare facilities for both outpatient and inpatient services. 18.1% of households experienced catastrophic health expenditure, with higher incidence among those below the poverty line Adjusted odds ratio (AOR) of 5.98 (95% CI: 2.61–16.60), illiterate heads of the family Adjusted odds ratio (AOR) of 4.42 95% CI: (1.35–14.4), and those seeking treatment from unregistered medical practitioners Adjusted odds ratio (AOR) of 4.60, 95% CI: (1.13–18.69). In conclusion, the study highlights the significant financial burden of OOPE and CHE in rural West Bengal, especially among vulnerable groups such as those with low education and below the poverty line.
Ghosh et al. (Thu,) studied this question.