Catastrophic Health Expenditure Out-of-pocket and Impoverishment Among Persons with Disability in India: Reflection from NSS, 2018

Out-of-pocket health expenditure is a serious issue among persons with disabilities (PWDs) and their families because they have a high need for medical care. Sustainable Development Goal 3.8 aims to reduce financial risk by providing universal health coverage. In the present study, we assess whether the nature of the health expenditure of PWDs in India is catastrophic or not and has led to impoverishment. The National Sample Survey (NSS), held in 2018 (76th round), deals with PWDs. We have used unit-level secondary data sets from this survey. If out-of-pocket health expenditures of a household exceed 30 per cent of total household spending, it is considered catastrophic health expenditures. To measure the depth of poverty, we estimate the poverty gap ratio. Dummy variable logistic regression models are used to determine the factors behind catastrophic health expenditure and impoverishment. The average annual per capita expenditure from out-of-pocket for healthcare among PWDs has been estimated at Rs 31,551. Out-of-pocket health expenditures of seventy per cent of people with disabilities were catastrophic in nature, pushing 38 per cent of them below the poverty line. The depth of poverty shows that, on average, money amounted to 35.60 per cent of the poverty line ($1.25 per capita per day as per World Bank) has to be provided to each person with disability lying below the poverty line to pull them to the above poverty line. We significantly observe that rural people, individuals, males with disabilities, those in the lower income quintiles, and members of scheduled caste and tribal communities are suffering from catastrophic health expenditure and related impoverishment. The study has important policy implications for the reduction of economic burden and impoverishment among persons with disabilities on account of catastrophic health expenditures incurred out-of-pocket.