ABSTRACT Background: Out-of-pocket (OOP) healthcare expenditures remain a primary driver of financial distress and poverty in India, especially among low-income households. This study examined the magnitude and determinants of catastrophic health expenditure (CHE), distress financing, and impoverishment due to health spending in low-income communities across selected districts in North India. Methodology: A community-based cross-sectional descriptive study was conducted from July 2024 to January 2025 in six low-income urban and rural blocks of Bareilly (Uttar Pradesh), Patiala (Punjab), and Dhanbad (Jharkhand). A total of 600 households were selected using a two-stage stratified random sampling technique. Data were collected using a structured, pretested interviewer-administered questionnaire adapted from the WHO’s health expenditure tool. CHE was defined using the WHO threshold (≥10% of total income or ≥ 40% of nonsubsistence spending). Data were analyzed using STATA v17.0, with multivariate logistic regression applied to identify predictors of CHE. Results: Approximately 48.2% of households experienced CHE, with 29.5% falling below the poverty line due to healthcare expenses. Distress financing was reported by 43.8%, predominantly through high-interest informal loans and the sale of assets. Households with chronic illness (adjusted odds ratio aOR: 2.36; 95% confidence interval CI: 1.74–3.19), hospitalization episodes (aOR: 3.41; 95% CI: 2.45–4.75), and those without insurance (aOR: 1.94; 95% CI: 1.38–2.73) were more likely to incur CHE. Conclusion: OOP health spending imposes a substantial financial burden on low-income households in North India, pushing many into poverty. Policy interventions must strengthen public healthcare financing, expand insurance coverage, and protect vulnerable groups from financial shocks.
Elliason et al. (2025) studied this question.