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Year : 2023  |  Volume : 21  |  Issue : 1  |  Page : 77

Understanding catastrophic healthcare expenditures - Implications for research

1 Department of Community Medicine, NRI Institute of Medical Sciences, Visakhapatnam, Andhra Pradesh, India
2 Department of Community Medicine, Trichy SRM Medical College and Hospital and Research Centre, Tiruchirappalli, India
3 Department of Community Medicine, Sri Lalithambigai Medical College and Hospital, Chennai, Tamil Nadu, India

Date of Submission26-May-2022
Date of Decision29-May-2022
Date of Acceptance29-Jun-2022
Date of Web Publication17-Jan-2023

Correspondence Address:
Dr. Hari Teja Avirneni
Department of Community Medicine, NRI Institute of Medical Sciences, Visakhapatnam, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/cmi.cmi_61_22

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How to cite this article:
Avirneni HT, Swaminathan SS, John A. Understanding catastrophic healthcare expenditures - Implications for research. Curr Med Issues 2023;21:77

How to cite this URL:
Avirneni HT, Swaminathan SS, John A. Understanding catastrophic healthcare expenditures - Implications for research. Curr Med Issues [serial online] 2023 [cited 2023 Jun 7];21:77. Available from: https://www.cmijournal.org/text.asp?2023/21/1/77/367860


The World Health Organization (WHO) in its World Health Report states that health systems in the countries across the world have a fundamental responsibility in protecting their citizens from the potential effects of ill-health. One such effect of ill-health is its impact on the financial status of an individual or household in the form of an economic burden. Hence, it is recommended and expected of the health systems to put in place, a healthcare financing system, which can reduce financial risks among the population. Such risks can sometimes be catastrophic impoverishing the households from medical expenditures.[1] In countries like India, where the majority of healthcare expenditures are paid out of pocket (out-of-pocket expenditure [OOPE]) by the households, it becomes essential to continuously record and monitor such expenditures on health. The 2017–2018 National Health Accounts estimated that household OOPE contributed to about 55% of current health expenditures (CHE) and about 48% of total health expenditures in the country, which is around 1.6% of gross domestic product (GDP).[2] It is of extreme importance to understand the effects of such OOPE in terms of having catastrophic effects on households. Therefore, it becomes necessary to monitor these kinds of expenditures to formulate policy reforms targeting the effects of CHE on households. As proposed by the WHO, CHE can be defined as OOPE more than or equal to 40% of the household's ability to pay, after meeting their basic needs.[3] However, measuring CHE has no single approach as multiple approaches have been defined and adopted in various studies, in different settings. Most commonly, OOPE when exceeds a set percentage of household's ability to pay for health care, after fulfilling their basic needs and necessities, is defined as CHE. Such percentage is usually set at 10% or 25% depending on the settings.[4],[5] Although estimating OOPE on health gives the status of catastrophic impoverishments, it is also important to look beyond the OOPE and CHE to the possible pathways and identify factors that lead to such events. Therefore, to get a complete understanding of such factors and their effects on a family, research studies that are longitudinal in nature and aim for triangulation of data using mixed methods are to be endorsed and promoted. Such an estimation would truly reflect the progress that is being made toward universal health coverage in any given setting with respect to financial risk protection aspects that are being formulated and implemented.

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Conflicts of interest

There are no conflicts of interest.

  References Top

World Health Organization. The World Health Report 2000: Health Systems Improving Performance. Geneva, Switzerland: WHO Publications; 2000. p. 215.  Back to cited text no. 1
Government of India, National Health System Resource Centre. National Health Account Estimates for India 2017-2018. Available from: https://nhsrcindia.org/sites/default/files/2021-11/National%20Health%20Accounts-%202017-18.pdf. [Last accessed on 2022 Apr 27].  Back to cited text no. 2
World Health Organization, Department of Health Systems Financing. Technical Briefs for Policymakers 2005: Designing Health Financing Systems to Reduce Catastrophic Health Expenditure. Available from: https://apps.who.int/iris/bitstream/handle/10665/70005/WHO_EIP_HSF_PB_05.02_eng.pdf. [Last accessed on 2022 Apr 20].  Back to cited text no. 3
World Bank. Tracking Universal Health Coverage: 2021 Global Monitoring Report. Available from: https://cdn.who.int/media/docs/default-source/world-health-data-platform/events/tracking-universal-health-coverage-2021-global-monitoring-report_uhc-day.pdf?sfvrsn=fd5c65c6_5&download=true. [Last accessed on 2022 Mar 28].  Back to cited text no. 4
Avirneni HT, Nandi P, Pawar SJ. Economic burden of CKD among the beneficiaries of a state-run insurance scheme. Online J Health Allied Sci 2021;20:5.  Back to cited text no. 5


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