Distressed financing of household out-of-pocket health care payments in India: incidence and correlates

Health Policy Plan. 2015 Jul;30(6):728-41. doi: 10.1093/heapol/czu050. Epub 2014 Jun 25.


Out-of-pocket (OOP) health care payments financed through borrowings or sale of household assets are referred to as distressed health care financing. This article expands this concept (to include contributions from friends or relatives) and examines the incidence and correlates of distressed health care financing in India. The analysis finds a decisive influence of distressed financing in India as over 60 and 40% of hospitalization cases from rural and urban areas, respectively, report use of such coping strategies. Altogether, sources such as borrowings, sale of household assets and contributions from friends and relatives account for 58 and 42% share in total OOP payments for inpatient care in rural and urban India, respectively. Further, the results show significant socioeconomic gradient in the distribution of distressed financing with huge disadvantages for marginalized sections, particularly females, elderly and backward social groups. Multivariate logistic regression informs that households are at an elevated risk of indebtedness while seeking treatment for non-communicable diseases, particularly cancer. Evidence based on intersectional framework reveals that, despite similar socioeconomic background, males are more likely to use borrowings for health care financing than females. In conclusion, the need for social protection policies and improved health care coverage is emphasized to curtail the incidence of distressed health care financing in India.

Keywords: India; Sources of financing; health care financing; intersectional approach, out-of-pocket payments.

MeSH terms

  • Cross-Sectional Studies
  • Family Characteristics*
  • Female
  • Financing, Personal / economics*
  • Health Expenditures / statistics & numerical data
  • Health Surveys
  • Humans
  • India
  • Male
  • Middle Aged