Disparities in catastrophic health expenditure for hospitalization in Urban Kerala, India: Evidence from 75th round of the National Sample Survey

Existing literature suggests significant disparities in health expenditure incurred by households receiving health services. To determine fair contributions by beneficiaries, it is crucial to understand the existing inequalities in the context of financial protection measures and the factors influencing them. This exploratory study looks at how catastrophic health expenditures (CHE) are distributed across economic groups. The study also casts light on what drives the inequalities in the incidences of CHE. The study uses unit-level data from the 75th round of the National Sample Survey fielded periodically by the Government of India. It employs logistic regression to study factors affecting CHE. Furthermore, the concentration index and its regression-based decomposition are employed to have a sense of inequality and the factors driving it. The findings reveal socioeconomic inequality in CHE incidence and highlight the contribution of medical institutions (whether public or private) and consumption expenditure of households to the total inequality. The present study, while critically looking at the pre-existing inequalities, highlights the shortcomings of health financing in urban areas and calls for a reconsideration of extant policy designs. The study maintains that factors outside the control of the health system may be responsible for disparities in catastrophic medical spending. Therefore, to reduce the burden of catastrophic health spending and its inequalities, future policy measures must take into account both elements within the health system and those outside of it.