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Health Economics Review
Published in: Health Economics Review 1/2017

Open Access 01-12-2017 | Research

Does spending matters? Re-looking into various covariates associated with Out of Pocket Expenditure (OOPE) and catastrophic spending on accidental injury from NSSO 71st round data

Authors: Jalandhar Pradhan, Rinshu Dwivedi, Sanghamitra Pati, Sarit Kumar Rout

Published in: Health Economics Review | Issue 1/2017

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Abstract

Background

Accidental Injury is a traumatic event which not only influences physical, psychological, and social wellbeing of the households but also exerts extensive financial burden on them. Despite the devastating economic burden of injuries, in India, there is limited data available on injury epidemiology. This paper aims to, first, examine the socio-economic differentials in Out of Pocket Expenditure (OOPE) on accidental injury; second, to look into the level of Catastrophic Health Expenditure (CHE) at different threshold levels; and last, to explore the adjusted effect of various socio-economic covariates on the level of CHE.

Methods

Data was extracted from the key indicators of social consumption in India: Health, National Sample Survey Organisation (NSSO), conducted by the Government of India during January–June-2014. Logistic regression analysis was employed to analyse the various covariates of OOPE and CHE associated to accidental injury.

Findings

Binary Logistic analysis has demonstrated a significant association between socioeconomic status of the households and the level of OOPE and CHE on accidental injury care. People who used private health services incurred 16 times higher odds of CHE than those who availed public facilities. The result shows that if the person is covered via any type of insurance, the odd of CHE was lower by about 28% than the uninsured. Longer duration of stay and death due to accidental injury was positively associated with higher level of OOPE. Economic status, nature of healthcare facility availed and regional affiliation significantly influence the level of OOPE and CHE.

Conclusion

Despite numerous efforts by the Central and State governments to reduce the financial burden of healthcare, large number of households are still paying a significant amount from their own pockets. There are huge differentials in cost for the treatment among public and private healthcare providers for accidental injury. It is expected that the findings would provide insights into the prevailing magnitude of accidental injuries in India, the profile of the population affected, and the level of OOPE among households.
Appendix
Available only for authorised users
Footnotes
1
“Injury” refers to damage to the body produced by energy exchanges that have relatively sudden discernible effects [3]
 
2
A road traffic injury is a fatal or non-fatal injury incurred as a result of a collision on a public road involving at least one moving vehicle [2].
 
3
Similar as accidental injury
 
4
Household out-of-pocket expenditureon health comprise cost-sharing, self-medication and other expenditure paid directly by private households, irrespective of whether the contact with the health care system was established on referral or on the patient’s own initiative [20]
 
5
Health spending is taken to be catastrophic when a household must reduce its basic expenditure over a period of time to cope with health costs, but there is no consensus on the threshold proportion of household expenditure [74]
 
6
An accident, also known as an unintentional injury, is an undesirable, incidental, and unplanned event that could have been prevented had circumstances leading up to the accident been recognized, and acted upon, prior to its occurrence [3].
 
7
It includes accidental injury, road traffic accidents (RTA) and falls.
 
Literature
1.
Reddy KS. Global burden of disease study 2015 provides GPS for global health 2030. Lancet. 2016;388(10053):1448–9.CrossRefPubMed
2.
3.
4.
5.
Singh A, Tetreault L, Kalsi-Ryan S, Nouri A, Fehlings MG. Global prevalence and incidence of traumatic spinal cord injury. Clin Epidemiol. 2014;6:309–31.PubMedPubMedCentral
6.
Viner RM, Coffey C, Mathers C, Bloem P, Costello A, Santelli J, Patton GC. 50-year mortality trends in children and young people: a study of 50 low-income, middle-income, and high-income countries. Lancet. 2011;377(9772):1162–74.CrossRefPubMed
7.
Chandran A, Hyder AA, Peek-Asa C. The global burden of unintentional injuries and an agenda for progress. Epidemiologic reviews. 2010;32(1):110–20.
8.
Stewart BT, Yankson IK, Afukaar F, Medina MCH, Cuong PV, Mock C. Road traffic and other unintentional injuries among travelers to developing countries. Med Clin N Am. 2016;100(2):331–43.CrossRefPubMedPubMedCentral
9.
10.
Haagsma JA, Graetz N, Bolliger I, Naghavi M, Higashi H, Mullany EC, et al. The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the global burden of disease study 2013. Inj Prev. 2016;22(1):3–18.
11.
Ruikar M. National statistics of road traffic accidents in India. J Ortop Traumatol Rehabil. 2013;6(1):1.CrossRef
12.
Kim DH, Chung YN, Park YS, Min KS, Lee MS, Kim YG. Epidemiologic impact of rapid industrialization on head injury based on traffic accident statistics in Korea. J Korean Neurosurg Soc. 2016;59(2):149–53.CrossRefPubMedPubMedCentral
13.
Rastogi D, Meena S, Sharma V, Singh GK. Causality of injury and outcome in patients admitted in a major trauma center in North India. Int J Crit Illn Inj Sci. 2014a;4(4):298.CrossRefPubMedPubMedCentral
14.
Rastogi D, Meena S, Sharma V, Singh GK. Epidemiology of patients admitted to a major trauma centre in northern India. Chin J Traumatol. 2014b;17(2):103–7.PubMed
15.
Mohanan M. Causal effects of health shocks on consumption and debt: quasi-experimental evidence from bus accident injuries. Rev Econ Stat. 2013;95(2):673–81.CrossRefPubMedPubMedCentral
16.
Prinja S, Jagnoor J, Chauhan AS, Aggarwal S, Nguyen H, Ivers R. Economic burden of hospitalization due to injuries in North India: a cohort study. Int J Environ Res Public Health. 2016;13(7):673.CrossRefPubMedCentral
17.
18.
Pradhan J, Dwivedi R. Do we provide affordable, accessible and administrable health care? An assessment of SES differential in out of pocket expenditure on delivery care in India. Sex Reprod Healthc. 2017;11:69–78.CrossRefPubMed
19.
Singh P, Kumar V. The rising burden of healthcare expenditure in India: a poverty nexus. Soc Indic Res. 2017;133(2):741–62.
20.
21.
Jayakrishnan T, Jeeja MC, Kuniyil V, Paramasivam S. Increasing out-of-pocket health care expenditure in India-due to supply or demand. PharmacoEconomics. 2016;1(105):1–6.
22.
Xu K, Evans DB, Carrin G, Aguilar-Rivera AM, Musgrove P, Evans T. Protecting households from catastrophic health spending. Health Aff. 2007a;26(4):972–83.CrossRef
23.
Gururaj G, Uthkarsh PS, Rao GN, Jayaram AN, Panduranganath V. Burden, pattern and outcomes of road traffic injuries in a rural district of India. Int J Inj Control Saf Promot. 2016;23(1):64–71.CrossRef
24.
Bhalla, K., Khurana, N., Bose, D., Navaratne, K. V., Tiwari, G., & Mohan, D. (2016). Official government statistics of road traffic deaths in India under-represent pedestrians and motorised two wheeler riders. Injury prevention, injuryprev-2016.
25.
Pal R, Agarwal A, Galwankar S, Swaroop M, Stawicki SP, Rajaram L, Menon G. The 2014 Academic College of Emergency Experts in India's INDO-US Joint Working Group (JWG) white paper on“ developing trauma sciences and injury care in India”. Int J Crit Illn Inj Sci. 2014;4(2):114.
26.
Mahajan N, Aggarwal M, Raina S, Verma LR, Mazta SR, Gupta BP. Pattern of non-fatal injuries in road traffic crashes in a hilly area: a study from Shimla, North India. Int J Crit Illn Inj Sci. 2013;3(3):190.CrossRefPubMedPubMedCentral
27.
Mohan D, Tiwari G, Mukherjee S. Urban traffic safety assessment: a case study of six Indian cities. IATSS Res. 2016;39(2):95–101.CrossRef
28.
Raina P, Sohel N, Oremus M, Shannon H, Mony P, Kumar R, et al. Assessing global risk factors for non-fatal injuries from road traffic accidents and falls in adults aged 35–70 years in 17 countries: a cross-sectional analysis of the prospective urban rural epidemiological (PURE) study. Inj Prev. 2016;22(2):92–8.CrossRefPubMed
29.
30.
Dandona R. Making road safety a public health concern for policy-makers in India. Natl Med J India. 2006;19(3):126–33.
31.
Pradhan M, Prescott N. Social risk management options for medical care in Indonesia. Health economics. 2002;11(5):431–46.
32.
Ranson MK. Reduction of catastrophic health care expenditures by a community-based health insurance scheme in Gujarat, India: current experiences and challenges. Bulletin of the World Health Organization. 2002;80(8):613–21.
33.
Wagstaff A, Doorslaer EV. Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993–1998. Health economics. 2003;12(11):921–33.
34.
35.
Russell S. The economic burden of illness for households in developing countries: a review of studies focusing on malaria, tuberculosis, and human immunodeficiency virus/acquired immunodeficiency syndrome. The American journal of tropical medicine and hygiene. 2004;71(2_suppl):147–55.
36.
Ghosh PK. Epidemiological study of the victims of vehicular accidents in Delhi. J Indian Med Assoc. 1992;90(12):309–12.PubMed
37.
Jha N, Srinivasa DK, Roy G, Jagdish S, Minocha RK. Epidemiological study of road traffic accident cases: a study from South India. Indian J Community Med. 2004;29(1):20–4.
38.
Palmer KT, Harris EC, Coggon D. Chronic health problems and risk of accidental injury in the workplace: a systematic literature review. Occupational and environmental medicine. 2008.
39.
Shaker RH, Eldesouky RS, Hasan OM, Bayomy H. Motorcycle crashes: attitudes of the motorcyclists regarding riders’ experience and safety measures. J Community Health. 2014;39(6):1222–30.CrossRefPubMed
40.
Kelly M, Strazdins L, Ellora TD, Khamman S, Seubsman SA, Sleigh AC. Thailand's work and health transition. International Labour Review. 2010;149(3):373–86.CrossRefPubMedPubMedCentral
41.
Al-Maniri AAN, Al-Reesi H, Al-Zakwani I, Nasrullah M. Road traffic fatalities in oman from 1995 to 2009: evidence from police reports. Int J Prev Med. 2013;4(6):656.PubMedPubMedCentral
42.
Oginni FO, Ugboko VI, Ogundipe O, Adegbehingbe BO. Motorcycle-related maxillofacial injuries among Nigerian intracity road users. J Oral Maxillofac Surg. 2006;64(1):56–62.CrossRefPubMed
43.
Meuleners LB, Harding A, Lee AH, Legge M. Fragility and crash over-representation among older drivers in Western Australia. Accid Anal Prev. 2006;38(5):1006–10.CrossRefPubMed
44.
45.
Harris CR, Jenkins M, Glaser D. Gender differences in risk assessment: why do women take fewer risks than men? Judgm Decis Mak. 2006;1(1):48.
46.
El-Menyar A, El-Hennawy H, Al-Thani H, Asim M, Abdelrahman H, Zarour A, et al. Traumatic injury among females: does gender matter? J Trauma Manag Outcomes. 2014;8(1):8.CrossRefPubMedPubMedCentral
47.
Karbakhsh, M., Zandi, N. S., Rouzrokh, M., & Zarei, M. R. (2009). Injury epidemiology in Kermanshah: the National Trauma Project in Islamic Republic of Iran.
48.
Santamariña-Rubio E, Pérez K, Olabarria M, Novoa AM. Gender differences in road traffic injury rate using time travelled as a measure of exposure. Accid Anal Prev. 2014;65:1–7.CrossRefPubMed
49.
Communist Party of China Central Committee. Implementation plan for the recent priorities of the health care system reform. Beijing: Government of the People’s Republic of China; 2009. p. 2009–11.
50.
Kalediene R, Starkuviene S, Petrauskiene J. Social dimensions of mortality from external causes in Lithuania: do education and place of residence matter? Soz Praventivmed. 2006;51(4):232–9.CrossRefPubMed
51.
52.
Kumar GA, Dilip TR, Dandona L, Dandona R. Burden of out-of-pocket expenditure for road traffic injuries in urban India. BMC Health Serv Res. 2012;12(1):285.CrossRefPubMedPubMedCentral
53.
Ministry Of Health and Family Welfare (MoHFW) (2005). Financing and delivery of health care services in India, background papers of the national commission on macroeconomics and health, government of India, New Delhi. 2005.
54.
Ekman B. Community-based health insurance in low-income countries: a systematic review of the evidence. Health Policy Plan. 2004;19(5):249–70.CrossRefPubMed
55.
Saksena P, Xu K, Elovainio R, Perrot J. Health services utilization and out-of-pocket expenditure at public and private facilities in low-income countries. World Health Rep. 2010;20:20.
56.
Srivastava NM, Awasthi S, Agarwal GG. Care-seeking behavior and out-of-pocket expenditure for sick newborns among urban poor in Lucknow, northern India: a prospective follow-up study. BMC Health Serv Res. 2009;9(1):61.CrossRefPubMedPubMedCentral
57.
Chalya PL, Mabula JB, Dass RM, Mbelenge N, Ngayomela IH, Chandika AB, Gilyoma JM. Injury characteristics and outcome of road traffic crash victims at Bugando Medical Centre in Northwestern Tanzania. J Trauma Manag Outcomes. 2012;6(1):1.CrossRefPubMedPubMedCentral
58.
Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2013;380(9859):2197–223.CrossRef
59.
60.
61.
Kumar, A., Verma, A., Yadav, M., & Srivastava, A. K. (2011). Fall: the accidental injury in geriatric population.
62.
63.
Holland C, Hill R. The effect of age, gender and driver status on pedestrians’ intentions to cross the road in risky situations. Accid Anal Prev. 2007;39(2):224–37.CrossRefPubMed
64.
Ryan GA, Legge M, Rosman D. Age related changes in drivers’ crash risk and crash type. Accid Anal Prev. 1998;30(3):379–87.CrossRefPubMed
65.
66.
Broyles RW, Clarke SR, Narine L, Baker DR. Factors contributing to the amount of vehicular damage resulting from collisions between four-wheel drive vehicles and passenger cars. Accident Analysis & Prevention. 2001;33(5):673–8.
67.
Bener A, Burgut HR, Sidahmed H, AlBuz R, Sanya R, Khan WA. Road traffic injuries and risk factors. Calif J Health Promot. 2009;7(2):92–101.
68.
Borrell C, Plasencia A, Huisman M, Costa G, Kunst A, Andersen O, Gadeyne S. Education level inequalities and transportation injury mortality in the middle aged and elderly in European settings. Inj Prev. 2005;11(3):138–42.CrossRefPubMedPubMedCentral
69.
Grimm M, Treibich C. Why do some motorbike riders wear a helmet and others don’t? Evidence from Delhi, India. Transp Res A Policy Pract. 2016;88:318–36.CrossRef
70.
Hung KV. Education influence in traffic safety: a case study in Vietnam. IATSS Res. 2011;34(2):87–93.CrossRef
71.
Zwerling C, Peek-Asa C, Whitten PS, Choi SW, Sprince NL, Jones MP. Fatal motor vehicle crashes in rural and urban areas: decomposing rates into contributing factors. Inj Prev. 2005;11(1):24–8.CrossRefPubMedPubMedCentral
72.
Archer, J., & Vogel, K. (2000). The traffic safety problem in urban areas. Research Report.
73.
Marmot M. The influence of income on health: views of an epidemiologist. Health Aff. 2002;21(2):31–46.CrossRef
74.
Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ. Household catastrophic health expenditure: a multicountry analysis. Lancet. 2003;362(9378):111–7.CrossRefPubMed
75.
Mandal BK, Yadav BN. Pattern and distribution of pedestrian injuries in fatal road traffic accidental cases in Dharan, Nepal. J Nat Sci Biol Med. 2014;5(2):320.CrossRefPubMedPubMedCentral
76.
Gururaj G. Road traffic deaths, injuries and disabilities in India: current scenario. Natl Med J India. 2008;21(1):14.PubMed
77.
Reddy GM, Negandhi H, Singh D, Singh A. Extent and determinants of cost of road traffic injuries in an Indian city. Indian J Med Sci. 2009;63(12):549.CrossRefPubMed
78.
Ladusingh L, Pandey A. The high cost of dying. Econ Polit Wkly. 2013;48(11):45.
79.
Peymani P, Heydari ST, Hoseinzadeh A, Sarikhani Y, Moafian G, Aghabeigi MR, et al. Epidemiological characteristics of fatal pedestrian accidents in Fars Province of Iran: a community-based survey. Chin J Traumatol. 2012;15(5):279–83.PubMed
80.
81.
Ameratunga S, Hijar M, Norton R. Road-traffic injuries: confronting disparities to address a global-health problem. Lancet. 2006;367(9521):1533–40.CrossRefPubMed
82.
83.
Paulozzi LJ, Ryan GW, Espitia-Hardeman VE, Xi Y. Economic development's effect on road transport-related mortality among different types of road users: a cross-sectional international study. Accid Anal Prev. 2007;39(3):606–17.CrossRefPubMed
84.
Surender J. Pattern of injuries in fatal road traffic accidents in Warangal area. J Indian Acad Forensic Med. 2013;35(1):55–9.
85.
Metadata
Title
Does spending matters? Re-looking into various covariates associated with Out of Pocket Expenditure (OOPE) and catastrophic spending on accidental injury from NSSO 71st round data
Authors
Jalandhar Pradhan
Rinshu Dwivedi
Sanghamitra Pati
Sarit Kumar Rout
Publication date
01-12-2017
Publisher
Springer Berlin Heidelberg
Published in
Health Economics Review / Issue 1/2017
Electronic ISSN: 2191-1991
DOI
https://doi.org/10.1186/s13561-017-0177-z

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