According to the study titled Moving to Universal Coverage? Trends in the Burden of Out-Of-Pocket Payments for Health Care across Social Groups in India, 1999-2000 to 2011-12 by Anup Karan, Sakthivel Selvaraj and Ajay Mahal, Plos One Journal, August 15, 2014 (please click here to access):
• The study has found rising share of out-of-pocket health expenditure in total household spending among disadvantaged households (SC/ST/Muslim/Poorest 20%), relative to their better-off counterparts, thus, indicating serious gaps in existing programmes with regard to access to affordable outpatient care and drugs.
• The proportion of out-of-pocket (OOP) expenditure on healthcare in total household spending increased faster among Muslim households relative to non-Muslim households by 0.9% during 2000-12.
• Similarly, the proportion of out-of-pocket expenditure on health in total household spending grew faster among SC/ST households relative to non SC/ST households by 0.6% during the same period. This means that despite large government investments in NRHM (during the period 2005-2012) that was intended to make healthcare available in rural India mostly in outpatient settings, one could see sharper increases in out-of-pocket expenses among Muslims and SC/ST compared to their better-off counterparts.
• Despite the rapid expansion of publicly financed insurance schemes for hospital-based services, such as RSBY and Aarogyasri, poor utilization of inpatient care (relative to the top 20% of households) among the poorest 20% as well as the SC/ST households could be observed.
• In both rural and urban areas, there has been a fall in the percentage of households reporting any out-of-pocket expenditure on inpatient care between 2000 and 2005 and then a rise between 2005 and 2012 for the same.
• In both rural (61.4% in 2005 versus 78.8% in 2012) and urban areas (62.9% in 2005 versus 75.9% in 2012), there has been a rise in the percentage of households reporting any out-of-pocket expenditure on outpatient care between 2005 and 2012.
• Among rural households, monthly out-of-pocket spending per member was almost 60% higher in 2012 compared to 2000 (INR 29.59 in 2000 versus INR 47.05 in 2012) and nearly 68% higher among urban households (INR 43.28 in 2000 versus INR 72.36 in 2012) over the same period (constant 1999-2000 prices). While household out-of-pocket expenses (per member) rose both for inpatient and outpatient care, inpatient OOP spending saw faster increases than outpatient OOP spending from 2000 to 2012 (constant 1999-2000 prices).
• The share of households reporting out-of-pocket spending in excess of 10% of their total expenditure increased from 15% in 2000 to 18.9% in 2012 among rural households and from 12.4% in 2000 to 15.9% in 2012 among urban households.
• Overall, the share of out-of-pocket healthcare expenses in total household spending increased from 5.8% in 2000 to 6.7% in 2012.
• Among the poorest 20% households, the percentage of households reporting any out-of-pocket healthcare expenses on inpatient care reduced from 14.6% in 2000 to 9.4% in 2012 but in case of outpatient care, there was a rise from 51.3% in 2000 to 73.3% in 2012.
• Among the richest 20% households, the percentage of households reporting any out-of-pocket healthcare expenses on inpatient care reduced marginally from 24.6% in 2000 to 22.0% in 2012 but in case of outpatient care, there was a rise from 68.2% in 2000 to 79.6% in 2012.
• The poorest 20% of the households registered a faster increase in the indicator "reporting any OOP payment" compared to the richest 20% during 2000-2012.
• Among the SC/ST households, the percentage of households reporting any out-of-pocket healthcare expenses on inpatient care reduced from 18.2% in 2000 to 12.6% in 2012 but in case of outpatient care, there was a rise from 58.0% in 2000 to 75.1% in 2012.
• Out-of-pocket healthcare expenses rose as a share of total household spending faster for SC/ST households relative to non-SC/ST households, irrespective of whether one considers overall OOP, OOP for inpatient care, or OOP for outpatient care (the coefficients for indicators of catastrophic spending were also mostly positive, but all statistically indistinguishable from zero).
• Over the same period, the proportion reporting "any OOP" grew more slowly for SC/ST household (relative to non-SC/ST household) (a difference of 21.2% points, relative to a baseline of 66.7% in 2000).
• Among the Muslim households, the percentage of households reporting any out-of-pocket healthcare expenses on inpatient care reduced from 18.6% in 2000 to 14.7% in 2012 but in case of outpatient care, there was a rise from 66.49% in 2000 to 82.76% in 2012.
• Among the poorest 20% households, proportion of out-of-pocket healthcare expenses in the total expenditure rose from 3.21% in 2000 to 4.12% in 2012 while among the richest 20% households, the same increased from 7.18% in 2000 to 8.52% in 2012.
• The share of out-of-pocket in total household spending increased sharply among Muslims (relative to non-Muslims) during 2000-2012 in all three of the indicators of OOP shares - outpatient care, inpatient care and overall - so their OOP spending burden also increased.
• Among the SC/ST households, proportion of out-of-pocket healthcare expenses in the total expenditure rose from 5.23% in 2000 to 6.57% in 2012 while among the Muslim households, the same increased from 5.49% in 2000 to 7.02% in 2012.
• Results for SC/ST households versus non-SC/ST households show no differences in rates of change in the population share incurring catastrophic spending during 2000-2012. Finally, over the period 2000-2012, the growth in the share of Muslim households reporting catastrophic spending exceeded that of non-Muslims by 0.8% points using the 10% threshold, and by 0.4% points using the 25% catastrophic threshold, although the results did not attain statistical significance.