Catastrophic health expenditure can be understood as health expenditure which cannot be met by household income, the result of which is a burden of disease. This disease burden is then suffered by families facing catastrophic health expenditure (hereafter CHE) who must learn to live with the poor health of their kin. As one can imagine, not only is high incidence of CHE a mark of poor development, it also leads precisely to poor development by preventing the growth of a healthy workforce.

CHE then is often observed in less-developed and developing countries. Developing countries - many of whom are in the tropics - are faced with the unique problem of dealing with both a high incidence of communicable diseases as well as increasing non-communicable diseases which emerge with development. It is then necessary for developing countries to ensure the creation of a robust healthcare system which can tackle both these issues.

India is one such country. It’s healthcare system follows a largely liberalised model with most health expenditure accruing due to OOP or out-of-pocket sources. As one can imagine in a largely agrarian economy, incomes of a large percentage of the population remain low. Is healthcare affordable then to the majority of people?

Unfortunately, the answer is no. Kastor and Mohanty’s 2018 paper, ‘Disease-specific out-of-pocket and catastrophic healthcare expenditure on hospitalization in India: Do Indian households face distress health financing?’ delves deeper into this matter. It’s results are important not only to understand the state of healthcare financing in India but also other developing countries.

Kastor and Mohanty find a high incidence of catastrophic healthcare expenditure in India. Further, the leading cause for CHE as well as the highest amount of OOP accrue to cancer treatment with heart-diseases following close behind. Almost 33% of inpatients reported facing distress financing across their data sourced from the NSSO. Note that this number only takes into account those who are hospitalized. The number of people living with the burden of disease may be even higher as those who cannot even afford hospitalization may be foregoing treatment entirely.

On the basis of their research, the authors recommend ‘free treatment for cancer and heart disease’ for the poorer sections of society. However, they also find that “people in the richest tertile spent substantially higher amounts on hospitalization” than others. This in part suggests that many more tertiles aside from the poorest may be foregoing healthcare - or certain aspects of it - due to associated costs. Then disease burden is something that affects all families in gradation with the richest facing simply the lowest levels of disease burden. This of course is not to say that the state should make healthcare free for all sections of the society -- such a task is simply unaffordable for the Indian State. 

Instead, the salient point of the matter is that disease burden is quite widespread in India and a major cause for concern for policymakers. In order for India to continue on its current path of development this is certainly something that must be tackled. Without giving it due attention, India - and other developing countries - can never hope to perform to the best of their abilities.