Multi-Layered Catastrophic Health Spending of Inpatient Women by Broad Group of Diseases in India
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Published:
Dec 15, 2021
Keywords:
Diseases healthcare disparity India inpatient women multi-layer CHS
Main Article Content
Abstract
Healthcare for Indian women needs prioritizing, as they continue to face social and economic discrimination over their healthcare, often with high out-of-pocket payments. The study examines the amount inpatient women have to pay for treatment of major diseases, re-classified into four groups as infectious, reproductive, non-communicable diseases (NCDs), and disabilities & injuries, across the country to comprehend the extent of catastrophic health spending (CHS) they experienced. The study is based on India’s 75th round of the National Sample Survey (NSS), i.e., Household Social Consumption: Health (2017-2018), consisting of 26,938 inpatient women aged 12 and above from India's urban and rural areas. We examine the prevalence of the four categories of diseases by individual, household, community, and healthcare characteristics. Expenditure estimates were derived from cross-tabulation, followed by binary logistic regression to assess the association between covariates and inpatient expenditures for the diseases. Indian women are more likely to be hospitalized for infectious diseases (43%), but the burden of CHS (overall) is highest for disabilities and injuries (INR 24,414), followed by NCDs (INR 23,053). Duration of hospitalization and possession of health insurance by women indicate maximum variation with medical spending. Almost 97% of women have incurred out-of-pocket expenditure on hospitalization, from which we identify three layers of CHS. A substantial proportion of women (23 to 50%) experienced CHS, i.e., up to 0-10%, 11-30%, and >30%, which varies distinctively by place of residence and across the six regions. Covariates like age, economic status, and healthcare are highly significant and associated with disease-wise CHS thresholds. Women in India face divergent financial hardships for healthcare. Given the heterogeneity of morbidities and socio-economic characteristics, the need for women-sensitive public health services and interventions are evident.
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How to Cite
Swargiary, M., Lhungdim, H., & Bharadwaz, M. P. . (2021). Multi-Layered Catastrophic Health Spending of Inpatient Women by Broad Group of Diseases in India. Journal of Population and Social Studies [JPSS], 30, 183–206. Retrieved from https://so03.tci-thaijo.org/index.php/jpss/article/view/257084
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Research Articles
References
• Alam, K., & Mahal, A. (2014). Economic impacts of health shocks on households in low and middle income countries: a review of the literature. Globalization and Health, 10, 21. https://doi.org/10.1186/1744-8603-10-21
• Berki, S. E. (1986). A look at catastrophic medical expenses and the poor. Health Affairs, 5(4), 138-145. https://doi.org/10.1377/hlthaff.5.4.138
• Boutayeb, A., & Boutayeb, S. (2005). The burden of non communicable diseases in developing countries. International Journal for Equity in Health, 4, 2. https://doi.org/10.1186/1475-9276-4-2
• Census India. (2011a). Gender Composition (No. 5). [dataset]. Office of Registrar General & Census Commissioner, India. https://censusindia.gov.in/2011-prov-results/prov_results_paper1_india.html
• Census India. (2011b). Status of Literacy (No. 6). [dataset]. Office of Registrar General & Census Commissioner, India. https://censusindia.gov.in/2011-prov-results/data_files/mp/07Literacy.pdf
• Chowdhury, S., Gupta, I., Trivedi, M., & Prinja, S. (2018). Inequity & burden of out-of-pocket health spending: District level evidences from India. The Indian Journal of Medical Research, 148(2), 180-189. https://doi.org/10.4103/ijmr.IJMR_90_17
• Chuma, J., & Maina, T. (2012). Catastrophic health care spending and impoverishment in Kenya. BMC Health Services Research, 12, 413. https://doi.org/10.1186/1472-6963-12-413
• Commission on Social Determinants of Health. (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. World Health Organization. https://apps.who.int/iris/handle/10665/43943
• Dash, A., & Mohanty, S. K. (2019). Do poor people in the poorer states pay more for healthcare in India? BMC Public Health, 19, 1020. https://doi.org/10.1186/s12889-019-7342-8
• Express News Service. (2017, October 3). Women’s health scheme ‘Sanitease’ launched. The Indian Express. https://indianexpress.com/article/india/womens-health-scheme-sanitease-launched-4873312/
• Fernandez, E., Schiaffino, A., Rajmil, L., Badia, X., & Segura, A. (1999). Gender inequalities in health and health care services use in Catalonia (Spain). Journal of Epidemiology & Community Health, 53(4), 218-222. https://doi.org/10.1136/jech.53.4.218
• Friedman, H. L. (1994). Reproductive health in adolescence. World Health Statistics Quarterly, 47(1), 31-35. https://europepmc.org/article/med/8085368
• Garg, C. C., & Karan, A. K. (2009). Reducing out-of-pocket expenditures to reduce poverty: A disaggregated analysis at rural-urban and state level in India. Health Policy and Planning, 24(2), 116-128. https://doi.org/10.1093/heapol/czn046
• GBD 2019 Universal Health Coverage Collaborators. (2020). Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 396(10258), 1250-1284. https://doi.org/10.1016/S0140-6736(20)30750-9
• Gotsadze, G., Zoidze, A., & Rukhadze, N. (2009). Household catastrophic health expenditure: Evidence from Georgia and its policy implications. BMC Health Services Research, 9, 69. https://doi.org/10.1186/1472-6963-9-69
• Gustafsson-Wright, E., Janssens, W., & van der Gaag, J. (2011). The inequitable impact of health shocks on the uninsured in Namibia. Health Policy and Planning, 26(2), 142-156. https://doi.org/10.1093/heapol/czq029
• Ho, S. H. (2015). A comparative assessment of emergency medicine between the widowers and widows among the elderly in Taiwan. Economics Bulletin, 35(3), 1795-1808. https://ideas.repec.org/a/ebl/ecbull/eb-13-00773.html
• Institute for Health Metrics and Evaluation. (2019). Financing Global Health 2018: Countries and Programs in Transition. IHME. http://www.healthdata.org/policy-report/financing-global-health-2018-countries-and-programs-transition
• Jeyashree, K., Abdulkader, R. S., Kathirvel, S., Chinnakali, P., & Kumar, A. (2018). Profile of and expenditure on morbidity and hospitalizations among elderly—Analysis of a nationally representative sample survey in India. Archives of Gerontology and Geriatrics, 74, 55-61. https://doi.org/10.1016/j.archger.2017.09.007
• Karan, A., Selvaraj, S., & Mahal, A. (2014). 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. PloS One, 9(8), e105162. https://doi.org/10.1371/journal.pone.0105162
• Kastor, A., & Mohanty, S. K. (2018). Disease-specific out-of-pocket and catastrophic health expenditure on hospitalization in India: Do Indian households face distress health financing? PloS One, 13(5), e0196106. https://doi.org/10.1371/journal.pone.0196106
• Ladusingh, L., Mohanty, S. K., & Thangjam, M. (2018). Triple burden of disease and out of pocket healthcare expenditure of women in India. PloS One, 13(5), e0196835. https://doi.org/10.1371/journal.pone.0196835
• Ministry of Statistics & Programme Implementation. (2019). National Sample Survey: 75th Round 2017-18 [dataset]. Government of India. http://mospi.nic.in/unit-level-data-report-nss-75th-round-july-2017-june-2018-schedule-250social-consumption-health
• Misra, S., Awasthi, S., Singh, J. V., Agarwal, M., & Kumar, V. (2015). Assessing the magnitude, distribution and determinants of catastrophic health expenditure in urban Lucknow, North India. Clinical Epidemiology and Global Health, 3(1), 10-16. https://doi.org/10.1016/j.cegh.2013.10.003
• Mohanty, S. K., Kastor, A., & Dwivedi, L. K. (2018). Issues and challenges in estimating catastrophic health spending in India. SARVEKSHANA: Journal of Sample Survey Office, 57(3&4), 19-35. http://mospi.nic.in/sites/default/files/publication_reports/sarvekshana_104.pdf
• Mondal, S., Kanjilal, B., Peters, D. H., & Lucas, H. (2014). Catastrophic out-of-pocket payment for health care and its impact on households: Experience from West Bengal, India. Economics Bulletin, 34(2), 1303-1316. https://ideas.repec.org/a/ebl/ecbull/eb-12-00716.html
• National Health Systems Resource Centre. (2019). National Health Accounts Estimates for India (2016–17) [dataset]. Ministry of Health and Family Welfare, Government of India. https://nhsrcindia.org/national-health-accounts-records
• NIHFW. (2015). Women’s Health. National Institute of Health & Family Welfare. https://www.nhp.gov.in/healthlyliving/women-s-health
• Onah, M. N., & Govender V. (2014). Out-of-pocket payments, health care access and utilisation in south-eastern Nigeria: A gender perspective. PLoS One, 9(4), e93887. https://doi.org/10.1371/journal.pone.0093887
• Pandey, A., Kumar, G. A., Dandona, R., & Dandona, L. (2018). Variations in catastrophic health expenditure across the states of India: 2004 to 2014. PloS One, 13(10), e0205510. https://doi.org/10.1371/journal.pone.0205510
• Paul, K., & Singh, J. (2017). Emerging trends and patterns of self-reported morbidity in India: Evidence from three rounds of national sample survey. Journal of Health, Population and Nutrition, 36, 32. https://doi.org/10.1186/s41043-017-0109-x
• Prinja, S., Jagnoor, J., Sharma, D., Aggarwal, S., Katoch, S., Lakshmi, P. V. M., & Ivers, R. (2019). Out-of-pocket expenditure and catastrophic health expenditure for hospitalization due to injuries in public sector hospitals in North India. PLoS One, 14(11), e0224721. https://doi.org/10.1371/journal.pone.0224721
• Raban, M. Z., Dandona, R., & Dandona, L. (2013). Variations in catastrophic health expenditure estimates from household surveys in India. Bulletin of the World Health Organization, 91, 726-735. https://doi.org/10.2471/blt.12.113100
• Ravi, S., Ahluwalia, R., & Bergkvist, S. (2016). Health and morbidity in India (2004-2014). Brookings India. https://www.think-asia.org/handle/11540/9062
• Saikia, N., Moradhvaj, & Bora, J. K. (2016). Gender difference in health-care expenditure: Evidence from India Human Development Survey. PloS One, 11(7), e0158332. https://doi.org/10.1371/journal.pone.0158332
• Saksena, P., Xu, K., Elovainio, R., & Perrot, J. (2012). Utilization and expenditure at public and private facilities in 39 low‐income countries. Tropical Medicine & International Health, 17(1), 23-35. https://doi.org/10.1111/j.1365-3156.2011.02894.x
• Stata Corporation. (2017). Stata Statistical Software: Release 15. StataCorp LLC.
• Su, T. T., Kouyaté, B., & Flessa, S. (2006). Catastrophic household expenditure for health care in a low-income society: a study from Nouna District, Burkina Faso. Bulletin of the World Health Organization, 84(1), 21-27. https://doi.org/10.2471/blt.05.023739
• Thyloth, M., Singh, H., & Subramanian, V. (2016). Increasing burden of mental illnesses across the globe: current status. Indian Journal of Social Psychiatry, 32(3), 254-256. https://doi.org/10.4103/0971-9962.193208
• UK FX. (2021). US Dollar to Indian Rupee Spot Exchange Rates for 2019. Exchange Rates UK. https://www.exchangerates.org.uk/USD-INR-spot-exchange-rates-history-2019.html
• UNDP. (2020). Human Development Reports: Human Development Index and its components.
• United Nations Development Programme. http://hdr.undp.org/en/composite/HDI
• UNICEF. (2021). Non-communicable diseases. UNICEF DATA. https://data.unicef.org/topic/child-health/noncommunicable-diseases/
• United Nations. (2019). World Population Prospects 2019. https://population.un.org/wpp/
• van Doorslaer, E., O'Donnell, O., Rannan-Eliya, R. P., Somanathan, A., Adhikari, S. R., Garg, C. C., Harbianto, D., Herrin, A. N., Huq, M. N., Ibragimova, S., Karan, A., Ng, C. W., Pande, B. R., Racelis, R., Tao, S., Tin, K., Tisayaticom, K., Trisnantoro, L., Vasavid, C., & Zhao, Y. (2006). Effect of payments for health care on poverty estimates in 11 countries in Asia: an analysis of household survey data. The Lancet, 368(9544), 1357-1364. https://doi.org/10.1016/s0140-6736(06)69560-3
• Wang, W., Temsah, G., & Carter, E. (2016). Levels and determinants of out-of-pocket health expenditures in the Democratic Republic of the Congo, Liberia, Namibia, and Rwanda. DHS Analytical Studies No. 59. ICF International. https://dhsprogram.com/publications/publication-as59-analytical-studies.cfm
• World Health Assembly, 53. (2000). The World Health Report 2000: health systems: improving performance. World Health Organization. https://apps.who.int/iris/handle/10665/79020
• World Health Organization. (2010). International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Version for 2010. https://icd.who.int/browse10/2010/en#/I
• World Health Organization. (2019a). Global spending on health: A world in transition. https://www.who.int/health_financing/documents/health-expenditure-report-2019.pdf
• World Health Organization. (2019b). World health statistics 2019: Monitoring health for the SDGs. https://apps.who.int/iris/handle/10665/324835
• Wyszewianski, L. (1986). Financially catastrophic and high-cost cases: Definitions, distinctions, and their implications for policy formulation. Inquiry, 23(4), 382-394. http://www.jstor.org/stable/29771827
• Xu, K., Evan, D. B., Carrin, G., Aguilar-Rivera, A. M., Musgrove, P., & Evans, T. (2007). Protecting households from catastrophic health spending. Health Affairs, 26(4), 972-983. https://doi.org/10.1377/hlthaff.26.4.972
• Xu, K., Evans, D. B., Kadama, P., Nabyonga, J., Ogwal, P. O., Nabukhonzo, P., & Aguilar, A. M. (2006). Understanding the impact of eliminating user fees: utilization and catastrophic health expenditures in Uganda. Social Science & Medicine, 62(4), 866-876. https://doi.org/10.1016/j.socscimed.2005.07.004
• Xu, K., Evans, D. B., Kawabata, K., Zeramdini, R., Klavus, J., & Murray, C. J. (2003). Household catastrophic health expenditure: a multi-country analysis. The Lancet, 362(9378), 111-117. https://doi.org/10.1016/s0140-6736(03)13861-5
• Yadav, A. K., & Singh, A. (2020). Age-and sex-specific burden of morbidity and disability in India: A current scenario. In S. Reddy and A. I. Tavares (Eds.), Evaluation of Health Services (Chapter 3). https://doi.org/10.5772/intechopen.89709
• Berki, S. E. (1986). A look at catastrophic medical expenses and the poor. Health Affairs, 5(4), 138-145. https://doi.org/10.1377/hlthaff.5.4.138
• Boutayeb, A., & Boutayeb, S. (2005). The burden of non communicable diseases in developing countries. International Journal for Equity in Health, 4, 2. https://doi.org/10.1186/1475-9276-4-2
• Census India. (2011a). Gender Composition (No. 5). [dataset]. Office of Registrar General & Census Commissioner, India. https://censusindia.gov.in/2011-prov-results/prov_results_paper1_india.html
• Census India. (2011b). Status of Literacy (No. 6). [dataset]. Office of Registrar General & Census Commissioner, India. https://censusindia.gov.in/2011-prov-results/data_files/mp/07Literacy.pdf
• Chowdhury, S., Gupta, I., Trivedi, M., & Prinja, S. (2018). Inequity & burden of out-of-pocket health spending: District level evidences from India. The Indian Journal of Medical Research, 148(2), 180-189. https://doi.org/10.4103/ijmr.IJMR_90_17
• Chuma, J., & Maina, T. (2012). Catastrophic health care spending and impoverishment in Kenya. BMC Health Services Research, 12, 413. https://doi.org/10.1186/1472-6963-12-413
• Commission on Social Determinants of Health. (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. World Health Organization. https://apps.who.int/iris/handle/10665/43943
• Dash, A., & Mohanty, S. K. (2019). Do poor people in the poorer states pay more for healthcare in India? BMC Public Health, 19, 1020. https://doi.org/10.1186/s12889-019-7342-8
• Express News Service. (2017, October 3). Women’s health scheme ‘Sanitease’ launched. The Indian Express. https://indianexpress.com/article/india/womens-health-scheme-sanitease-launched-4873312/
• Fernandez, E., Schiaffino, A., Rajmil, L., Badia, X., & Segura, A. (1999). Gender inequalities in health and health care services use in Catalonia (Spain). Journal of Epidemiology & Community Health, 53(4), 218-222. https://doi.org/10.1136/jech.53.4.218
• Friedman, H. L. (1994). Reproductive health in adolescence. World Health Statistics Quarterly, 47(1), 31-35. https://europepmc.org/article/med/8085368
• Garg, C. C., & Karan, A. K. (2009). Reducing out-of-pocket expenditures to reduce poverty: A disaggregated analysis at rural-urban and state level in India. Health Policy and Planning, 24(2), 116-128. https://doi.org/10.1093/heapol/czn046
• GBD 2019 Universal Health Coverage Collaborators. (2020). Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 396(10258), 1250-1284. https://doi.org/10.1016/S0140-6736(20)30750-9
• Gotsadze, G., Zoidze, A., & Rukhadze, N. (2009). Household catastrophic health expenditure: Evidence from Georgia and its policy implications. BMC Health Services Research, 9, 69. https://doi.org/10.1186/1472-6963-9-69
• Gustafsson-Wright, E., Janssens, W., & van der Gaag, J. (2011). The inequitable impact of health shocks on the uninsured in Namibia. Health Policy and Planning, 26(2), 142-156. https://doi.org/10.1093/heapol/czq029
• Ho, S. H. (2015). A comparative assessment of emergency medicine between the widowers and widows among the elderly in Taiwan. Economics Bulletin, 35(3), 1795-1808. https://ideas.repec.org/a/ebl/ecbull/eb-13-00773.html
• Institute for Health Metrics and Evaluation. (2019). Financing Global Health 2018: Countries and Programs in Transition. IHME. http://www.healthdata.org/policy-report/financing-global-health-2018-countries-and-programs-transition
• Jeyashree, K., Abdulkader, R. S., Kathirvel, S., Chinnakali, P., & Kumar, A. (2018). Profile of and expenditure on morbidity and hospitalizations among elderly—Analysis of a nationally representative sample survey in India. Archives of Gerontology and Geriatrics, 74, 55-61. https://doi.org/10.1016/j.archger.2017.09.007
• Karan, A., Selvaraj, S., & Mahal, A. (2014). 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. PloS One, 9(8), e105162. https://doi.org/10.1371/journal.pone.0105162
• Kastor, A., & Mohanty, S. K. (2018). Disease-specific out-of-pocket and catastrophic health expenditure on hospitalization in India: Do Indian households face distress health financing? PloS One, 13(5), e0196106. https://doi.org/10.1371/journal.pone.0196106
• Ladusingh, L., Mohanty, S. K., & Thangjam, M. (2018). Triple burden of disease and out of pocket healthcare expenditure of women in India. PloS One, 13(5), e0196835. https://doi.org/10.1371/journal.pone.0196835
• Ministry of Statistics & Programme Implementation. (2019). National Sample Survey: 75th Round 2017-18 [dataset]. Government of India. http://mospi.nic.in/unit-level-data-report-nss-75th-round-july-2017-june-2018-schedule-250social-consumption-health
• Misra, S., Awasthi, S., Singh, J. V., Agarwal, M., & Kumar, V. (2015). Assessing the magnitude, distribution and determinants of catastrophic health expenditure in urban Lucknow, North India. Clinical Epidemiology and Global Health, 3(1), 10-16. https://doi.org/10.1016/j.cegh.2013.10.003
• Mohanty, S. K., Kastor, A., & Dwivedi, L. K. (2018). Issues and challenges in estimating catastrophic health spending in India. SARVEKSHANA: Journal of Sample Survey Office, 57(3&4), 19-35. http://mospi.nic.in/sites/default/files/publication_reports/sarvekshana_104.pdf
• Mondal, S., Kanjilal, B., Peters, D. H., & Lucas, H. (2014). Catastrophic out-of-pocket payment for health care and its impact on households: Experience from West Bengal, India. Economics Bulletin, 34(2), 1303-1316. https://ideas.repec.org/a/ebl/ecbull/eb-12-00716.html
• National Health Systems Resource Centre. (2019). National Health Accounts Estimates for India (2016–17) [dataset]. Ministry of Health and Family Welfare, Government of India. https://nhsrcindia.org/national-health-accounts-records
• NIHFW. (2015). Women’s Health. National Institute of Health & Family Welfare. https://www.nhp.gov.in/healthlyliving/women-s-health
• Onah, M. N., & Govender V. (2014). Out-of-pocket payments, health care access and utilisation in south-eastern Nigeria: A gender perspective. PLoS One, 9(4), e93887. https://doi.org/10.1371/journal.pone.0093887
• Pandey, A., Kumar, G. A., Dandona, R., & Dandona, L. (2018). Variations in catastrophic health expenditure across the states of India: 2004 to 2014. PloS One, 13(10), e0205510. https://doi.org/10.1371/journal.pone.0205510
• Paul, K., & Singh, J. (2017). Emerging trends and patterns of self-reported morbidity in India: Evidence from three rounds of national sample survey. Journal of Health, Population and Nutrition, 36, 32. https://doi.org/10.1186/s41043-017-0109-x
• Prinja, S., Jagnoor, J., Sharma, D., Aggarwal, S., Katoch, S., Lakshmi, P. V. M., & Ivers, R. (2019). Out-of-pocket expenditure and catastrophic health expenditure for hospitalization due to injuries in public sector hospitals in North India. PLoS One, 14(11), e0224721. https://doi.org/10.1371/journal.pone.0224721
• Raban, M. Z., Dandona, R., & Dandona, L. (2013). Variations in catastrophic health expenditure estimates from household surveys in India. Bulletin of the World Health Organization, 91, 726-735. https://doi.org/10.2471/blt.12.113100
• Ravi, S., Ahluwalia, R., & Bergkvist, S. (2016). Health and morbidity in India (2004-2014). Brookings India. https://www.think-asia.org/handle/11540/9062
• Saikia, N., Moradhvaj, & Bora, J. K. (2016). Gender difference in health-care expenditure: Evidence from India Human Development Survey. PloS One, 11(7), e0158332. https://doi.org/10.1371/journal.pone.0158332
• Saksena, P., Xu, K., Elovainio, R., & Perrot, J. (2012). Utilization and expenditure at public and private facilities in 39 low‐income countries. Tropical Medicine & International Health, 17(1), 23-35. https://doi.org/10.1111/j.1365-3156.2011.02894.x
• Stata Corporation. (2017). Stata Statistical Software: Release 15. StataCorp LLC.
• Su, T. T., Kouyaté, B., & Flessa, S. (2006). Catastrophic household expenditure for health care in a low-income society: a study from Nouna District, Burkina Faso. Bulletin of the World Health Organization, 84(1), 21-27. https://doi.org/10.2471/blt.05.023739
• Thyloth, M., Singh, H., & Subramanian, V. (2016). Increasing burden of mental illnesses across the globe: current status. Indian Journal of Social Psychiatry, 32(3), 254-256. https://doi.org/10.4103/0971-9962.193208
• UK FX. (2021). US Dollar to Indian Rupee Spot Exchange Rates for 2019. Exchange Rates UK. https://www.exchangerates.org.uk/USD-INR-spot-exchange-rates-history-2019.html
• UNDP. (2020). Human Development Reports: Human Development Index and its components.
• United Nations Development Programme. http://hdr.undp.org/en/composite/HDI
• UNICEF. (2021). Non-communicable diseases. UNICEF DATA. https://data.unicef.org/topic/child-health/noncommunicable-diseases/
• United Nations. (2019). World Population Prospects 2019. https://population.un.org/wpp/
• van Doorslaer, E., O'Donnell, O., Rannan-Eliya, R. P., Somanathan, A., Adhikari, S. R., Garg, C. C., Harbianto, D., Herrin, A. N., Huq, M. N., Ibragimova, S., Karan, A., Ng, C. W., Pande, B. R., Racelis, R., Tao, S., Tin, K., Tisayaticom, K., Trisnantoro, L., Vasavid, C., & Zhao, Y. (2006). Effect of payments for health care on poverty estimates in 11 countries in Asia: an analysis of household survey data. The Lancet, 368(9544), 1357-1364. https://doi.org/10.1016/s0140-6736(06)69560-3
• Wang, W., Temsah, G., & Carter, E. (2016). Levels and determinants of out-of-pocket health expenditures in the Democratic Republic of the Congo, Liberia, Namibia, and Rwanda. DHS Analytical Studies No. 59. ICF International. https://dhsprogram.com/publications/publication-as59-analytical-studies.cfm
• World Health Assembly, 53. (2000). The World Health Report 2000: health systems: improving performance. World Health Organization. https://apps.who.int/iris/handle/10665/79020
• World Health Organization. (2010). International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Version for 2010. https://icd.who.int/browse10/2010/en#/I
• World Health Organization. (2019a). Global spending on health: A world in transition. https://www.who.int/health_financing/documents/health-expenditure-report-2019.pdf
• World Health Organization. (2019b). World health statistics 2019: Monitoring health for the SDGs. https://apps.who.int/iris/handle/10665/324835
• Wyszewianski, L. (1986). Financially catastrophic and high-cost cases: Definitions, distinctions, and their implications for policy formulation. Inquiry, 23(4), 382-394. http://www.jstor.org/stable/29771827
• Xu, K., Evan, D. B., Carrin, G., Aguilar-Rivera, A. M., Musgrove, P., & Evans, T. (2007). Protecting households from catastrophic health spending. Health Affairs, 26(4), 972-983. https://doi.org/10.1377/hlthaff.26.4.972
• Xu, K., Evans, D. B., Kadama, P., Nabyonga, J., Ogwal, P. O., Nabukhonzo, P., & Aguilar, A. M. (2006). Understanding the impact of eliminating user fees: utilization and catastrophic health expenditures in Uganda. Social Science & Medicine, 62(4), 866-876. https://doi.org/10.1016/j.socscimed.2005.07.004
• Xu, K., Evans, D. B., Kawabata, K., Zeramdini, R., Klavus, J., & Murray, C. J. (2003). Household catastrophic health expenditure: a multi-country analysis. The Lancet, 362(9378), 111-117. https://doi.org/10.1016/s0140-6736(03)13861-5
• Yadav, A. K., & Singh, A. (2020). Age-and sex-specific burden of morbidity and disability in India: A current scenario. In S. Reddy and A. I. Tavares (Eds.), Evaluation of Health Services (Chapter 3). https://doi.org/10.5772/intechopen.89709