Catastrophic health expenditure and inequalities -- a district level study of West Bengal

Abstract: In this study, I aimed to estimate the incidence of catastrophic health expenditure and analyze the extent of inequalities in out-of-pocket health expenditure and its decomposition according to gender, sector, religion and social groups of the households across Districts of West Bengal. I analysed health spending in West Bengal, using National Sample Survey 71st round pooled data suitably represented to estimate up to district level. We measured CHE at different thresholds when OOP in health expenditure. Gini Coefficients and its decomposition techniques were applied to assess the degree of inequality in OOP health expenditures and between different socio geographic factors across districts. The incidence of catastrophic payments varies considerably across districts. Only 14.1 percent population of West Bengal was covered under health coverage in 2014. The inequality in OOP health expenditure for West Bengal has been observed with gini coefficient of 0.67. Based on the findings from this analysis, more attention is needed on effective financial protection for people of West Bengal to promote fairness, with special focus on the districts with higher inequality. This study only provides the extent of CHE and inequality across Districts of West Bengal but the causality may be taken in future scope of study.