OBJECTIVES: India has an increasing number of elderly people. Burden of out-of-pocket health expenditures (OOPHE) in India have been continuously increasing. This research analyzes the Horizontal Inequities in OOPHE and Catastrophic Health Expenditure (CHE) incurred due to communicable diseases in India

METHODS: National Sample Survey 75th Round (2017-2018) is used. Direct and Indirect expenditures on treatment of communicable diseases net of the reimbursements was estimated. CHE as defined by Xu et al (2013) i.e., expenditure on healthcare more than 10% of total household budget was computed for varied communicable diseases. Additionally, concentration indices and its decomposition based on Probit Regressions was employed to measure the income-related inequality of CHE. The comparison in inequities between the treatment in public facilities vis a vis private facility was conducted via Dominance testing between the two independent Concentration curves. The comparison of inequality by Geographic location (Rural-Urban) and Nature of Ailment was also be gleaned. Health inequality was decomposed into individual level determinants using an array of household and individual level variables viz. socio-economic, demographic and need based to elucidate the determinants associated with inequality and inequity consanguineous to utilization of services.

RESULTS: Proportion of elderly experiencing CHE in India is around 32% and the mean positive overshoot is 16%. Higher degree of inequality in experiencing CHE is among the people belonging to poorer households. Communicable diseases contribute to the major cause of experiencing CHE, specifically infections, tuberculosis, and sexually transmitted diseases. Infections constitute the major cause of experiencing CHE for ambulatory healthcare expenditures.

CONCLUSIONS: Identifying the various determinants of the OOPHE and CHE due to communicable diseases in India will help the government to establish policies and direct public health actions to protect the people from experiencing burden due to OOPHE and CHE and also to reduce horizontal inequities in experiencing healthcare expenditures.