Magdalena Z. Raban, Rakhi Dandona and Lalit Dandona

Bulletin of the World Health Organization


To assess the comparability of out-of-pocket (OOP)payment and catastrophic health
expenditure (CHE) estimates from different household surveys in India.

Data on CHE, outpatient and inpatient OOP payments and other
expenditure from all major national or multi-state surveys since 2000 were
compared. These included two consumer expenditure surveys (the National Sample
Survey for 2004–05 [NSS 2004–05] and 2009–10 [NSS 2009–10]) and three health-
focused surveys (the World Health Survey 2003 [WHS 2003]; the National Sample
Survey on Morbidity, Health Care and the Condition of the Aged 2004 [NSS 2004];
and the Study on Global Ageing and Adult Health 2007–08 [SAGE 2007–08]). All but
the NSS 2004–05 and the NSS 2009–10 used different questionnaires.

CHE estimates from WHS 2003 and SAGE 2007–08 were twice as
high as those from NSS 2004–05, NSS 2009–10 and NSS 2004. Inpatient OOP
payment estimates were twice as high in WHS 2003 and SAGE 2007–08 because in
these surveys a much higher proportion of households reported such payments.
However, other estimated expenditures were half as high in the WHS 2003 as in the
other surveys because a very small number of items was used to capture these

The wide variations observed in CHE and OOP payment estimates resulted from
methodological differences.Survey methods used to assess CHE in India need to be
standardized and validated to accurately track CHE and assess the impact of recent
policies to reduce it.

Published online: 12 July 2013