Background and objectives:
Precise identification of households vulnerable to catastrophic health expenditure (CHE) is crucial in the efforts towards Universal Health Coverage. This paper has two main objectives. Firstly, to map the household-level determinants of CHE for people who have required medical care (hospitalization or ambulatory) due to non-communicable diseases (NCDs). Secondly, estimation of proportion of households that have been pushed into poverty due to the incurring of catastrophic health expenditure as a result of NCDs.

Methods:
Data from the 71st and 75th Rounds of NSSO morbidity and healthcare surveys was used for analysis, encompassing a sample of over 179,755 households. Key information on expenditure for hospitalization (inpatient) and ambulatory care (outpatient) was collected pertaining to NCDs. An array of household level socio-economic, demographic and need-based correlates embedded in the Anderson and Newman model were incorporated in the study. Incidence and intensity of CHE was calculated using overshoot and mean positive overshoot measures. Probit regression was undertaken to estimate the impact of correlates on the probability of incurring catastrophic expenses (out-of-pocket expenditure as share of monthly per capita expenditure greater than 10% ) due to health shocks. Adjustment of monthly per capita expenditure was done using OECD equivalence scale.

Results:
Household income level, location (rural/urban), type of facility where care was sought (public or private), availability of insurance cover and number of household members with chronic ailments influence the likelihood of incurring CHE for both inpatients and outpatients. Roughly 60% of all households with members affected by NCDs incurred CHE, with 24% of them pushed into poverty (World Bank poverty line).

Conclusion:
This highlights the urgent need for schemes like the National Health Protection Mission to identify vulnerabilities at the household level that go beyond income or occupation-based classifications and also expand the coverage to include outpatient services.