Catastrophic Health-care Expenditure and Willingness to Pay for Health Insurance in a Metropolitan City: A Cross-Sectional Study

BACKGROUND: Health insurance can be a very useful strategy to mitigate the disabling effects of catastrophic health expenditure in India. OBJECTIVES: The aim of the study is to estimate catastrophic health expenditure incurred and the willingness to pay and ability to pay for health insurance among the unsubscribed. MATERIALS AND METHODS: A total of 201 principal earning members of households belonging to the 25–45 years age group were interviewed in a community-based household survey in a conveniently selected ward in Mumbai with the help of a pretested, semi-structured interview schedule. RESULTS: The proportion of households with catastrophic health expenditure was 22.4% (total expenditure estimate) and 17.4% (nonfood expenditure estimate). There was a statistically significant association between socioeconomic class and occurrence of catastrophic health expenditure. The average amount the respondents were willing to pay as premium for health insurance per month was ₹272 and the average amount they were able to pay was ₹259. CONCLUSION: Catastrophic health expenditure continues to be a disastrous problem in around 20% of Indian households. Targeted health insurance schemes with different premiums and coverages for different income and employment groups should be considered.