Journal of Public Health

, Volume 26, Issue 5, pp 485–494 | Cite as

Economic burden, impoverishment and coping mechanisms associated with out-of-pocket health expenditure: analysis of rural-urban differentials in India

  • Shivendra Sangar
  • Varun Dutt
  • Ramna ThakurEmail author
Original Article



This article aimed to study the burden, impact and coping mechanisms associated with out-of-pocket (OOP) health expenditure in rural and urban areas in India.


National Sample Survey Organisation (NSSO) data on ‘Health and Morbidity’ gathered in 2004 and 2014 were employed to measure the catastrophic burden, impoverishment impact and various coping strategies associated with out-of-pocket health in India.


Results revealed that over the study period, considerable rural-urban differentials existed in the economic burden and impact of out-of-pocket health expenditure. As a coping strategy, borrowing and other distress sources were used in higher proportions by the rural population than their urban counterparts. Overall, our results demonstrated an alarming situation regarding health care financing in India.


Substantial investment in public health is needed, especially in rural areas as it is here that people are facing the real brunt of catastrophic OOP health expenditures in the form of impoverishment with more dependence on distress sources including borrowing and sale of assets as coping mechanisms.


Rural Urban Out of pocket Burden Coping 



This research received no grant from any funding agency in the public, commercial or not-for-profit sectors.

Compliance with ethical standards

Informed consent

The study used a data set that is available online in the public domain; hence, there was no need to seek ethical consent to publish this study.

Ethical treatment of experimental subjects (animal and human)

This article does not contain any studies with human or animal subjects performed by the author.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of Humanities and Social SciencesIndian Institute of TechnologyMandiIndia

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