{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:03:40Z","timestamp":1791389020471,"version":"4.3.3"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>As per the World Bank Poverty and Inequality Platform (2021), approximately 12.92% of India\u2019s population was below the poverty line in 2018, based on the international poverty line of $2.15 per day (PPP 2017). According to the National Health Authority (NHA) Estimates for 2018\u201319, the out-of-pocket health expenditure (OOPHE) share of total health expenditure (THE) was reported as 48.2% for the entire population, a decline from 64.2% in 2013\u201314. Thus, OOPHE is a major reason pushing households into poverty. Therefore, we seek to estimate the impact of OOPHE on poverty in India. We use data from the nationally representative survey on Household Social Consumption Health (2017\u20132018) and estimate poverty gap at the household level before and after making the OOPHE. Further, binary logit model was used for predicting the effects of various factors on the incidence of poverty. We find that the duration of hospitalization, household size, usage of private healthcare, out of pocket health expenditure, income, aged people in the family and caste are the significant determinants of impoverishment. Also, the implementation of various healthcare schemes and public health initiatives have not been substantial as they are found to be limited, and a significant proportion of the population is left with no health coverage. Findings stress on the need for the expansion of public health insurance coverage for safeguarding households against falling into poverty.<\/jats:p>","DOI":"10.3389\/fpubh.2026.1762886","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T06:50:10Z","timestamp":1773903010000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of out-of-pocket health expenditure on poverty in India"],"prefix":"10.3389","volume":"14","author":[{"given":"Neeraj","family":"Soni","sequence":"first","affiliation":[{"name":"Sri Sathya Sai Institute of Higher Learning (Deemed to be University)","place":["Prasanthi Nilayam, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajabushan Jagadish","family":"Nayak","sequence":"additional","affiliation":[{"name":"Sri Sathya Sai Institute of Higher Learning (Deemed to be University)","place":["Prasanthi Nilayam, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prasant","family":"Blon","sequence":"additional","affiliation":[{"name":"Sri Sathya Sai Institute of Higher Learning (Deemed to be University)","place":["Prasanthi Nilayam, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghna","family":"Ghosh","sequence":"additional","affiliation":[{"name":"BITS Law School","place":["Mumbai, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanupriya","family":"Singh","sequence":"additional","affiliation":[{"name":"Independent Health Researcher","place":["Mumbai, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish","family":"Singh","sequence":"additional","affiliation":[{"name":"Shailesh J Mehta School of Management, Indian Institute of Technology Bombay","place":["Mumbai, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"key":"ref1","year":"2020"},{"key":"ref2","year":"2019"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1016\/S0140-6736(10)61894-6","article-title":"Health care and equity in India","volume":"377","author":"Balarajan","year":"2011","journal-title":"Lancet"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1590\/S0042-96862003000700013","article-title":"Poverty, equity, human rights and health","volume":"81","author":"Braveman","year":"2003","journal-title":"Bull World Health Organ"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1093\/heapol\/czn046","article-title":"Reducing out-of-pocket expenditures to reduce poverty: a disaggregated analysis at rural-urban and state level in India","volume":"24","author":"Garg","year":"2009","journal-title":"Health Policy Plan"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e0196106","DOI":"10.1371\/journal.pone.0196106","article-title":"Disease-specific out-of-pocket and catastrophic health expenditure on hospitalization in India: do Indian households face distress health financing?","volume":"13","author":"Kastor","year":"2018","journal-title":"PLoS One"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"849","DOI":"10.2471\/BLT.07.049403","article-title":"Coping with out-of-pocket health payments: empirical evidence from 15 African countries","volume":"86","author":"Leive","year":"2008","journal-title":"Bull World Health Organ"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1186\/s12913-025-13842-y","article-title":"Distress financing on inpatient health expenditure across states in India","volume":"26","author":"Meena","year":"2025","journal-title":"BMC Health Serv Res"},{"key":"ref9","volume-title":"Report of the Expert Group to Review the Methodology for Estimation of Poverty","year":"2011"},{"key":"ref10","article-title":"Ministry of Planning. Poverty and extreme poverty.","year":"2023"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"7120","DOI":"10.4103\/jfmpc.jfmpc_590_22","article-title":"Impoverishing effects of out-of-pocket healthcare expenditures in India","volume":"11","author":"Sriram","year":"2022","journal-title":"J Family Med Prim Care"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1186\/s12962-021-00301-8","article-title":"Strategies for reducing out of pocket payments in the health system: a scoping review","volume":"19","author":"Jalali","year":"2021","journal-title":"Cost Eff Resour Alloc"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"749","DOI":"10.2190\/HS.39.4.i","article-title":"The concentration of disadvantage and the rise of an urban penalty: urban slum prevalence and the social production of health inequalities in the developing countries","volume":"39","author":"Rice","year":"2009","journal-title":"Int J Health 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