Determinants of Catastrophic Health Expenditure among Rural Households in Northeast India

Abstract: In India, healthcare Financing is heavily reliant on out-of-pocket expenditure, particularly among the poor and vulnerable. Public health insurance schemes such as Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) use Socio-Economic Caste Census (SECC) deprivation criteria to identify eligible households. The study attempts to identify socio-economic determinants of catastrophic health expenditure. The study uses unit-level data from the NSS 75th Round (2017–18), restricted to rural households in Northeast India. By rebuilding four deprivation indicators (D2, D3, D5, and D7) from similar NSS variables, SECC-2011 eligibility is proxied. SECC-eligible households were those that met at least one deprivation requirement. After adjusting for sociodemographic factors, survey-weighted logistic regression was used to investigate the relationship between SECC eligibility and health insurance coverage. There is a significant eligibility–coverage disparity: 61.7% of rural households were qualified for SECC, only 11.7% had insurance, and roughly 88% did not. Enrolment is not guaranteed by SECC-based eligibility, which emphasizes the need to improve enrolment processes beyond eligibility requirements.