Assessing the incidence and intensity of catastrophic health expenditure: Evidence from households in India

Background: Out-of-Pocket (OOP) payments remain the dominant mode of healthcare financing in India, exposing households to substantial financial risk. Despite ongoing policy efforts toward universal health coverage, Catastrophic Health Expenditure (CHE) continues to threaten household economic security. Materials and Methods: This study examines the incidence and intensity of catastrophic health expenditure among Indian households using data from the Consumer Expenditure Survey (CES) 2023–24. CHE incidence is defined as the proportion of households whose healthcare spending exceeds a specified threshold of total consumption expenditure, while CHE intensity is measured using the mean overshoot, capturing the extent to which health payments surpass this threshold. State-level analyses are conducted to assess regional variation in financial burden.Results: The findings reveal that approximately one-third of Indian households incurred catastrophic health expenditure. Substantial inter-state disparities were observed in both the incidence and intensity of CHE. States such as Maharashtra, Gujarat, and Tamil Nadu exhibited relatively higher levels of catastrophic spending, indicating uneven economic resilience and variations in healthcare financing arrangements across regions.Conclusion: Catastrophic health expenditure remains widespread in India, highlighting persistent gaps in financial protection against health shocks. The pronounced state-level variation underscores the need for region-specific policy responses. Strengthening public health infrastructure, expanding the depth and effectiveness of health insurance coverage, and prioritizing financial protection for economically vulnerable households are critical to reducing the burden of catastrophic health expenditure in India.