ABSTRACT
Introduction: Globally, one-third of current health expenditure had been out-of-pocket expenditure (OOPE). The health system financing of almost all low- and middle-income countries including India rely heavily on out-of-pocket (OOP) payments for health care. OOPE on health payments is particularly hard on any community, especially the poor leading to incomplete or even no treatment during their ill health. This study estimated OOPE among residents of a rural community in West Bengal and explored the associated factors with high OOP expenses. Methods: A community-based cross-sectional study was conducted in a rural community in Singur, West Bengal from June 2019 to February 2020. The study was done among 398 villagers selected from 15 clusters or villages. Households were randomly selected in each village. All members of the selected households were interviewed. SPSS was used for data analysis both for descriptive and inferential statistics. Results: Only 14.6% of morbid persons had catastrophic expenditure. The incidence of catastrophic expenditure was higher among those who opted for private practitioners and or ayurveda, yoga and naturopathy, unani, siddha, and homeopathy (AYUSH) facilities. There was zero catastrophic expenditure for the unqualified sector. There was an increasing trend of OOP payments among the lower socioeconomic groups. Again, low-income individuals had a higher share in cumulative expenditure (Gini coefficient of 0.35). Most of the participants (78.4%) had no health insurance coverage. Conclusion: Promotion for higher utilization of public health facilities may reduce the burden of OOP expenses. Government health insurance schemes must be widened with the inclusion of coverage of outpatient services. Integrating AYUSH services in the public sector is another option to reduce OOP expenses.
ABSTRACT
CONTEXT: Garment Industry is considered to be the second-largest employment sector in India. Occupational health problems among workers are often ignored, work-related musculoskeletal disorders (WMSD) accounts for the majority of it. The leverage of a healthy workforce is indispensable in the smooth running of the country's economic machinery. AIMS: To find out the prevalence of WMSD among the workers and to assess the relationship of WMSDs with sociodemographic, behavioral, and occupational factors. SETTINGS AND DESIGN: A cross-sectional study was conducted from June 2017 to August 2019 among 222 workers in three garment factories located in a municipality area of south 24 Parganas District, West Bengal. METHODS AND MATERIAL: Sociodemographic and behavioral characteristics, occupational differentials, and morbidity profiles were assessed using a pre-designed, pre-tested schedule. STATISTICAL ANALYSIS USED: Data were analyzed by SPSS ver. 16.0. Logistic regression was done to determine the associates of WMSDs. RESULTS: Most of the workers were males (70.27%), belonged to the age-group of 36-55 (42.34%) and were illiterate (33.78%). WMSD was prevalent among 70.72% of the workers. Presence of WMSD was significantly associated with educational status{illiterate (OR: 3.59; CI: 1.56-8.22), below secondary (OR-2.89;CI: 1.26-6.62)}, sitting job (OR: 2.02; CI: 1.01-4.03), unsatisfactory working environment (OR: 8.38; CI:1.95-36.06), and level of distress {mild (OR-2.89;CI: 1.26-6.62), moderate-severe (OR: 6.98; CI: 1.46-33.25)}. CONCLUSIONS: Improving health awareness and periodic health check-up is the need of the hour for the sustenance of the massive workforce, which can be achieved through the integration of basic occupational health services (BOHS) with primary health care (PHC) infrastructure.
