14 Health Indicators in CPHS

by Gayatri Dewan

Of all the indicators that measure the wellbeing of individuals, health is unquestionably the most important. But, unlike say income, health cannot be measured unequivocally on a scale. We therefore need a collection of indicators to measure health.

Health is, to a great extent and ultimately about feeling healthy. CPHS takes this tenet literally. It asks all individuals 3 direct questions regarding their perception of their own health.

CPHS also asks 10 questions at the household level regarding expenditure on healthcare, and the presence of water, sanitation, and hygiene facilities in the household. In addition, at the individual level, CPHS asks each member whether they possess a health insurance policy or not. So, what are these 14 health indicators?

To begin with, one of the most straightforward yet telling indicators in CPHS is the indicator titled Self-assessed status of member being healthy or not (99)1. This indicates whether an individual is feeling healthy as of the day of the survey. Answered as a simple yes or no, it denotes how the respondent feels as opposed to their status based on diagnostic tests.

It is possible that the self-reported health status may not represent the complete picture of an individual’s underlying health conditions. To uncover these details, CPHS also asks the Status of member being on medication or not (100) and the Status of member being hospitalized (101). These questions serve to expand our knowledge of members’ wellbeing. For instance, it’s possible to encounter an individual who states that she is healthy, but may simultaneously be suffering from a chronic disease, and owe her health to a regular course of medication. Therefore, studying self-reported health and medication status in conjunction can enable researchers to draw out interesting results. With respect to the type of medication, CPHS recognizes India’s diverse medical practices and considers all systems- be it allopathic, ayurvedic, homeopathic, unani or others. Next, to be considered hospitalized, an individual must stay overnight at the hospital with an officially allotted bed, and not merely be visiting the hospital for check-ups/diagnosis.

CPHS captures just one behavioural indicator at the individual level. This seeks an answer to Whether member has health insurance policy or not (108). CPHS is agnostic to who provides or pays for the insurance it could be the individual, the family, or the employer. What is important is whether the members of sample households have medical insurance cover or not.

Having asked about each member’s health, the next logical step is to study their health-seeking behaviour. This is achieved by mapping the healthcare costs borne by households, and the various forms of health services sought by them. CPHS captures the expenditure incurred by households on 7 independent heads as listed below.

  1. Monthly household expenditure on medicines (319)- All types of medicines from across all disciplines are considered, along with the purchase of balms, creams, ointments, etc. for medical purposes, either over-the-counter or by prescription.
  2. Monthly household expenditure on doctors/physiotherapists fee (320)- Consultations/treatment by all doctors, dentists, physiotherapists, etc.
  3. Monthly household expenditure on medical tests (321)- Any tests ordered by doctors and undertaken by household members to identify their ailments, including X-rays, blood tests, MRIs, CT scans, etc.
  4. Monthly household expenditure on hospitalization fees (322)- Includes costs such as charges for a room, treatment procedures. Importantly, this amount is recorded even if it is reimbursed by insurance.
  5. Monthly household expenditure on premium for health insurance (323)- If the household has health insurance, the premium paid for the same is recorded.
  6. Monthly household expenditure on health supplements (189)- Includes over-the-counter items like Horlicks, Bournvita, Whey Protein, Glucon-D, Chayawanprash intended to supplement one’s diet, but excludes medically prescribed health supplements taken for illnesses.
  7. Monthly household expenditure on health enhancements (324)- Includes services such as gyms, yoga sessions, nutritionist’s fees to improve one’s health status.

At times, households may not be able to cover the above healthcare costs out of their savings. In such cases, they borrow from either formal or informal sources like banks, NBFCs, friends, SHGs, moneylenders, etc. Therefore, CPHS also asks Does the household have a borrowing for medical expenditure (457) as of the date of the survey. This data is captured by source of borrowing. This can help investigate questions such as the gap between healthcare requirements and access in India, or the impact of healthcare costs on a household’s financial wellbeing, among other things.

Lastly, health status is not only dependent on the healthcare services availed by households, but equally on basic amenities of water and sanitation. Therefore, CPHS records whether a Household has access to water inside household (631) and whether a Household has toilet within premises (634). In order to answer in the affirmative, a household would need to have access to a municipal tap/well within the premises. Similarly, the toilet should be within the boundary of the household and should provide adequate privacy. Access to both the toilet and water should be exclusive to the household, rather than being a community facility.

Health outcomes do not exist in isolation. They impact and are affected by factors such as education, employment, and income, which are also captured by the survey. CPHS provides an exciting array of indicators, using which researchers can study Indian households’ wellbeing reasonably comprehensively.

1 Serial number of the indicator. For the full list visit: CPdx

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