The 2030 sustainable development goal 3.8 is achieving universal health coverage (UHC). UHC targets quality health services to everyone while ensuring their financial protection. In India, owing to the enormous health care expenditure and low self-insurance rates, people resort to informal coping strategies like borrowing from friends/family/money lenders or selling off assets to finance their health care bills. These strategies are referred to as hardship financing. The thesis investigates the extent and motives behind hardship financing and the resultant financial burden in India. The present study examines the factors associated with hardship financing in Indian households and assesses the contributing factors to the reduction in hardship financing from 2014 to 2018. The study further explores the contribution of underlying factors to the rural-urban gap in hardship financing using two rounds of national sample survey organization's data on social consumption: health. While the overall rural-urban gap in hardship financing has decreased over time, there is still evidence of lingering disparities between the two regions. The individual's income status has the most significant contribution to worsening the rural disadvantage in hardship financing, and its contribution to the gap has increased from 25% in 2014 to 44% in 2018. The study sheds light on the various economic and social vulnerabilities existing in Indian society, widening the rural-urban gap in hardship financing. Furthermore, we use a qualitative survey to capture the grassroots-level reality of financial hardships from severe illness shocks in poor households. In the Pathanamthitta district of Kerala, borrowing is people's primary hardship financing strategy. But as financial stability worsens, the strategy changes to selling assets. Moreover, the financial protection offered by government schemes is limited, and people encounter significant out-of-pocket expenditures for drugs and medical tests, leading to a poverty trap.


Keywords: SDG 3.8, Universal Health Coverage, Hardship Financing, Households, India