Abstract
BackgroundIn India, Non Communicable Diseases (NCDs) and injuries account for an estimated 62% of the total age-standardized burden of forgone Disability Adjusted Life Years (DALYs). Public and private financing of clinical services to reduce the NCD burden is a major challenge.MethodsWe used National Sample Survey Organization (NSSO) survey data from 1995-96 and 2004 covering nearly 200 thousand households to assess healthcare utilization patterns and out of pocket health spending by disease category. For this purpose, self-reported diseases and conditions were categorized into NCDs and non-NCDs. Survey data were used to assess how households financed their overall health expenditures and related this pattern to specific health conditions. We measured catastrophic spending on NCD-related hospitalization, defined as occurring when health expenditures exceeded 40% of a household's ability to pay, that is, household consumption spending less combined survival consumption expenditure; and impoverishment when per capita expenditure within the household decreased to below the poverty line once health spending was netted out.ResultsThe share of NCDs in out of pocket health expenses incurred by households increased over time, from 31.6 percent in 1995-96 to 47.3 percent in 2004. In both years, own savings and income were the most important source of financing for many health conditions, typically between 40-60 percent of all spending, whereas 30-35 percent was from borrowing. The odds of catastrophic hospitalization expenditures for cancer was nearly 170% greater and for CVD and injuries 22 percent greater than the odds due to communicable diseases. Impoverishment patterns were similar.ConclusionsOut of pocket expenses for treating NCDs rose sharply over the period from 1995-96 to 2004. When NCDs are present, the financial risks to which Indians households are exposed are significant.
Highlights
While financing is important for all diseases and health conditions, our focus in this study is on Non Communicable Diseases (NCDs) because of their current large burden
Our results show that the odds of catastrophic spending and impoverishment are higher for those hospitalized with NCDs than for those hospitalized with communicable conditions
A 133% likelihood of falling into poverty was found. These basic findings persisted even when we disaggregated the analysis by household expenditure quintiles, ranging from the poorest to the richest 20% for the population. This is the first nationally representative study in India on health spending associated with NCDs, the way such spending is financed, and the implications this spending has on catastrophic spending and impoverishment
Summary
Non-communicable diseases (NCDs), primarily chronic diseases (heart disease, diabetes, cancer, and chronic respiratory disease/asthma) and injuries, and mental illness, account for an estimated 62% of the total age-standardized burden of forgone disability adjusted life-years (DALYs) in India, with the remainder from communicable diseases and maternal and child health issues [1]. Risk factors such as tobacco use and a growing morbidity from obesity, heart disease, diabetes, cancer, and chronic respiratory disease along with injuries account for this share. While financing is important for all diseases and health conditions, our focus in this study is on NCDs because of their current large burden
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