Erika Binnendijk1, Ruth Koren, David M Dror. 1. Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands Felsenstein Medical Research Center, Tel Aviv University Ramat Aviv, Tel Aviv, Israel Micro Insurance Academy, New Delhi, India.
Abstract
OBJECTIVE: Non-communicable diseases (NCD) are on the increase in low-income countries, where healthcare costs are paid mostly out-of-pocket. We investigate the financial burden of NCD vs. communicable diseases (CD) among rural poor in India and assess whether they can afford to treat NCD. METHODS: We used data from two household surveys undertaken in 2009-2010 among 7389 rural poor households (39 205 individuals) in Odisha and Bihar. All persons from the sampled households, irrespective of age and gender, were included in the analysis. We classify self-reported illnesses as NCD, CD or 'other morbidities' following the WHO classification. RESULTS: Non-communicable diseases accounted for around 20% of the diseases in the month preceding the survey in Odisha and 30% in Bihar. The most prevalent NCD, representing the highest share in outpatient costs, were musculoskeletal, digestive and cardiovascular diseases. Cardiovascular and digestive problems also generated the highest inpatient costs. Women, older persons and less-poor households reported higher prevalence of NCD. Outpatient costs (consultations, medicines, laboratory tests and imaging) represented a bigger share of income for NCD than for CD. Patients with NCD were more likely to report a hospitalisation. CONCLUSION: Patients with NCD in rural poor settings in India pay considerably more than patients with CD. For NCD cases that are chronic, with recurring costs, this would be aggravated. The cost of NCD care consumes a big part of the per person share of household income, obliging patients with NCD to rely on informal intra-family cross-subsidisation. An alternative solution to finance NCD care for rural poor patients is needed.
OBJECTIVE: Non-communicable diseases (NCD) are on the increase in low-income countries, where healthcare costs are paid mostly out-of-pocket. We investigate the financial burden of NCD vs. communicable diseases (CD) among rural poor in India and assess whether they can afford to treat NCD. METHODS: We used data from two household surveys undertaken in 2009-2010 among 7389 rural poor households (39 205 individuals) in Odisha and Bihar. All persons from the sampled households, irrespective of age and gender, were included in the analysis. We classify self-reported illnesses as NCD, CD or 'other morbidities' following the WHO classification. RESULTS: Non-communicable diseases accounted for around 20% of the diseases in the month preceding the survey in Odisha and 30% in Bihar. The most prevalent NCD, representing the highest share in outpatient costs, were musculoskeletal, digestive and cardiovascular diseases. Cardiovascular and digestive problems also generated the highest inpatient costs. Women, older persons and less-poor households reported higher prevalence of NCD. Outpatient costs (consultations, medicines, laboratory tests and imaging) represented a bigger share of income for NCD than for CD. Patients with NCD were more likely to report a hospitalisation. CONCLUSION:Patients with NCD in rural poor settings in India pay considerably more than patients with CD. For NCD cases that are chronic, with recurring costs, this would be aggravated. The cost of NCD care consumes a big part of the per person share of household income, obliging patients with NCD to rely on informal intra-family cross-subsidisation. An alternative solution to finance NCD care for rural poor patients is needed.
Keywords:
Inde; India; enfermedades no transmisibles; financement de la santé; financiación de la salud; health financing; low‐income population; maladies non transmissibles; milieu rural; non‐communicable diseases; población con ingresos bajos; population à faibles revenus; rural
Authors: Apurv Soni; Allison Earon; Anna Handorf; Nisha Fahey; Kandarp Talati; John Bostrom; Ki Chon; Craig Napolitano; Michael Chin; John Sullivan; Shyamsundar Raithatha; Robert Goldberg; Somashekhar Nimbalkar; Jeroan Allison; Sunil Thanvi; David McManus Journal: JMIR Public Health Surveill Date: 2016-10-13
Authors: Wendy Janssens; Jann Goedecke; Godelieve J de Bree; Sunday A Aderibigbe; Tanimola M Akande; Alice Mesnard Journal: PLoS One Date: 2016-11-10 Impact factor: 3.240