Cost of hospitalisation for non-communicable diseases in India: are we pro-poor?

J P Tripathy; B M Prasad; H D Shewade; A M V Kumar; R Zachariah; S Chadha; J Tonsing; A D Harries

doi:10.1111/tmi.12732

Cost of hospitalisation for non-communicable diseases in India: are we pro-poor?

Trop Med Int Health. 2016 Aug;21(8):1019-1028. doi: 10.1111/tmi.12732. Epub 2016 Jun 22.

Authors

J P Tripathy¹, B M Prasad², H D Shewade¹, A M V Kumar¹, R Zachariah³, S Chadha², J Tonsing¹, A D Harries^{4

5}

Affiliations

¹ International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India.
² Project Axshya, International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India.
³ Brussels Operational Centre, Médecins Sans Frontieres, Luxembourg City, Luxembourg.
⁴ International Union Against Tuberculosis and Lung Disease, Paris, France.
⁵ London School of Hygiene and Tropical Medicine, London, UK.

PMID: 27253634
DOI: 10.1111/tmi.12732

Abstract

Objectives: To estimate out-of-pocket (OOP) expenditure due to hospitalisation from NCDs and its impact on households in India.

Methods: The study analysed nationwide representative data collected by the National Sample Survey Organisation in 2014 that reported health service utilisation and healthcare-related OOP expenditure by income quintiles and by type of health facility (public or private). The recall period for inpatient hospitalisation expenditure was 365 days. Consumption expenditure was collected for a recall period of 1 month. OOP expenditure amounting to >10% of annual consumption expenditure was termed as catastrophic. Weighted analysis was performed.

Results: The median expenditure per episode of hospitalisation due to NCDs was USD 149 - this was ~3 times higher among the richest quintile compared to poorest quintile. There was a significantly higher prevalence of catastrophic expenditure among the poorest quintile, more so for cancers (85%), psychiatric and neurological disorders (63%) and injuries (63%). Mean private-sector OOP hospitalisation expenditure was nearly five times higher than that in the public sector. Medicines accounted for 40% and 27% of public- and private-sector OOP hospitalisation expenditure, respectively.

Conclusion: Strengthening of public health facilities is required at community level for the prevention, control and management of NCDs. Promotion of generic medicines, better availability of essential drugs and possible subsidisation for the poorest quintile will be measures to consider to reduce OOP expenditure in public-sector facilities.

Keywords: blessure; cancer; catastrophic expenditure; cáncer; dépenses catastrophiques; dépenses directes de la poche; enfermedades no transmisibles; gastos catastróficos; gastos de bolsillo; injury; lesiones; maladies non transmissibles; non-communicable diseases; out-of-pocket expenditure.