Hospitalisation expenditure on tuberculosis among tribal populations in India: A repeated cross-sectional analysis of national sample survey data, 2004 to 2018

Denny John; Jeetendra Yadav; Devdatta Ray; Paramita Bhattacharya; Nirmalya Mukherjee; Rajan Patil; Vivek Varma; Sahadeb Hembram; Moumita Hansda

doi:10.1016/j.puhip.2024.100490

Hospitalisation expenditure on tuberculosis among tribal populations in India: A repeated cross-sectional analysis of national sample survey data, 2004 to 2018

Public Health Pract (Oxf). 2024 Mar 5:7:100490. doi: 10.1016/j.puhip.2024.100490. eCollection 2024 Jun.

Authors

Denny John¹, Jeetendra Yadav², Devdatta Ray³, Paramita Bhattacharya⁴, Nirmalya Mukherjee⁴, Rajan Patil⁵, Vivek Varma⁶, Sahadeb Hembram⁷, Moumita Hansda⁷

Affiliations

¹ Faculty of Life and Allied Health Sciences, MS Ramaiah University of Applied Sciences, Bengaluru, India.
² ICMR-National Institute of Medical Statistics, New Delhi, India.
³ Manipal Academy of Higher Education, Manipal, India.
⁴ Centre for Public Health Research, MANT, Kolkata, India.
⁵ KLE University, Belgaum, India.
⁶ Assam University, Silchar, India.
⁷ MANT, Kolkata, India.

Abstract

Objective: Tribal population in India (8.6% of the total population) have a greater prevalence of tuberculosis compared to the national average. The article aims to study out-of-pocket expenditure (OOPE), hardship financing, and impoverishment effects of TB hospitalisation treatment among tribal populations in India.

Methods: Data of three rounds of National Sample Surveys (NSS) 60th (2004-05), 71st (2013-14) and 75th (2017-18) rounds were analyzed. Descriptive statistics, bivariate estimates and multivariate models were performed to calculate the OOPE, healthcare burden (HCB), catastrophic health expenditure (CHE), hardship financing and impoverishment effects using standard definitions at February 2023 price values. Propensity score matching (PSM) was used to examine the effect of health insurance coverage on catastrophic health expenditure, and impoverishment.

Results: Over two-thirds of the TB cases are seen in the economically productive age group (14-59 years). Substantial OOPE and its impact on HCB, CHE, and poverty impact observed among 15-35 age group across all three rounds. Illiterate patients and those availing private hospitals for TB treatment had higher OOPE, HCB, hardship financing, CHE, and poverty impact. 38.5% (2014) and 33.2% (2018) are covered with any kind of public healthcare coverage, PSM analysis shows households with health insurance have lower incidence of CHE and impoverishment effects due to TB hospitalisation expenditure.

Conclusions: The current study aids in comprehending the patterns in the financial burden of TB on tribal households during the previous 15 years and gives policy makers information for efficient resource allocation management for TB among Indian tribal communities.