Non-communicable diseases (NCDs) in India have assumed significant proportions in contributing to the overall disease burden over the past 30 years. In 2017, NCDs accounted for 63.7% of all mortality and was a major contributor to the cost of treatment for inpatient admissions (40%) and ambulatory care (35%). It is estimated that NCDs in India account for an economic burden in the range of 5–10% of GDP, significantly slowing down economic growth.
Households, especially those of low socioeconomic status, become vulnerable to catastrophic health expenditure and impoverishment due to health shocks caused by NCDs culminating in a trans-generational cycle of poverty. The study gauged: a) Extent of out-of-pocket expenditure (OOPE) on healthcare b) Incidence and Intensity of catastrophic health expenditure as per income quintiles c) Impoverishing effects of catastrophic health expenditure d) Determinants influencing the catastrophic health expenditure.
The key findings are as follows –
a) Around two-third of households with NCDs incur catastrophic expenditure at 10% threshold; b) Catastrophic payments were concentrated amongst the poor with further widening of inequality in the incidence of catastrophic payments from 2014 to 2017–18; c) The intensity (depth) of catastrophic payments was colossal with around two-fifth and one-third of all households with NCDs spending beyond 10% catastrophic threshold in 2014 and 2017–18 respectively; d) Level of impoverishment increased due to OOP payments on NCDs, as around one-twelfth and one-eighth of all households with NCD burden in 2014 and 2017–18 respectively, were pushed to poverty; e) Severity of impoverishment amongst those households that were already poor increased further by a fraction of one-fourth and one-fifth respectively in 2014 and 2017–18, connoting further deepening of poverty and f) States having a higher burden of NCDs and economically backward status estimated to have higher levels of CHE and poverty-deepening impacts
In India, the high out-of-pocket expenditure is predominantly attributed to the paucity of insurance coverage and social security net. As a corollary, catastrophic payments towards healthcare precipitates an increase in impoverishment. A major proportion of the OOP on NCD care was associated with hospitalization-related expenses and procedures. The rate of hospitalization amongst individuals ailing with NCDs increased by 33% from 2014 to 2017–18. Concurrently, the cost of NCD- related hospitalization also increased by ₹ 4461.
The incidence of CHE for outpatient care exhibited a higher prevalence of OOP burden when treatment was sought from private providers vis-à-vis public providers, thereby indicating the need for more decisive interventions by the government in improving the quality of services in public facilities. It was also conceded that households in rural areas were more likely to endure the impact of catastrophic payments despite lower OOPE.
Persistently high catastrophic expenditure on NCDs in India and subsequent impoverishment insinuates that government-financed health insurance schemes and National Health Mission were ineffective in protecting poor households from economic shocks. Thus, it is imperative to have an augmented financial risk protection mechanism in India, particularly for the poor and the vulnerable. However, in 2018, the Government of India launched a flagship scheme of Ayushman Bharat (AB-PMJAY) aimed at providing financial risk protection against health shocks to the bottom 40% population of India, with a cover of INR 5 lakh per household annually for secondary and tertiary care hospitalizations. However, the outpatient expenses are not covered under AB-PMJAY which constitutes a majority of OOPE in chronically ill patients suffering from NCDs
Read more at Verma, V.R., Kumar, P. & Dash, U. Assessing the household economic burden of non-communicable diseases in India: evidence from repeated cross-sectional surveys. BMC Public Health 21, 881 (2021). https://doi.org/10.1186/s12889-021-10828-3
