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

• Published in: Tropical medicine & international health 2016-08, Vol.21 (8), p.1019-1028
• Main Authors: Tripathy, J. P., Prasad, B. M., Shewade, H. D., Kumar, A. M. V., Zachariah, R., Chadha, S., Tonsing, J., Harries, A. D.
• Format: Article
• Language: English
• Subjects: blessure; cancer; catastrophic expenditure; cáncer; dépenses catastrophiques; dépenses directes de la poche; enfermedades no transmisibles; gastos catastróficos; gastos de bolsillo; Health care expenditures; Health economics; Hospitalization; injury; lesiones; maladies non transmissibles; non‐communicable diseases; out‐of‐pocket expenditure
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/tmi.12732

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. Objectifs Estimer les dépenses directes de la poche (DDP) liées à l'hospitalisation pour les maladies non transmissibles (MNT) et leur impact sur les ménages en Inde. Méthodes L’étude a analysé les données représentatives à l’échelle nationale recueillies par la National Sample Survey Organization en 2014, qui a rapporté l'utilisation des services de santé et les DDP liées aux soins de santé par quintiles de revenus et par type d’établissement de santé (public ou privé). La période de rappel pour les dépenses d'hospitalisation des patients était de 365 jours. Les dépenses de consommation ont été recueillies pour une période de rappel d'un mois. Les DDP représentant > 10% des dépenses annuelles de consommation ont été qualifiées de catastrophiques. Une analyse pondérée a été réalisée. Résultats Les dépenses médianes par épisode d'hospitalisation pour les MNT étaient de 149 USD, environ