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Background & objectives: The Government of India has initiated a population based screening (PBS) for noncommunicable diseases (NCDs). A health technology assessment agency in India commissioned a study to assess the cost-effectiveness of screening diabetes and hypertension. The present study was undertaken to estimate the cost of PBS for Type II diabetes and hypertension. Second, out-of-pocket expenditure (OOPE) for outpatient care and health-related quality of life (HRQoL) among diabetes and hypertension patients were estimated. Methods: Economic cost of PBS of diabetes and hypertension was assessed using micro-costing methodology from a health system perspective in two States. A total of 165 outpatients with diabetes, 300 with hypertension and 497 with both were recruited to collect data on OOPE and HRQoL. Results: On coverage of 50 per cent, the PBS of diabetes and hypertension incurred a cost of ? 45.2 per person screened. The mean OOPE on outpatient consultation for a patient with diabetes, hypertension and both diabetes and hypertension was ? 4381 (95% confidence interval [CI]: 3786-4976), ? 1427 (95% CI: 1278-1576) and ? 3932 (95% CI: 3614-4250), respectively. Catastrophic health expenditure was incurred by 20, 1.3 and 14.8 per cent of patients with diabetes, hypertension and both diabetes and hypertension, respectively. The mean HRQoL score of patients with diabetes, hypertension and both was 0.76 (95% CI: 0.72-0.8), 0.89 (95% CI: 0.87-0.91) and 0.68 (95% CI: 0.66-0.7), respectively. Interpretations & conclusions: The findings of our study are useful for assessing cost-effectiveness of screening strategies for diabetes and hypertension.
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Background: The expenses that the patient or the family pays directly to the health care provider, without a third-party (insurer or State) is known as 'Out of Pocket Expenditure' (OOPE). These expenses could be medi-cal and non-medical. About 150 million people face financial catastrophe every year due to health care pay-ments and cancer is one of the leading causes of high OOPE. Objectives: This study was conducted to estimate the OOPE among cancer patients and to determine the OOPE in relation to type of cancer and treatment modality.Methodology: A cross sectional study was conducted at a tertiary care centre in Hyderabad during August and September,2022 with a total study population of 400 cancer patients. After consenting the participants, data was collected via face-to-face interview using a semi structured questionnaire. Results: The mean OOPE per patient was found to be $1032.65 (₹84,643.20). This includes the medical and non-medical costs. Leukaemia was found to have the highest OOPE amongst all cancers followed by colon cancer. Similarly, radiotherapy + surgery was found to have the highest OOPE followed by chemotherapy + radiotherapy + surgery.Conclusion And Interpretation- This study is unique in its way that no other study has considered OOPE for different cancers in single research. We would like to highlight the quantification of OOPE among various types of cancers and its variation based on treatment modality used. It is necessary that future government in-itiatives consider the importance of mitigating the OOPE along with provision of cancer care.
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Background: Tuberculosis (TB) patients suffer enormously due to huge cost on diagnosis and treatment. This study aims to assess the total expenditure and its predictors among patients of TB. Methodology: A longitudinal study was conducted among TB Patients registered in first quarter of 2018 at District Tuberculosis Center, Jammu. Data was collected by interviewing the patients and their attendants. Statistical significance of median expenditure between patients of pulmonary and extrapulmonary TB in rela-tion to various predictors was assessed using nonparametric tests followed by Multiple Linear Regression. Results: Total median cost, median direct and indirect cost incurred by a TB patient were recorded as USD 489.55, USD 246.55 and USD 229.5 respectively. Treatment costs were slightly higher in patients of pulmo-nary TB in comparison to extrapulmonary TB (p>0.05). On bivariate analysis, upper class, previously treated patients, Category 2 patients, with chronic illnesses, with guardians and who were employed expended signif-icantly higher amounts on their treatment, but on multivariate analysis, only formal employment, current earning and being reimbursed significantly predicted the total cost (p < .001, adjusted R square = 0.56). Conclusion: Huge direct costs incurred by patients is a matter of great concern, more so as the Indian gov-ernment has made all diagnostics and treatment free since the inception of the RNTCP.
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Introduction: Catastrophic health spending is one of the major factors pushing people into poverty. Reducing “out-of-pocket expenditure (OOPE)” on health through health insurance coverage is an effective approach. The objectives of this study are (1) to estimate health insurance coverage among rural and urban households (HHs) and (2) to determine the proportion of income spent on health as OOPE among the selected HHs. Material and Methods: A cross-sectional study was conducted in rural and urban parts of district Faridabad, Haryana. A sample of 374 were taken from rural and urban areas. The unit of the study was HHs in both the areas. The proportion of income spent on health care (both direct and indirect expenses included) as OOPE was taken as outcome variable. Results: Health insurance coverage was higher among urban HHs (58.0%) as compared to the rural (38.5%). The rural population was availing of private consultation, laboratory, and pharmacy services to a greater extent than the urban; hence, they were spending a substantial proportion of their income on health-care services. The majority of the HHs in the rural and urban areas spent up to 20% of their income on health care. Conclusion: Universal health coverage without health insurance is unlikely.
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Introduction : Rashtriya Bal Swasthya Karyakram (RBSK) is a systemic approach of 4‘D’s (Defect, Diseases, Deficiency, Developmental delay) for early identification and linkage with care, support and treatment. (1) Document utilization of RBSK services within a year of referral, (2) Assess reasonsObjectives : for non-utilization of services and (3) Assess out of pocket expenditure (OOPE) among users and non-users of the program. Retrospective Cohort Study was conducted at an Urban Health Centre (UHC) takingMethod: two cohorts of children referred for 4‘D’s during April 2018-March 2020 under RBSK. A total of 102 cases were sampled. Probability Proportionate to size (PPS) method was used to ensure proportionate representation of each of 4‘D’s in the sample. Required number of participants in each category were selected randomly. Out of 102 sampled cases, 97 were covered. Utilization of services was 50.5%; majorResults: reasons for non-utilization were preference for private providers and reluctance to stay at Comprehensive Malnutrition Treatment Centre (CMTC). Mean OOPE in users was Rs. 21545, significantly less (p <.05) than Rs. 70198 in non-users. After referral by RBSK team, only half utilized the services. Among users,Conclusion: OOPE was less for total cost incurred and also for direct cost incurred like consultation charges, medicines, consumables etc. Counselling those parents whose children are detected with any of 4Ds, to visit Child Malnutrition Treatment Center (CMTC)/ District Early Intervention Center (DEIC) remains a challenge.
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Background: Healthcare for mothers and children is a significant indicator of a country's well-being. In-dia is one of the nations that were experiencing a rather slow improvement in maternal and child health. Aims: The objective of this study is to analyse the changes in health infrastructure, government health expenditure, antenatal care, postnatal care, institutional delivery, Maternal Mortality Ratio (MMR) and the determinants of MMR in India. Methodology: The study is based on secondary data. It employs an Average Increasing Rate (AIR) and Average Reduction Rate (ARR), as well as a panel data random effect model. Results: Empirical results say MMR has a statistically significant inverse relationship with female litera-cy, Per capita Net State Domestic Product (PNSDP), and institutional delivery. The study concludes that after the introduction of NRHM and its constituent elements like JSY and JSSK, government expenditure on health, health infrastructure, the percentage of antenatal care, post-natal care, and institutional deliv-ery increased in most of the Indian states, thus helping to increase the pace of the reduction of MMR. However, state performance varies greatly. Conclusions: Policy alone will not provide the desired results; it is also critical to focus on education, particularly female literacy, and economic empowerment.
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Cancer is one of the leading causes of premature death and disability worldwide. With the progress of the health-care system, the cost of cancer treatment is also rising. Poor households suffer disproportionately from the financial burden of cancer treatment, which has pushed many households into poverty. Thus, cancer poses an economic burden for individuals, families, societies, and governments because of the prolonged medical costs, out-of-pocket expenditures, loss of productivity, and premature deaths. Moreover, the psychological breakdown phenomenon and social implications of cancer play a vital role in dealing with cancer patients. The psychological effect of battling with cancer falls not only on the patient but also on the caregivers and family members. With these backgrounds, an attempt is made in this review paper to highlight the implications of cancer on financial and psychological aspects.
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Background: The price of medicine in India has always been a point of discussion in public domain. The price range of the same drug is very large with more than 100% difference between various brands available in different settings. Aims and Objectives: To assess the price of different drugs at Jan Aushasdhi (JA), AMRIT and Private Chemist and to compare the prices of these three outlets so that the issues. Material and Methods: This institution-based cross-sectional study was carried out from May 2019 to June 2019. A pretested proforma was prepared to compare the prices of 284 different medicines in Jan Aushadhi, AMRIT and private chemist shops. The collected data were entered in an Excel spreadsheet and presented in Proportions, percentages, and mean. Results: The price of 284 medicines were compared from JA (Median(IQR)- 15.18(18.75) INR) and Private chemist shop (Median(IQR)-88(111.5) INR) while 249 medicine from AMRIT (Median(IQR)-61.05(78.33) INR). Although the majority of the AMRIT drugs are cheaper than the chemist shop except for 31% of Antipsychotic drugs, 26.6% of antihypertensives, 25% of respiratory drugs, 25% of steroids, 21.9% of antibiotics. Conclusion: We concluded that JA is providing drugs cheaper than AMRIT and Private chemist . The prices of medicines offered at AMRIT are lower than market pricing but they are costlier when compared to JA prices.
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Background: Health insurance is also called as medical insurance offering coverage that pays for unexpected medical and surgical expenses to the policyholder. A health insurance plan is one of the most secured and safest way to provide financial coverage to the insured family. Objective of this study was to assess utilization, satisfaction, out of pocket expenses and to determine the health seeking behaviour of the insured residents of the rural field practice area of SSIMS and RC, Davanagere.Methods: The study was done in the rural field practice area of the medical college, Davangere from January 2016 to December 2016. A sample of 600 families were studied by systematic random sampling and data was collected from the head of the family using structured questionnaire by house to house interview. Statistical analysis was carried out by SPSS v10, percentages, proportions and Chi-square tests were applied to find the association among the variables.Results: The utilization of health insurance in the present study was 50.2% and satisfaction regarding the health insurance schemes was 93.4%.Conclusions: The study reveals that the out of pocket expenses is high among the uninsured families compared to the insured families. The Insurance policies should be revived to do favour the patients so that more families will be encouraged to enrol and utilize so that the out of pocket expenses will be reduced.
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Background: Neonatal health remains a thrust area of public health, and an increased out-of-pocket expenditure (OOPE) may hamper efforts toward universal health coverage. Public spending on health remains low and insurance schemes few, thereby forcing impoverishment upon individuals already close to poverty line. Objective: To determine catastrophic health expenditure (CHE) in neonates admitted to the government neonatal intensive care unit (NICU) and factors associated with of out-of-pocket expenditure. Methods: This cross-sectional study was conducted in a governmental NICU at Agra from May 2017 to April 2018. A sample of 450 neonatal admissions was studied. Respondents were interviewed for required data. OOPE included costs at NICU, intervening health facilities, and transport as well. SPSS version (23.0 Trial) and Epi Info were used for analysis. Results: Of the 450 neonates analyzed, the median total OOPE was Rs. 3000. CHE was found among 55.8% of cases with 22% spending more than their household monthly income. On binary logistic regression, a higher total OOPE of Rs. 3000 or more was found to be significantly associated with higher odds of residing outside Agra (adjusted odds ratio [AOR] = 1.829), delay in first cry (AOR = 1.623), referral points ?3 (AOR = 3.449), private sector as first referral (AOR = 2.476), and when treatment was accorded during transport (AOR = 1.972). Conclusions: OOPE on neonates amounts to a substantial figure and is more than the country average. This needs to be addressed sufficiently and comprehensively through government schemes, private enterprises, and public杙rivate partnerships.
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Background: India ranks among the bottom five countries in public health spending. Out of pocket spending of households on healthcare is almost 70% of income and reimbursement in any form availed by households whose members are employed in the formal sector is negligible. Objectives: To determine the usual source of medical care opted for by the study population. To find out the illness pattern and its age/sex distribution in the study population. To find out the expenditure incurred on illness and its source of procurement by the study population. Methodology: 52.42% urban Aligarh resides in slums. A cross sectional study was done to study the newer slum pockets. 3409 households with a population of 16,978 were studied with the help of pretested questionnaire; SPSS 20 was used for statistical analysis. Results: In our study, we found that almost all the households suffered from catastrophic health expenditure. The study population, which was already vulnerable owing to their low socio-economic and migrant status was further forced into poverty and indebtedness on account of expenditure on illness. Conclusions: National health financing systems should be designed to protect households from financial catastrophe, by reducing out-of-pocket spending.
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Background: Health is one of the most important components of an effective poverty reduction strategy. However, use of health services is sometimes associated with out-of-pocket (OOP) payments. Urology disorders are often chronic and affect individuals not by shortening survival, but by impairing quality of life hence posing a substantial economic impact for patients. A well-planned health finance systems protects population against the financial risks of ill-health. This study addressed concerns over high levels of out-of-pocket payments even by those who have insurance coverage.Methods: Descriptive study was conducted among 160 patients admitted in Urology Department who are covered under various health schemes for the duration of 6 months.Results: Of the 160 study participants studied, 129 (80.62%) were males, 37 (23.13%), 64 (40%) were illiterates and most of the families 127 (79.38%) were from rural area. Various health schemes availed were, 120 (75%) Arogya Karnataka, 8 (11.25%) RBSY Kerala and 6 (3.75%) Sampoorna Suraksha. Expenses other than medical included home care assistance, adaptations to home and cost of parallel treatment. The main source for out of pocket expenditure was borrowing money from relatives or friends 70 (43.8%), self-finance 46 (28.7%) and selling valuables 28 (17.5%). Prevalence of catastrophic health expenditure in our study was 8.75%.Conclusions: The government should increase the public health spending to reduce the out of pocket expenditure by the families and the public must be educated about the availability of insurance scheme and their efficient/optimum utilization.
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Introduction: Rabies is an infectious viral disease that isalmost always fatal. It is present on all continents, exceptAntarctica, with over 95% of human deaths occurring in theAsia and Africa regions. Treating a rabies exposure, wherethe average cost of rabies post-exposure prophylaxis (PEP) isUS$ 40 in Africa, and US$ 49 in Asia, can be a catastrophicfinancial burden on affected families whose average dailyincome is around US$ 1–2 per person. Study was conductedwith the objectives to analyse the direct and indirect out ofpocket expenditure of the post exposure prophylaxis ofanimal bites in spite of free supply of anti-rabies vaccine andimmunoglobulin.Material and methods: A cross sectional observational studywas carried out at Anti Rabies Clinic, SMS Hospital Jaipur,Rajasthan from October 2018 to March 2019 to know out ofpocket expenditure of animal bite patients and its determinants.Prior approval from institutional ethics committee andinformed consent were taken and a pre-designed, pre-testedproforma was filled from the persons attending anti rabiesclinic on last visit of post-exposure prophylaxis (PEP). Apartfrom socio-demographic details, information about director indirect out of pocket expenditure due to animal bite wasrecorded and analysis was done using chi square test, ANOVAtest, ‘t’-test and univariate and multivariate regression.Results: Total out of pocket expenditure by 81 studied patientswas Rs. 53201.00, out of which 91.69% i.e. Rs. 48780.00 wereindirect expenses and 5.04% i.e. Rs. 2681.00 was expenditureon medical and surgical management including registrationand consumables. Only 3.27% i.e. Rs. 1740.00 was on postexposure anti-rabies prophylaxis of 81 patients. Mean out ofpocket expenditure was Rs. 656.80±1387.76 ranging from Rs.0.00 to Rs. 8550.00 per patient with median of Rs. 290.00.Conclusion: Despite free supply of anti-rabies vaccine andanti-rabies serum under Mukhyamantri Nishulk Dava Yojna(MNDY) the indirect out of pocket expenditure in animal bitetreatment is still high, which should draw attention for policymakers.
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Noncommunicable diseases (NCDs) have become a major public health problem in India accounting for 62% of the total burden of foregone DALYs and 53% of total deaths. Out-of-pocket expenditure associated with the acute and long-term effects of NCDs is high resulting in catastrophic health expenditure for the households. A large national survey in India found that spending on NCDs accounted for 5.17% of household expenditure. According to a macroeconomic analysis, it is estimated that each 10% increase in NCDs is associated with a 0.5% lower rate of annual economic growth. The income loss due to hypertension is the highest, followed by diabetes and cardiovascular diseases. The macroeconomic impact of NCDs is profound as they cause loss of productivity and decrease in gross domestic product. Since the health sector alone cannot deal with the “chronic emergency” of NCDs, a multisectoral action addressing the social determinants and strengthening of health systems for universal coverage to population and individual services is required.
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With the upcoming technical interventions in the health sector of India, India has been able to create a great scope for Medical Tourism in the country. People from different nations are coming to India to avail many critical treatments at an affordable price. Even after such great development, Health Equity has always been a great challenge for our country. Through Health Equity, we mean availing the standard health services by the under-privileged, marginalized group of people compared to the privileged segment of the community. The present study will help us to highlight on the prioritization of the allocation of the resources to the most eminent tier of the Health care structure. Also, this study will focus on the effectiveness of this component of the Health care structure of India and how this can help in throwing light on the disparity of the health care services through a proposed model.
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BACKGROUND: The main aim of this study was to evaluate the achievements of some important goals of Iran's urban family physician plan. This plan was implemented when the country experienced economic instability. We examine whether an economic crisis affects the efficacy of a healthcare program. METHODS: We used the household income and expenditures survey data for 2011 (before program implementation) and 2012 (after program implementation). Changes in out-of-pocket payments and healthcare utilization were investigated using the propensity score matching estimator. Furthermore, changes in inequality in these two dimensions were examined. RESULTS: No changes in out-of-pocket payments and healthcare utilization were found after the implementation of this program; however, inequality in out-of-pocket payments increased during the reform. CONCLUSION: The urban family physician program was not implemented completely and many of its fundamental settings were not conducted because of lack of necessary healthcare infrastructure and budget limitations. Family physician programs should be implemented under a strong healthcare infrastructure and favorable economic conditions.
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Humans , Budgets , Delivery of Health Care , Family Characteristics , Health Expenditures , Iran , Physicians, Family , Propensity Score , Socioeconomic FactorsABSTRACT
Objective:To compare and analyze the changes and the influencing factors of out of pocket(OOP) expenditure before and after the new medical reform.Methods:2000-2015 time series data was used to compare the changes of OOP in different years.The cross-section data was applied to compare the OOP of China and other countries.The principle component analysis method was used to research the contribution rates of different factors for the OOP ratio changes.Result:According to the vertical comparison,it found that the OPP ratio showed steady decreasing trend.The horizontal comparison found that there were great gap for OOP ratios of China and other countries.The per capita GDP,under five mortality and proportion over 65 years were significant factors for OOP.Conclusion:The OOP ratio still needed to be devreased,which needed to promote the economic growth,implement medical insurance system,improve the public health input and decrease the health economic burden for residents.
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Background: Hypertension is a chronic non-communicable disease that effects adversely on heart, brain and kidney. Nearly 2/3rd of all hypertensive patients live in low and middle income countries, so the economic burden of hypertension is huge. India is one of those countries which spent more than 1/3rd of all income on CVD and hypertension. This study was conceptualized to study the disease and economic burden of hypertension. Methods: A cross-sectional study was conducted in New Collector Compound (NCC) of Malwani. Five plots of NCC were selected by simple random sampling. A list of hypertensive patients was prepared by house-to-house survey. Fifty per cent patients were selected randomly for studying economic burden. Results: The study covered 447 households and 2360 persons. Eighty participants (3.4%) were found hypertensive. The average annual total cost of hypertension and related disorders was Rs. 7154. It was Rs. 6073 and Rs. 8235 for government and private respectively. Only 7.50% households were not incurring any cost of illness. The average annual out of pocket expenditure (OOPE) was Rs. 4042 and Rs. 7621 for government and private facilities respectively. Fifteen per cent households were incurring catastrophic expenditure at highest threshold of 40%. The catastrophic spending led to impoverishment of 34.2% households. Conclusions: High prevalence of hypertension, high OOPE, high incidence of catastrophic spending and impoverishment among households intensively reflect the need of interventions. Early preventive measures may be a key in controlling economic and disease burden. There is need to provide the financial risk protection against the OOPE for outpatient care.
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Background: Nepal is an underdeveloped country in which half of the total health expenditure is from out-of-pocket payments. Thus, the Government of Nepal introduced universal free health-care services up to the level of district hospitals, and targeted these services to poor and marginalized people in regional and subregional hospitals. The aim of this descriptive study was to explore the implementation and utilization of free health-care services by the target population (poor and marginalized people) in two tertiary-care hospitals in western Nepal, one with a social care unit (Western Regional Hospital) and one without a social care unit (Lumbini Zonal Hospital). Methods: Medical records maintained by the two hospitals for one Nepali calendar year were collected and analysed, along with information from key informant interviews with staff from each hospital and patient exit interviews. Results: Utilization of free health-care services by poor and marginalized people in the two tertiary-care hospitals was suboptimal: only 8.4% of patients using services were exempted from payment in Western Regional Hospital, whereas it was even fewer, at 2.7%, in Lumbini Zonal Hospital. There was also unintended use of services by nontarget people. Qualitative analysis indicated a lack of awareness of free health-care services among clients, and lack of awareness regarding target groups among staff at the hospitals. Importantly, many services were utilized by people from rural areas adjoining the district in which the hospital was situated. Conclusion: Utilization of free health-care services by the target population in the two tertiary-care hospitals was very low. This was the result of poor dissemination of information about the free health-care programme by the hospitals to the target population, and also a lack of knowledge regarding free services and target groups among staff working in these hospitals. Thus, it is imperative to implement educational programmes for hospital staff and for poor and marginalized people. Unintended use of free services was also seen by nontarget groups; this suggests that there should further simplification of the process to identify target groups.
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Inappropriate access of essential medicines contributes substantially to out-of-budget expense. Out-of-pocket expenditure makes a vital (up to 70%) health expenditure in India. This research study was conducted to investigate the comparative relative price to patient of selected essential medicines used for common ailments in Sonipat city. A research study on a price-to-be-paid to patient of selected essential medicines for selected common ailments was conducted. Standardized methodology of World Health Organization and Health Action International was employed. Prices were compared to an International Reference Price (Median Price Ratio). The study was conducted on all the two hundred retail pharmacy outlets attached to all residential areas of Sonipat city. The difference between lowest price and highest price (of available medicine) ranged from 0.30 – 40% in case of antimicrobials and 0.17 – 3.4% in case of antiulcers, antiemetics and analgesics. Dissemination of well documented information on affordability to medicine consumers may enhance consumer demand for lower price medicine and thus may serve to enhance the availability of demanded medicine in all the areas of Sonipat city.