Department of Humanities and Social Sciences, National Institute of Technology, Rourkela, India.
PLoS One. 2021 Dec 10;16(12):e0260628. doi: 10.1371/journal.pone.0260628. eCollection 2021.
Non-communicable diseases (NCDs) are the leading global cause of death and disproportionately concentrate among those living in low-income and middle-income countries. However, its economic impact on households remains less well known in the Indian context. This study aims to assess the economic impact of NCDs in terms of out-of-pocket expenditure (OOPE) and its catastrophic impact on NCDs affected households in India.
Data were collected from the 75th round of the National Sample Survey Office, Government of India, conducted in the year 2017-18. This is the latest round of data available on health, which constitutes a sample of 113,823 households. The collection of data is based on a stratified multi-stage sampling method. Generalised Linear Regression model was employed to identify the socio-economic covariates associated with the catastrophic health expenditure (CHE) on hospitalisation.
The result shows a higher burden of OOPE on NCDs affected households. The mean expenditure by NCDs households in public hospitals is INR 13,170 which is more than twice as compared to the non-NCDs households INR 6,245. Particularly, the proportion of total medical expenditure incurred on medicines (0.39) and diagnostics (0.15) is troublesome for households with NCDs, treated in public hospitals. Moreover, results from the generalised linear regression model confirm the significant relationship between CHE with residence, caste, religion, household size, and economic status of households. The intensity of CHE is more for the households who are poor, drinking unsafe water, using firewood as cooking fuel, and household size of 1-5 members.
Therefore, an urgent need for a prevention strategy should be made by the government to protect households from the economic burden of NCDs. Specifically, to reduce the burden of CHE associated with NCDs, a customised disease-specific health insurance package should be introduced by the government of India in both public and private facilities.
非传染性疾病（NCDs）是全球死亡的主要原因，在中低收入国家的人口中不成比例地集中。然而，其对家庭的经济影响在印度的情况知之甚少。本研究旨在评估 NCDs 在自付支出（OOPE）方面的经济影响及其对印度受 NCDs 影响的家庭的灾难性影响。
数据来自印度政府国家抽样调查办公室的第 75 轮调查，该调查于 2017-18 年进行。这是关于健康的最新一轮数据，构成了一个包含 113823 户家庭的样本。数据收集采用分层多阶段抽样方法。采用广义线性回归模型确定与住院治疗灾难性卫生支出（CHE）相关的社会经济协变量。
结果显示，NCDs 患者家庭的 OOPE 负担更高。NCDs 家庭在公立医院的平均支出为 13170 卢比，是 NCDs 家庭的两倍多，而非 NCDs 家庭为 6245 卢比。特别是，在公立医院接受治疗的 NCDs 家庭在药品（0.39）和诊断（0.15）方面的总医疗支出比例令人担忧。此外，广义线性回归模型的结果证实了 CHE 与家庭住址、种姓、宗教、家庭规模和经济状况之间的显著关系。对于贫困、饮用不安全水、使用木柴作为烹饪燃料以及家庭规模为 1-5 人的家庭，CHE 的强度更高。
因此，政府迫切需要制定一项预防策略，以保护家庭免受 NCDs 的经济负担。具体来说，为了减轻与 NCDs 相关的 CHE 负担，印度政府应在公共和私人设施中引入定制的特定疾病健康保险计划。
