工资损失在疾病经济负担中的重要性：来自印度的纵向证据。

Shrinivas Aditya, Jalota Suhani, Mahajan Aprajit, Miller Grant

Indian Institute of Management, Bangalore, India.

Stanford University, Stanford, USA; Myna Mahila Foundation, Mumbai, India.

Soc Sci Med. 2023 Jan;317:115583. doi: 10.1016/j.socscimed.2022.115583. Epub 2022 Dec 1.

BACKGROUND

A key aim of Universal Health Coverage (UHC) is to protect individuals and households against the financial risk of illness, and large-scale health insurance expansions are a central focus of the UHC agenda. Importantly, however, health insurance does not protect against a key dimension of financial risk associated with illness: forgone wage income. In this paper, we quantify the economic burden of illness in India attributable - separately - to wage loss and to medical care spending, as well as differences in them across the socio-economic distribution.

METHODS

We use data from two longitudinal Indian household surveys: (i) the Village Dynamics in South Asia (VDSA) survey (1300 households surveyed every month for 60 months between 2010 and 2015) and (ii) the Indian Human Development Survey (IHDS) (more than 40,000 households surveyed in 2005 and again in 2011). Our regression models include a series of fixed effects that account for time-invariant household- (or individual-) level and time-varying unobservables common across households.

FINDINGS

We find that, in the VDSA sample, wage loss accounts for more than 80% of the total economic burden of illness among the poorest households, but only about 20% of the economic burden of illness among the most affluent. Estimates from the IHDS sample confirm that this socio-economic gradient is present in the Indian population generally.

CONCLUSIONS

Wage loss accounts for a substantial share of the total economic burden of illness in India - and disproportionately so among the poorest households. Our findings imply that if UHC is to achieve its objective of protecting households against the financial risk of illness - particularly poor households, the inclusion of wage loss insurance or another illness-related income replacement benefit is needed.

背景

全民健康覆盖（UHC）的一个关键目标是保护个人和家庭免受疾病带来的经济风险，大规模的健康保险扩张是UHC议程的核心重点。然而，重要的是，健康保险并不能防范与疾病相关的经济风险的一个关键方面：工资收入损失。在本文中，我们分别量化了印度因病导致的经济负担中归因于工资损失和医疗支出的部分，以及它们在社会经济分布上的差异。

方法

我们使用了两项印度纵向家庭调查的数据：（i）南亚村庄动态（VDSA）调查（2010年至2015年期间，每月对1300户家庭进行调查，共调查60个月）和（ii）印度人类发展调查（IHDS）（2005年对40000多户家庭进行了调查，并于2011年再次进行调查）。我们的回归模型包括一系列固定效应，这些效应考虑了家庭（或个人）层面的时不变因素以及家庭间共同的随时间变化的不可观测因素。