The Economic impact of Non-communicable Diseases on households in India

Abstract

Background: In India, Non Communicable Diseases (NCDs) and injuries account for an estimated 62% of the total age-standardized burden of forgone Disability Adjusted Life Years (DALYs). Public and private financing of clinical services to reduce the NCD burden is a major challenge.

Methods: We used National Sample Survey Organization (NSSO) survey data from 1995-96 and 2004 covering nearly 200 thousand households to assess healthcare utilization patterns and out of pocket health spending by disease category. For this purpose, self-reported diseases and conditions were categorized into NCDs and non-NCDs. Survey data were used to assess how households financed their overall health expenditures and related this pattern to specific health conditions. We measured catastrophic spending on NCD-related hospitalization, defined as occurring when health expenditures exceeded 40% of a household's ability to pay, that is, household consumption spending less combined survival consumption expenditure; and impoverishment when per capita expenditure within the household decreased to below the poverty line once health spending was netted out.

Results: The share of NCDs in out of pocket health expenses incurred by households increased over time, from 31.6 percent in 1995-96 to 47.3 percent in 2004. In both years, own savings and income were the most important source of financing for many health conditions, typically between 40-60 percent of all spending, whereas 30-35 percent was from borrowing. The odds of catastrophic hospitalization expenditures for cancer was nearly 170% greater and for CVD and injuries 22 percent greater than the odds due to communicable diseases. Impoverishment patterns were similar.

Conclusions: Out of pocket expenses for treating NCDs rose sharply over the period from 1995-96 to 2004. When NCDs are present, the financial risks to which Indians households are exposed are significant.

Figure 1

Classification of 2004 Household Survey response categories from National Sample Survey Data into disease categories.

Figure 2

Out of pocket expenses per hospital stay in public and private systems among those with major NCDs in India, 1995-96 and 2004.

Figure 3

Out of pocket expenses per outpatient visit in public and private systems among those with major NCDs in India, 1995-96 and 2004.

Figure 4

Source of funds for out of pocket spending on health care for hospital stays in India, 1995-96 and 2004.

Figure 5

Share of per capita household income spent on out of pocket expenses for healthcare by expenditure quintiles in urban and rural area in India, 2004.