Background Rising non-communicable diseases (NCDs) coupled with increasing injuries have resulted in a significant increase in health spending in India. While out-of-pocket expenditure remains the major source of health care financing in India (two-thirds of the total health spending), the financial burden varies enormously across diseases and by the economic well-being of the households. Though prior studies have examined the variation in disease pattern, little is known about the financial risk to the families by type of diseases in India. In this context, the present study examines disease-specific out-of-pocket expenditure (OOPE), catastrophic health expenditure (CHE) and distress health financing. Methods and materials Unit data from the 71st round of the National Sample Survey Organization (2014) was used for this study. OOPE is defined as health spending on hospitalization net of reimbursement, and CHE is defined as household health spending exceeding 10% of household consumption expenditure. Distress health financing is defined as a situation when a household has to borrow money or sell their property/assets or when it gets contributions from friends/relatives to meet its health care expenses. OOPE was estimated for 16 selected diseases and across three broad categories- communicable diseases, NCDs and injuries. Multivariate logistic regression was used to understand the determinants of distress financing and CHE. Results Mean OOPE on hospitalization was INR 19,210 and was the highest for cancer (INR 57,232) followed by heart diseases (INR 40,947). About 28% of the households incurred CHE and faced distress financing. Among all the diseases, cancer caused the highest CHE (79%) and distress financing (43%). More than one-third of the inpatients reported distressed financing for heart diseases, neurological disorders, genito urinary problems, musculoskeletal diseases, gastro-intestinal problems and injuries. The likelihood of incurring distress financing was 3.2 times higher for those hospitalized for cancer (OR 3.23; 95% CI: 2.62-3.99) and 2.6 times for tuberculosis patients (OR 2.61; 95% CI: 2.06-3.31). A large proportion of households who had reported distress financing also incurred CHE. Recommendations Free treatment for cancer and heart diseases is recommended for the vulnerable sections of the society. Risk-pooling and social security mechanisms based on contributions from both households as well as the central and state governments can reduce the financial burden of diseases and avert households from distress health financing.

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Disease-specific out-of-pocket and catastrophic health expenditure on hospitalization in India: Do Indian households face distress health financing?

The prevalence and economic burden of chronic diseases are increasing worldwide. Nevertheless, little information is available on catastrophic health expenditures (CHE) associated with chronic diseases in Korea. This study explored the burden of household out-of-pocket health expenditures among the Korean population for different chronic diseases. This study was conducted utilizing data collected from the 7,006 households that participated in the Korea Health Panel Survey (KHPS) in 2008. The effect of CHE in relation to type of chronic disease was assessed via multiple logistic regression analysis. Roughly 3.5% of the participating households experienced CHE. As opposed to households headed by females and middle-aged individuals (40–59 years), those of low economic status, elderly households, and households with a member who suffered from a chronic disease were more likely to experience CHE. According to type of chronic condition, households with a member who suffered from cerebrovascular disease, diabetes, or chronic kidney disease were at a significantly higher risk of experiencing CHE. Although Korea has greatly expanded its health insurance coverage, financial protection against CHE remains a concern. Policy-makers need to focus on expanding benefits according to the economic burden of individual chronic conditions.

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Association between chronic disease and catastrophic health expenditure in Korea

The World Health Organization estimates that annually 150 million people experience severe (catastrophic) financial difficulties as a result of healthcare payments. Therefore, a systematic review was carried out to identify the determinants of household catastrophic health expenditure (CHE) in low-to high-income countries around the world. Both electronic and manual searches were conducted. The main outcome of interest was the determinants of CHE due to healthcare payments. Thirty eight studies met the inclusion criteria for review. The analysis revealed that household economic status, incidence of hospitalisation, presence of an elderly or disabled household member in the family, and presence of a family member with a chronic illness were the common significant factors associated with household CHE. The crucial finding of the current study is that socioeconomic inequality plays an important role in the incidence of CHE all over the world, where low-income households are at high risk of financial hardship from healthcare payments. This suggests that healthcare financing policies should be revised in order to narrow the gap in socioeconomic inequality and social safety nets should be implemented and strengthened for people who have a high need for health care.

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Determinants of Household Catastrophic Health Expenditure: A Systematic Review.

This study aimed to estimate the cost of colorectal cancer (CRC) management and to explore the prevalence and determinants of catastrophic health expenditure (CHE) among CRC patients and their families arising from the costs of CRC management. Data were collected prospectively from 138 CRC patients. Patients were interviewed by using a structured questionnaire at the time of the diagnosis, then at 6 months and 12 months following diagnosis. Simple descriptive methods and multivariate binary logistic regression were used in the analysis. The mean cost of managing CRC was RM8306.9 (US$2595.9), and 47.8% of patients' families experienced CHE. The main determinants of CHE were the economic status of the family and the likelihood of the patient undergoing surgery. The results of this study strongly suggest that stakeholders and policy makers should provide individuals with financial protection against the consequences of cancer, a costly illness that often requires prolonged treatment.

Catastrophic Health Expenditure Among Colorectal Cancer Patients and Families: A Case of Malaysia.

Non communicable diseases (NCD) are a rising problem worldwide and is a cause of public health concern in India too. These diseases result in high health care demand and are expensive especially in low resource settings. We studied the NCD burden estimates for India and its major states and the associated cost in 2017. The disease burden was estimated using DALYs (Disability Adjusted life years), the Years of Life lost (YLL) and Years lived in disability (YLD). Health expenditure data from National Sample Survey was used to calculate out of pocket expenditure (OOPE) and catastrophic health expenditure (CHE). NCDs account for 16939 DALYs per 100 000 in India. About 50–70% of patients took treatment in private facilities. There is huge variation in the utilization of health facilities, disease burden and cost of treatment across the states. Karnataka had highest DALY rate of 25790 DALYs per 100 000 but Chandigarh showed highest mean OOPE of INR 63952 and Arunachal Pradesh showed the highest CHE of 47.7 percent. The economic burden of NCDs is notably high both in terms of OOPE and CHE and indicate variation across states in both disease burden and economic burden. The findings highlight the need for improvement of NCD management programmes in socioeconomically lower states of India. 

Burden of non-communicable diseases and its associated economic costs in India

. This study explored the burden of household out-of-pocket health expenditure on urban inhabitants with different socio-economic status and health insurance schemes in Nakhon Sawan Municipality. This study employed a cross sectional survey by using a structured questionnaire. Health personnel from six primary care units interviewed a representative of the sampled households. Sampled households were selected by a two-stage random sampling technique. Descriptive statistics were used to describe general household characteristics, and Mantel-Haenszel odds ratio was used to explain the relationships between factors and catastrophic health expenditure. From 406 sampled households, there were 1,421 household members and 340 individuals who reported illness within the last month. The poor and non-poor groups reported hypertension, diabetes, and the common cold as the most common ailments. Most patients sought care at a regional hospital and then primary care units, drug stores, and private hospitals, respectively. Household out-of-pocket medical costs were most frequently paid to drug stores and to private clinics. The direct non-medical costs were mostly paid for transportation and food. Factors related to catastrohpic health expenditure were the Civil Servant Medical Benefit Scheme (CSMBS) cardholder, use of public hospital, private hospital, and clinic. Furthermore, catastrophic expenditures were related to non-medical costs and time loss for indirect cost. Catastrophic rates of the poor were 12.5 and 30.4% from direct and non-medical cost, respectively. The rates for the non-poor were lower.

Catastrophic health expenditure in an urban city: seven years after universal coverage policy in Thailand.

Background: The scoping review of published studies aims to explore what practices and processes can improve equity (horizontal and vertical) in countries that adopted Area Health Management (AHM) utilizing the “Six Building Blocks Plus” (SBBP) concept. 

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How area health management leads to improved equity in health: a scoping review

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Catastrophic health expenditure in an urban city: seven years after universal coverage policy in Thailand.

How area health management leads to improved equity in health: a scoping review