Skip to main content

Advertisement

SpringerLink
Log in

Impacts of chronic non-communicable diseases on households’ out-of-pocket healthcare expenditures in Sri Lanka

  • Research Article
  • Published:
International Journal of Health Economics and Management Aims and scope Submit manuscript

Abstract

This article examines the effects of chronic non-communicable diseases (NCDs) on households’ out-of-pocket health expenditures in Sri Lanka. We explore the disease specific impacts on out-of-pocket health care expenses from chronic NCDs such as heart diseases, hypertension, cancer, diabetics and asthma. We use nationwide cross-sectional household income and expenditure survey 2012/2013 data compiled by the department of census and statistics of Sri Lanka. Employing propensity score matching method to account for selectivity bias, we find that chronic NCD affected households appear to spend significantly higher out-of-pocket health care expenditures and encounter grater economic burden than matched control group despite having universal public health care policy in Sri Lanka. The results also suggest that out-of-pocket expenses on medicines and other pharmaceutical products as well as expenses on medical laboratory tests and other ancillary services are particularly higher for households with chronic NCD patients. The findings underline the importance of protecting households against the financial burden due to NCDs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Source: Authors estimations using HIES 2012/2013 data

Fig. 2

Source: Authors estimations using HIES 2012/2013 data

Similar content being viewed by others

References

  • Alam, K., & Mahal, A. (2014). The economic burden of Angina on households in South Asia. BMC Public Health, 14(1), 1.

    Article  Google Scholar 

  • Amarasinghe, S., De Alwis, S., Saleem, S., Ranna-Eliya, R., & Dalpatadu, S. (2015). IHP technical reports series, number 2: Private health sector review 2012. Colombo: Institute for Health Policy.

    Google Scholar 

  • Amarasinghe, S. N., Thowfeek, F. R., Anuranga, C., Dalpatadu, K. C. S., & Rannan-Eliya, R. P. (2015). Sri Lanka Health Accounts: National Health Expenditure 1990–2014. Health Expenditure Series No. 4. Colombo: Institute for Health Policy.

    Google Scholar 

  • Austin, P. C. (2009a). Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Statistics in Medicine, 28(25), 3083–3107.

    Article  PubMed  PubMed Central  Google Scholar 

  • Austin, P. C. (2009b). Type I error rates, coverage of confidence intervals, and variance estimation in propensity-score matched analyses. The International Journal of Biostatistics, 5(1), 13.

    Article  PubMed Central  Google Scholar 

  • Austin, P. C. (2011). An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behavioral Research, 46(3), 399–424.

    Article  PubMed  PubMed Central  Google Scholar 

  • Austin, P. C., & Mamdani, M. M. (2006). A comparison of propensity score methods: A case-study estimating the effectiveness of post-AMI statin use. Statistics in Medicine, 25, 2084–2106.

    Article  PubMed  Google Scholar 

  • Bahadori, K., Doyle-Waters, M. M., Marra, C., Lynd, L., Alasaly, K., Swiston, J., et al. (2009). Economic burden of asthma: A systematic review. BMC Pulmonary Medicine, 9(1), 1.

    Article  Google Scholar 

  • Bhojani, U., Thriveni, B. S., Devadasan, R., Munegowda, C. M., Devadasan, N., Kolsteren, P., et al. (2012). Out-of-pocket healthcare payments on chronic conditions impoverish urban poor in Bangalore, India. BMC Public Health, 12(1), 1.

    Article  Google Scholar 

  • Caliendo, M., & Kopeinig, S. (2008). Some practical guidance for the implementation of propensity score matching. Journal of Economic Surveys, 22(1), 31–72.

    Article  Google Scholar 

  • Department of Census and Statistics of Sri Lanka (DCS). (2015).Household Income and Expenditure Survey, 2012/2013 Final Report. Colombo: Department of Census and Statistics of Sri Lanka.

  • Engelgau, M., Rosenhouse, S., El-Saharty, S., & Mahal, A. (2011). The economic effect of non-communicable diseases on households and nations: A review of existing evidence. Journal of Communication in Healthcare, 16(Suppl. 2), 75–81.

    Article  Google Scholar 

  • Garg, C. C., & Karan, A. K. (2009). Reducing out-of-pocket expenditures to reduce poverty: A disaggregated analysis at rural-urban and state level in India. Health Policy and Planning, 24(2), 116–128.

    Article  PubMed  Google Scholar 

  • Garrido, M. M., Kelley, A. S., Paris, J., Roza, K., Meier, D. E., Morrison, R. S., et al. (2014). Methods for constructing and assessing propensity scores. Health Services Research, 49(5), 1701–1720.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gertler, P. J., Martinez, S., Premand, P., Rawlings, L. B., & Vermeersch, C. M. (2010). Impact evaluation in practice. Washington DC: World Bank Publications.

    Book  Google Scholar 

  • Govindaraj, R., Navaratne, K., Cavagnero, E., & Seshadri, S. R. (2014). Healthcare in Sri Lanka: What can the private health sector offer? Health, Nutrition and Population (HNP) Discussion Paper. Washington DC: World Bank Group.

    Google Scholar 

  • Hajizadeh, M., & Nghiem, H. S. (2011). Out-of-pocket expenditures for hospital care in Iran: Who is at risk of incurring catastrophic payments? International Journal of Health Care Finance and Economics, 11(4), 267–285.

    Article  PubMed  Google Scholar 

  • Hamid, S. A., Ahsan, S. M., & Begum, A. (2014). Disease-specific impoverishment impact of out-of-pocket payments for health care: Evidence from rural Bangladesh. Applied Health Economics and Health Policy, 12(4), 421–433.

    Article  PubMed  Google Scholar 

  • Imai, K., King, G., & Stuart, E. A. (2008). Misunderstandings between experimentalists and observationalists about causal inference. Journal of the Royal Statistical Society: Series A (Statistics in Society), 171(2), 481–502.

    Article  Google Scholar 

  • International Monetary Fund (IMF). (2015). World economic outlook database. Washington DC: IMF.

  • Jaspers, L., Colpani, V., Chaker, L., van der Lee, S. J., Muka, T., Imo, D., et al. (2015). The global impact of non-communicable diseases on households and impoverishment: A systematic review. European Journal of Epidemiology, 30(3), 163–188.

    Article  PubMed  Google Scholar 

  • Kankeu, H. T., Saksena, P., Xu, K., & Evans, D. B. (2013). The financial burden from non-communicable diseases in low-and middle-income countries: A literature review. Health Research Policy and Systems, 11, 31.

    Article  PubMed  PubMed Central  Google Scholar 

  • Karan, A., Engelgau, M., & Mahal, A. (2014). The household-level economic burden of heart disease in India. Tropical Medicine and International Health, 19(5), 581–591.

    Article  PubMed  Google Scholar 

  • Kumara, A. S., & Samaratunge, R. (2016). Patterns and determinants of out-of-pocket health care expenditure in Sri Lanka: Evidence from household surveys. Health Policy and Planning, 31(8), 970–983.

    Article  PubMed  Google Scholar 

  • Le, C., Zhankun, S., Jun, D., & Keying, Z. (2012). The economic burden of hypertension in rural south-west China. Tropical Medicine and International Health, 17(12), 1544–1551.

    Article  PubMed  Google Scholar 

  • Leuven, E., Sianesi, B. (2015). PSMATCH2: Stata module to perform full Mahalanobis and propensity score matching, common support graphing, and covariate imbalance testing. Statistical Software Components.

  • Mahal, A., Karan, A., & Engelgau, M. (2010). The economic implications of non-communicable disease for India. Health, Nutrition and Population (HNP) Discussion paper. Washington DC: World Bank Group.

  • Mahal, A., Karan, A., Fan, V. Y., & Engelgau, M. (2013). The economic burden of cancers on Indian households. PLoS One, 8(8), e71853.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Ministry of Healthcare and Nutrition Sri Lanka (MOHNSL). (2009). The national policy & strategic framework for prevention and control of chronic non-communicable diseases. Colombo: MOHNSL.

    Google Scholar 

  • Murphy, A., Mahal, A., Richardson, E., & Moran, A. E. (2013). The economic burden of chronic disease care faced by households in Ukraine: A cross-sectional matching study of angina patients. International Journal of Equity in Health, 12, 38.

    Article  Google Scholar 

  • Popkin, B., Horton, S., Kim, S., Mahal, A., & Shuigao, J. (2001). Trends in diet, nutritional status, and diet-related non-communicable diseases in China and India: The economic costs of the nutrition transition. Nutrition Reviews, 59(12), 379–390.

    Article  PubMed  CAS  Google Scholar 

  • Rannan-Eliya, R. P., & Sikurajapathy, L. (2008). Sri Lanka: “Good practice” in expanding health care coverage: Research Studies Series, Number 3. Colombo: Institute for Health Policy.

    Google Scholar 

  • Rannan-Eliya, R. P., Wijemanne, N., Liyanage, I. K., Jayanthan, J., Dalpatadu, S., Amarasinghe, S., et al. (2015). The quality of outpatient primary care in public and private sectors in Sri Lanka-how well do patient perceptions match reality and what are the implications? Health Policy and Planning, 30(suppl 1), i59–i74.

    Article  PubMed  Google Scholar 

  • Rosenbaum, P. R., & Rubin, D. B. (1983). The central role of the propensity score in observational studies for causal effects. Biometrika, 70(1), 41–55.

    Article  Google Scholar 

  • Russell, S., & Gilson, L. (2006). Are health services protecting the livelihoods the urban poor in Sri Lanka? Findings from two low-income areas of Colombo. Social Science and Medicine, 63(7), 1732–1744.

    Article  Google Scholar 

  • Séne, L. M., & Cissé, M. (2015). Catastrophic out-of-pocket payments for health and poverty nexus: Evidence from Senegal. International Journal of Health Economics and Management, 15(3), 307–328.

    Article  PubMed  Google Scholar 

  • Shahrawat, R., & Rao, K. D. (2012). Insured yet vulnerable: Out-of-pocket payments and India’s poor. Health Policy and Planning, 27(3), 213–221.

    Article  PubMed  Google Scholar 

  • Smith, J., & Todd, P. (2005). Does matching overcome LaLonde’s critique of nonexperimental estimators? Journal of Econometrics, 125(1–2), 305–353.

    Article  Google Scholar 

  • Somkotra, T., & Lagrada, L. S. (2008). Payments for health care and its effect on catastrophe and Impoverishment: Experience from the transition to Universal Coverage in Thailand. Social Science & Medicine, 67(12), 2027–2035.

    Article  Google Scholar 

  • van Doorslaer, E., O’Donnell, O., Rannan-Eliya, R. P., Somanathan, A., Adhikari, S. R., Garg, C. C., et al. (2006). Effect of payments for health care on poverty estimates in 11 countries in Asia: An analysis of household survey data. Lancet, 368(9544), 1357–1364.

    Article  PubMed  Google Scholar 

  • van Doorslaer, E., O’Donnell, O., Rannan-Eliya, R. P., Somanathan, A., Adhikari, S. R., Garg, C. C., et al. (2007). Catastrophic payments for health care in Asia. Health Economics, 16(11), 1159–1184.

    Article  PubMed  Google Scholar 

  • Wagstaff, A., & van Doorslaer, E. (2003). Catastrophe and impoverishment in paying for health care: With applications to Vietnam 1993–1998. Health Economics, 12(11), 921–934.

    Article  PubMed  Google Scholar 

  • Wang, Z., Li, X., & Chen, M. (2015). Catastrophic health expenditures and its inequality in elderly households with chronic disease patients in China. International Journal for Equity in Health, 14(1), 8.

    Article  PubMed  PubMed Central  Google Scholar 

  • World Bank. (2015). World development indicators. Washington DC: World Bank.

  • World Health Organization (WHO). (2014). Noncommunicable diseases (NCD) country profiles. Geneva: WHO.

    Google Scholar 

  • Zaidi, A. A., Ansari, T. Z., & Khan, A. (2012). The financial burden of cancer: Estimates from patients undergoing cancer care in a tertiary care hospital. International Journal for Equity in Health, 11(1), 60.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

I am grateful to Alexander von Humboldt Foundation in Germany for providing funding for this research project and department of census and statistics of Sri Lanka for providing the data. All remaining errors are mine.

Author information

Authors and Affiliations

  1. Department of Industrial Management, Faculty of Applied Sciences, Wayamba University of Sri Lanka, Kuliyapitiya, 60200, Sri Lanka

    Asankha Pallegedara

  2. Chair of Development Economics, Faculty of Business Administration and Economics, University of Passau, Innstrasse 29, 94032, Passau, Germany

    Asankha Pallegedara

Authors
  1. Asankha Pallegedara
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Asankha Pallegedara.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pallegedara, A. Impacts of chronic non-communicable diseases on households’ out-of-pocket healthcare expenditures in Sri Lanka. Int J Health Econ Manag. 18, 301–319 (2018). https://doi.org/10.1007/s10754-018-9235-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10754-018-9235-2

Keywords

JEL Classification

Search

Navigation