Burden of Healthcare Utilization and Out-of-Pocket Costs Among Individuals with NCDs in an Indian Setting
- 472 Downloads
Non communicable diseases (NCDs) are now the major cause of death and disability worldwide. It increasingly affects people from developing as well as developed countries. Over the coming decades the burden from NCDs is projected to rise particularly fast in the developing world. There is a lack of optimal data collection about the burden of risk factors related to NCDs especially in the developing countries. To assess the burden of healthcare utilization and out-of-pocket costs associated with NCDs in an Indian setting. A cross sectional study was performed to enroll a convenient sample of 166 participants aged 18 years and above from a tertiary hospital in Punjab, a Northern state of India. The data was gathered during the period of Feb 2010–April 2010. A mixed methods approach was used to assess the burden of diabetes, hypertension, high cholesterol, and their associated risk factors. Further we evaluated the burden of healthcare utilization and out-of-pocket costs associated with these conditions using self-reported assessments. Results showed the average age of the participants was 50 years, 63 % (n = 104) were females, 32 % (n = 53) had education less than high school and 20 % (n = 33) had no formal education. About 96 % of the study participants were living with a partner. Majority of the study participants were non-smokers and 17 % (n = 27) of them reported to have history of alcohol consumption. The majority of the participants had access to cell phones (94 %; n = 156) and about 40 % (n = 66) had computers at home. About 33 % (n = 55) of the study participants had some form of previous knowledge of computers. Majority of the study participants went to the private hospital (47.5 %) for seeking healthcare. About 32 % (n = 53) also sought healthcare from some kind of healthcare professional including a primary care doctor or a nurse or even a pharmacist in a village setting. Doctor visits related to diabetes were higher as compared to the individuals either with hypertension or high cholesterol. However; the out-of-pocket costs of the visit to the healthcare professional were much higher for hypertension than for diabetes or high cholesterol. A strengthened surveillance system, effective inter-sectoral action, and improved access to basic healthcare are pivotal to prevent NCDs. A multifaceted NCDs surveillance system could help us measure the burden of risk factors, its associated health care utilization and out of pocket costs, and further facilitate interventions that can guide evidence based decision making.
KeywordsNon communicable diseases Risk factors Out-of-pocket costs Healthcare utilization Surveillance
- 1.World Health Organization (2009). Key messages on non-communicable diseases and injuries which have emerged from discussions at ECOSOC during the first half of 2009. Available from: http://www.who.int/nmh/publications/ecosoc_summary_en.pdf.
- 2.World Health Organization (2009). Global health risks: mortality and burden of disease attributable to selected major risks.Google Scholar
- 4.World Economic Forum (2010). Global risks 2010: A global risk network report. Available from: http://www3.weforum.org/docs/WEF_GlobalRisks_Report_2010.pdf.
- 6.World Health Organization (2005). The impact of chronic disease in India: Facing the facts report. Available from: http://www.who.int/chp/chronic_disease_report/media/india.pdf.
- 7.Vaz, M., Yusuf, S., Bharathi, A., Kurpad, A., & Swaminathan, S. (2005). The nutrition transition in India. South African Journal of Clinical Nutrition, 18(2), 198–201.Google Scholar
- 8.Shah, B., Kumar, N., Menon, G., Khurana, S., & Kumar, H. (2004). Assessment of burden of non communicable diseases. New Delhi: Indian Council of Medical Research.Google Scholar
- 9.Ministry of Health and Family Welfare (2005). Report of the National Commission on Macroeconomics and Health. Available from: http://www.who.int/macrohealth/action/Report%20of%20the%20National%20Commission.pdf.
- 10.Yusuf, S., Islam, S., Chow, C. K., Rangarajan, S., Dagenais, G., Diaz, R., et al. (2011). Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income, and low-income countries (the PURE Study): A prospective epidemiological survey. Lancet, 378(9798), 1231–1243.PubMedCrossRefGoogle Scholar
- 12.Ministry of Health and Family Welfare. (2011) Report of the Working Group on Disease Burden for 12th five year plan. Government of India. Planning Commission.Google Scholar
- 13.National Institute of Medical Statistics and Indian Council Research (2009). Integrated Disease Surveillance Project (IDSP), non-communicable disease risk factors survey. New Delhi: India. Available from: http://www.icmr.nic.in/final/IDSP-NCD%20Reports/Phase-1%20States%20of%20India.pdf.
- 15.Martine G. (2005) Population/development/environment trends in a globalized context: challenges for the 21 st century. Genus 247–277.Google Scholar
- 16.Shetty P, Schmidhuber (2011). Journal Expert Paper No. 2011/3.Google Scholar
- 17.Shetty, P. S. (2002). Nutrition transition in India. Public Health Nutrients, 5(1a), 175–182.Google Scholar
- 18.Ministry of Human Resource Development (2002). National Nutrition Policy. Government of India. Department of Women and Child Development.Google Scholar
- 19.Ministry of Health and Family Welfare. National Cardiovascular Disease Database. Government of India and World Health Organization. Available from: http://www.whoindia.org/LinkFiles/NMH_Resources_National_CVD_database-Final_Report.pdf.
- 20.Suhrcke, M., Nugent, R. A., Stuckler, D., & Rocco, L. (2006). Chronic disease: An economic perspective. London: Oxford Health Alliance.Google Scholar
- 22.Gupta, I., Kandamuthan, S., & Upadhyaya, D. (2006). Economic impact of cardiovascular diseases in India. Delhi: Institute of Economic Growth.Google Scholar
- 24.Registrar General of India. Summary statistics of causes of death, India. (2008). New Delhi. India: Ministry of Home Affairs, Office of the Registrar General of India.Google Scholar
- 25.Andranovich G, Howell RE (1995). USDA Sustainable Agriculture Research and Education Program. The Community Survey: A Tool for Particiation and Fact-finding.Western Regional Extension.Google Scholar
- 27.Murray, C. J. L., & Lopez, A. D. (1996). The global burden of disease (p. 270). Geneva: WHO.Google Scholar