Background: Cancer affects the well-being not only of the patients but also of the other members of the household. Objectives: In this study, we assessed the nature and magnitude of the economic and non-economic burden on patients with cancer and their families due to the inpatient and outpatient cancer care. Materials and Methods: This study was conducted using the secondary data from the 75th round of the National Sample Survey Organization survey on health and morbidity, titled “Social Consumption: Health,” for the year 2017–2018. The burden of cancer on individuals was assessed in terms of the health-care expenditure and utilization of inpatient and outpatient cancer treatment. At the household level, cancer burden was assessed in terms of per person health-care expenditure, impact on the standard of living, strategies adopted for financing the health-care expenditure, and utilization of and expenditure on health-care by other members of the family. Propensity score matching was used to generate matched data separately for inpatient and outpatient cases and at individual and household levels to control for confounders. The difference in the burden between the matched cancer-affected and unaffected individuals/households was estimated using the average treatment effect. Results: For the year 2017–2018, data were available for a total of 113,823 households with 555,352 individuals across India. The mean out-of-pocket expenditure (OOPE) for a patient with cancer exceeded that of patients with other chronic diseases by 2895 for each outpatient visit and 52393 for each inpatient admission. The mean length of the hospital stay due to cancer was found to be 7 days longer than that due to any other chronic disease. The per person inpatient health-care expenditure for the other members of a cancer-affected household was 11,000 less than that of other members of the unaffected households. More than 50% of households with cancer patients had to borrow money to pay for inpatient care compared to control households. The share of OOPE for outpatient care in the monthly consumption expenditure of a cancer-affected household was twice as high as that of an unaffected household. Moreover, the number of outpatient visits for other ailing persons in a cancer-affected household was one-fourth that of an unaffected household. Conclusion: Cancer imposes an immense economic and non-economic burden on affected individuals and households. Therefore, there is a need to design appropriate health-care strategies for providing optimal financial support to patients with cancer.

Various estimates of impoverishment on account of out-of-pocket expenditure (OOPE) on health are available for India, covering different time periods, but there is a void in terms of comparable estimates. This article uses national level surveys conducted by National Sample Survey Organization for measurement of living standards (Consumption Expenditure Survey [CES]) for 2004–2005 and 2011–2012 and Health and Morbidity Survey (HMS) for 2004 and 2014 to quantify the trends in impoverishment estimates over time and identify the factors explaining these trends. Using consistent methodology, it is estimated that the increase in the number of persons impoverished due to OOPE using HMS is 19.78 million (from 77.9 million to 97.78 million) between 2004 and 2014, while using CES, the increase is 2.90 million (from 51.48 to 54.38 million) between 2004–2005 and 2011–2012. Expenditure on outpatient care including drugs led to 72 million people being pushed below poverty line in 2014. Most of the increase in impoverishment has come in lower income quintiles both in rural and urban areas. Government needs to focus on reducing OOPE for bottom three income quintiles and more specifically the household expenditure on medicines.

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Background Aam Aadmi Mohalla Clinics (AAMC) are the community level public primary care facilities recently introduced to strengthen primary care in Delhi, India by bringing affordable healthcare close to home. Objectives This study looks at the primary care attributes of AAMC from a patient perspective, to assess their features, strengths and weaknesses. Methods Using a primary care survey tool, a cross-sectional survey of 360 users was conducted at 18 facilities across 9 districts of Delhi to gather information on six dimensions of primary care delivery. Thematic analysis of responses to quantitative, multiple-choice and Likert scale questions using percentage of respondents in each category; and a strengths, weaknesses, opportunities and suggestions (SWOS) framework, was used to examine the primary care attributes. Results AAMCs have done well in improving proximity, availability, physical and financial access to primary care with respondents reporting their residence within 1 kilometre of AAMCs (95%), physician being available (100%), free drugs in stock (99%). Service delivery is however not comprehensive with missing preventive care. Respondents reported missing gatekeeping, weak referral mechanism (6–19%), and low physician’s familiarity with their overall health (2%). Conclusion AAMCs have brought affordable healthcare with free medicines and diagnostics to neighbourhood. There is an opportunity for attaining universal healthcare that is responsive to user needs through provision of comprehensive care. Compulsory enrolment of neighbourhood population with an electronic database of patients has an immense potential to improve longitudinality and coordination of care.

To study the disease burden and financial burden of water, sanitation and hygiene (WASH) relateddiseases among individuals in India. Methods: The prevalence and economic burden of WASH-related diseases was estimated using 75th Round National Sample Survey: 'Household social consumption: Health'. A multilevel logistic regression model was used to assess the effect of community level factors in the prevalence of these diseases. Results: The prevalence of WASH-related diseases in India was at 5.7% of all outpatient visits and 6.9% of all hospital admissions during in 2017-18.66% of all outpatient malaria visits in rural areas were associated with restrictions in daily activities of ailing individuals. The mean out-of-pocket expenditure across all WASH-related diseases was ₹703 per outpatient visit and ₹9656 per hospital admission. The monthly OOPE on outpatient care for 74% persons with jaundice in rural areas, was greater than their monthly per capita consumption expenditure and 97% persons with malaria in urban areas faced catastrophic OOPE on outpatient care. Each hospital admission for jaundice in urban areas led to an earning loss of ₹2260. The intra-class correlation at community level from the multilevel logistic regression for diseases prevalence were 0.28 and 0.26 for outpatient and inpatient cases, indicating the role of community level factors in the variation in disease prevalence. Conclusion: There is a high prevalence, financial burden and effect of community level factors on WASH-related diseases in India. Holistic strengthening of WASH facilities is required to mitigate the avoidable burden of these diseases.