Household expenditure on leprosy outpatient services in the Indian health system: A comparative study

Abstract

BackgroundLeprosy is a major public health problem in many low and middle income countries, especially in India, and contributes considerably to the global burden of the disease. Leprosy and poverty are closely associated, and therefore the economic burden of leprosy is a concern. However, evidence on patient’s expenditure is scarce. In this study, we estimate the expenditure in primary care (outpatient) by leprosy households in two different public health settings.Methodology/Principal findingsWe performed a cross-sectional study, comparing the Union Territory of Dadra and Nagar Haveli with the Umbergaon block of Valsad, Gujrat, India. A household (HH) survey was conducted between May and October, 2016. We calculated direct and indirect expenditure by zero inflated negative binomial and negative binomial regression. The sampled households were comparable on socioeconomic indicators. The mean direct expenditure was USD 6.5 (95% CI: 2.4–17.9) in Dadra and Nagar Haveli and USD 5.4 (95% CI: 3.8–7.9) per visit in Umbergaon. The mean indirect expenditure was USD 8.7 (95% CI: 7.2–10.6) in Dadra and Nagar Haveli and USD 12.4 (95% CI: 7.0–21.9) in Umbergaon. The age of the leprosy patients and type of health facilities were the major predictors of total expenditure on leprosy primary care. The higher the age, the higher the expenditure at both sites. The private facilities are more expensive than the government facilities at both sites. If the public health system is enhanced, government facilities are the first preference for patients.Conclusions/SignificanceAn enhanced public health system reduces the patient’s expenditure and improves the health seeking behaviour. We recommend investing in health system strengthening to reduce the economic burden of leprosy.

Leprosy services in primary health care in India: comparative economic cost analysis of two public‐health settings

“…Patients also prefer to visit health facilities only for essential curative care such as acute co‐morbidity or leprosy reactions, and remain non‐regular for routine health check‐ups. The afflicted population is mainly poor, and indirect costs such as wage loss and transportation are a disincentive for them to pay health‐centre visits . The same study informed that the out‐of‐pocket expenditure due to leprosy was lower in DNH than Umbergaon .…”

“…The afflicted population is mainly poor, and indirect costs such as wage loss and transportation are a disincentive for them to pay health-centre visits [25]. The same study informed that the out-of-pocket expenditure due to leprosy was lower in DNH than Umbergaon [25]. If aligned with our study results, then we can infer that an enhanced health system is comparatively costly, particularly due to the investment in prevention, but that it also reduces the out-of-pocket expenditure burden on the households.…”

Leprosy post-exposure prophylaxis in the Indian health system: A cost-effectiveness analysis

“…Despite the highest ANCDR in DNH, the G2D rate is low (0.37% of all new cases) compared to other endemic parts of India [14]. In DNH, the uptake of leprosy services and public health expenditure is better than the neighbouring areas [15,16]. S1 Table provides detailed information on demography, socioeconomics and epidemiology of DNH.…”

The Skin—A Common Pathway for Integrating Diagnosis and Management of NTDs

“…The impoverishing effects of NTDs are amplified in poor and vulnerable communities; physical labour is often the main source of income, and social protection mechanisms (insurance against ill-health and disability) are not accessible [ 6 ]. In rural India, households with a family member affected by leprosy can incur catastrophic health expenditure, mostly as a result of loss of income due to chronic ill-health [ 7 , 8 ]. Significant health expenditure and productivity loss has also been demonstrated for other skin NTDs including podoconiosis and leishmaniasis [ 9 , 10 , 11 ].…”