The financial burden from non-communicable diseases in low- and middle-income countries: a literature review

Abstract

Non-communicable diseases (NCDs) were previously considered to only affect high-income countries. However, they now account for a very large burden in terms of both mortality and morbidity in low- and middle-income countries (LMICs), although little is known about the impact these diseases have on households in these countries. In this paper, we present a literature review on the costs imposed by NCDs on households in LMICs. We examine both the costs of obtaining medical care and the costs associated with being unable to work, while discussing the methodological issues of particular studies. The results suggest that NCDs pose a heavy financial burden on many affected households; poor households are the most financially affected when they seek care. Medicines are usually the largest component of costs and the use of originator brand medicines leads to higher than necessary expenses. In particular, in the treatment of diabetes, insulin – when required – represents an important source of spending for patients and their families. These financial costs deter many people suffering from NCDs from seeking the care they need. The limited health insurance coverage for NCDs is reflected in the low proportions of patients claiming reimbursement and the low reimbursement rates in existing insurance schemes. The costs associated with lost income-earning opportunities are also significant for many households. Therefore, NCDs impose a substantial financial burden on many households, including the poor in low-income countries. The financial costs of obtaining care also impose insurmountable barriers to access for some people, which illustrates the urgency of improving financial risk protection in health in LMIC settings and ensuring that NCDs are taken into account in these systems. In this paper, we identify areas where further research is needed to have a better view of the costs incurred by households because of NCDs; namely, the extension of the geographical scope, the inclusion of certain diseases hitherto little studied, the introduction of a time dimension, and more comparisons with acute illnesses.

Returning home to die or leaving home to seek health care? Location of death of urban and rural residents in Burkina Faso and Senegal

“…Finally, cultural barriers or poverty can compromise patients’ demand for health services. In particular, treatment of non-communicable diseases is generally costly in contexts where individuals have no health insurance [22]. …”

“…This is likely to happen when there is a little hope of a cure. Some chronic diseases, for instance, cannot be treated effectively, even in the largest city hospitals, as treatments are too costly for both individuals and the state [22]. A recent example is that of rural–urban migrants with HIV/AIDS in urban areas of South Africa who often returned to their village to receive supportive care and to die [23,24].…”

Influência do excesso de peso e da obesidade nos gastos em saúde nos domicílios brasileiros

“…Em estudos que tiveram como exposição uma ou mais doenças crônicas, verificou-se que os domicílios com moradores nesta situação apresentaram maiores gastos em saúde 15,19,34 . Nesse contexto, um trabalho utilizando dados da população norte-americana mostrou que os gastos em saúde via desembolso direto aumentaram em função do crescimento do número de doenças crônicas dos moradores dos domicílios, mesmo após ajuste para as variáveis sociodemográficas e acesso a seguro de saúde privado.…”

“…Gastos familiares em saúde têm sido considerados catastróficos quando ultrapassam 10% ou mais da renda, mas revisões da literatura para estudos sobre consequências econômicas de doenças e gastos familiares em saúde apresentam resultados semelhantes aos encontrados neste estudo, para países de renda média ou baixa 12,19 , sendo estes valores também semelhantes aos registrados em trabalhos realizados em países com renda alta 30 . Estudo realizado com os dados das POF de 2002-2003 e 2008-2009 utilizou diferentes pontos de corte para a definição de pobreza, e constatou que os gastos em saúde contribuem para que um maior número de domicílios seja classificado como pobre, com importante contribuição dos gastos em medicamentos 36 .…”

“…Achados da literatura nacional e internacional apontam como fatores que afetam potencialmente os gastos familiares em saúde: renda domiciliar 13,14,15 e localização dos domicílios (região e área) 16 , ambas relacionadas ao acesso à saúde; mas também a composição familiar, como a presença de idoso nos domicílios 13,14,17 e a ocorrência de determinadas doenças entre os moradores, com destaque para as condições crônicas 15,18,19 . A obesidade também está relacionada a alguns desses fatores 20,21,22 e, uma vez que esta tem impacto financeiro sobre o SUS 5,6,7 , pode também resultar em maiores gastos em saúde para as famílias.…”