Variations in catastrophic health expenditure across the states of India: 2004 to 2014

Pandey, Anamika; Kumar, G Anil; Dandona, Rakhi; Dandona, Lalit

doi:10.1371/journal.pone.0205510

Cited by 45 publications

(51 citation statements)

References 30 publications

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“…The reduction of CHE in Peru was similar to national estimates of a retrospective study worldwide [ 6 ], although it differs from the growing trend of CHE in countries in other parts of the world, such as Cambodia [ 32 ], Iran [ 33 ], India [ 34 ], or countries in the region, such as Brazil [ 35 ] and Chile [ 4 ]. Differences in population characteristics, poverty rates, national income level, economic structure, and payment mechanisms for access to health services may explain the difference in CHE proportions.…”

Section: Discussionsupporting

confidence: 65%

“…One study found that 12.9% of Peruvians reported that they did not receive medical care because they did not have money, and 43.1% of people in moderate or extreme poverty claimed that money was a barrier for access to healthcare [31]. The reduction of CHE in Peru was similar to national estimates of a retrospective study worldwide [6], although it differs from the growing trend of CHE in countries in other parts of the world, such as Cambodia [32], Iran [33], India [34], or countries in the region, such as Brazil [35] and Chile [4]. Differences in population characteristics, poverty rates, national income level, economic structure, and payment mechanisms for access to health services may explain the difference in CHE proportions.…”

Section: Discussionmentioning

confidence: 77%

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Measuring Out-of-pocket Payment, Catastrophic Health Expenditure and the Related Socioeconomic Inequality in Peru: A Comparison Between 2008 and 2017

Hernández-Vasquéz

Rojas‐Roque²,

Vargas-Fernández

et al. 2020

J Prev Med Public Health

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Describe out-of-pocket payment (OOP) and the proportion of Peruvian households with catastrophic health expenditure (CHE) and evaluate changes in socioeconomic inequalities in CHE between 2008 and 2017. Methods: We used data from the 2008 and 2017 National Household Surveys on Living and Poverty Conditions (ENAHO in Spanish), which are based on probabilistic stratified, multistage and independent sampling of areas. OOP was converted into constant dollars of 2017. A household with CHE was assumed when the proportion between OOP and payment capacity was ≥0.40. OOP was described by median and interquartile range while CHE was described by weighted proportions and 95% confidence intervals (CIs). To estimate the socioeconomic inequality in CHE we computed the Erreygers concentration index. Results: The median OOP reduced from 205.8 US dollars to 158.7 US dollars between 2008 and 2017. The proportion of CHE decreased from 4.9% (95% CI, 4.5 to 5.2) in 2008 to 3.7% (95% CI, 3.4 to 4.0) in 2017. Comparison of socioeconomic inequality of CHE showed no differences between 2008 and 2017, except for rural households in which CHE was less concentrated in richer households (p<0.05) and in households located on the rest of the coast, showing an increase in the concentration of CHE in richer households (p<0.05). Conclusions: Although OOP and CHE reduced between 2008 and 2017, there is still socioeconomic inequality in the burden of CHE across different subpopulations. To reverse this situation, access to health resources and health services should be promoted and guaranteed to all populations.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 77%

Measuring Out-of-pocket Payment, Catastrophic Health Expenditure and the Related Socioeconomic Inequality in Peru: A Comparison Between 2008 and 2017

Hernández-Vasquéz

Rojas‐Roque²,

Vargas-Fernández

et al. 2020

J Prev Med Public Health

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“…Alarmingly poor availability in government hospitals drives patients to OOP payments in GSDPs or private retail pharmacies. Pandey et al [36] reported that Kerala has the highest burden of catastrophic health expenditure in India, where over 43% households spend ≥10% of total household expenditure on healthdisproportionately affecting the poor. Therefore, government must allocate adequate funds, and streamline medicine procurement and supply systems to ensure a steady supply of medicines, either free or at affordable prices, in public sector facilities.…”

Section: Discussionmentioning

confidence: 99%

“…Given the chronic nature of disease, affordability should be seen in context of lifelong polypharmacy [46]. For instance, coronary heart disease would require daily therapy with aspirin, statins, beta-blockers and ACE-inhibitors [35][36][37][38], the monthly supply of which would cost about 2.9-10.3 days' wages, depending on the medicines prescribed. In diabetes, monotherapy with glimepiridefirst line medicine along with metforminas well as insulin are unaffordable in Kerala.…”

Section: Discussionmentioning

confidence: 99%

Availability, price and affordability of essential medicines for managing cardiovascular diseases and diabetes: a statewide survey in Kerala, India

Satheesh

Sharma

Puthean³

et al. 2020

Tropical Med Int Health

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objective Limited access to essential medicines (EMs) for cardiovascular disease (CVD) and diabetes is a major concern in low-and middle-income countries. We aimed to generate data on availability, price and affordability of EMs for CVD and diabetes in India. methods Using WHO/HAI survey methodology, we evaluated availability and prices of 23 EMs in 30 public sector facilities (government hospitals and semi-public/government-subsidised-discountpharmacies (GSDPs)) and 60 private retail pharmacies across six districts in Kerala state, India (November 2018-May 2019). Median Price Ratios (MPRs) were calculated by comparing consumer prices with international reference prices. We also analysed data (collected in July 2020) on six anti-hypertensive fixed-dose-combinations (FDCs) that were designated as 'essential' by the WHO in 2019. results Mean availability of surveyed generic EMs was 45.7% in government hospitals, 64.7% in GSDPs and 72.0% in private retail pharmacies. On average, the most-sold and highest-priced generics, respectively, were 6.6% and 8.9% costlier than the lowest-priced generics (LPG). Median MPR for LPG was 2.71 in private retail and 2.25 in GSDPs. Monthly supply of LPG would cost the lowestpaid worker 1.11 and 0.79 days' wages in private retail and GSDPs, respectively. Mean availability of the surveyed FDCs was poor (private retail: 15-85%; GSDPs: 8.3-66.7%), and the private retail prices of FDCs were comparable to the sum of corresponding constituent monotherapies. conclusion Availability of CVD and diabetes EMs fall short of WHO's 80% target in both sectors. Although availability in the private retail pharmacies was near-optimal, prices appear unaffordable compared to GSDPs. Initiatives such as mandating generic prescribing, adding the WHO-approved FDCs in local EM lists, improving price transparency, and streamlining medicine supply to ensure equitable access to EMs, especially in the public sector, are crucial in tackling Kerala's ever-increasing CVD burden. keywords cardiovascular disease, diabetes, access to medicines, essential medicines, India Sustainable Development Goals (SDGs): SDG 1 (no poverty), SDG 3 (good health and well-being), SDG 10 (reduced inequalities), SDG 16 (peace, justice and strong institutions), SDG 17 (partnerships for the goals) *Equal contribution, joint first authors. † Equal contribution, joint last authors.

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“…In reverse, being in speci c social, cultural, and economic conditions can enhance the risk of disability (18,19). Farrowing growth in socio-economic inequality aggravates the risk of an increase in the unmet need for healthcare in developing countries (20).…”

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confidence: 99%

Measuring the contributions of elderly and non-elderly age-groups to the disability burden in India: A Decomposition Analysis.

Chanda

Puri

Yadav

2020

Preprint

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Background Disability has been an essential component of the health and development framework of India. Despite policy norms, a surge in disability across the population interrogates the role of the increasing elderly population in terms of chronic diseases led disabilities. The regional variation in demographic transitions possesses an unequal risk for the occurrence of disability in the population. The demographic and socio-economic factors can explain the inequality contributed by the elderly and non-elderly population. Methods We have used the National Sample Survey-76th round (2018) to measure the risk difference of disability between elderly and non-elderly age-groups across selected background characteristics. Fairlie’s decomposition technique has been adopted to measure the contribution made by the socio-economic factors in explaining the differences in the prevalence of disability. Distribution of states with respect to prevalence and risk difference of disability between elderly and non-elderly are plotted, to understand the regional inequality in the occurrence of disability in India. Results The study calculates a risk difference of 68 per 1000 population in India, explaining a higher risk of disability among the elderly that varies across socio-economic factors. Belonging from the Central region of India represents a higher risk of disability at old age (risk difference 76.8 per 1000 population) than the rest of the regions in India. Gender, marital status, and education explain 72 percent of the gap in the occurrence of disability between two broad age-groups. Despite having a similar disability prevalence, Kerala and Odisha have risk differences of 32 and 85 per 1000 population, respectively. Conclusions The gap in the disability prevalence is significantly explained by the marital status and educational status of the individuals. Disparity in the risk difference of disability among elderly and non-elderly across states suggests that large size of the elderly population is not the only reason for the increasing disability burden in India. Inadequate healthcare infrastructure and access also results into an unmet health care need pertaining to disability. Study suggests a policy relevance for disability-inclusive and geriatric centric healthcare and social supports in synchronisation with the demand realised by the states in India.

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Variations in catastrophic health expenditure across the states of India: 2004 to 2014

Cited by 45 publications

References 30 publications

Measuring Out-of-pocket Payment, Catastrophic Health Expenditure and the Related Socioeconomic Inequality in Peru: A Comparison Between 2008 and 2017

Measuring Out-of-pocket Payment, Catastrophic Health Expenditure and the Related Socioeconomic Inequality in Peru: A Comparison Between 2008 and 2017

Availability, price and affordability of essential medicines for managing cardiovascular diseases and diabetes: a statewide survey in Kerala, India

Measuring the contributions of elderly and non-elderly age-groups to the disability burden in India: A Decomposition Analysis.

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