Abstract
The increasing burden of communicable and non-communicable diseases are imposing unavoidable costs on Indians. As a consequence it exacerbate poverty and drag many poor further down by heavy medical expenses. This study aims to estimate the extent of healthcare expenditure on the individuals who were hospitalized due to various diseases. Further, this study examines the burden of healthcare expenditure on impoverishment level in India. The unit level record of the 71st round of the National Sample Survey Office (NSSO) is used in the analysis. The result reveals, cost of hospitalization due to non-communicable diseases is three times higher than communicable diseases in India. Therefore, an overall level of impoverishment has been increased by 1.61 percent/year which shows the high financial risk for the people surviving at the threshold of poverty.
Similar content being viewed by others
Change history
19 June 2017
An erratum to this article has been published.
References
Abegunde, D., & Stanciole, A. (2008). The economic impact of chronic diseases: How do households respond to shocks? Evidence from Russia. Social Science and Medicine, 66(11), 2296–2307.
Atun, R., Knaul, F. M., Akachi, Y., & Frenk, J. (2012). Innovative financing for health: What is truly innovative? The Lancet, 380(9858), 2044–2049.
Bajpai, V. (2014). The challenges confronting public hospitals in India, their origins, and possible solutions. Advances in Public Health, 898502, 1–27.
Balarajan, Y., Selvaraj, S., & Subramanian, S. V. (2011). Health care and equity in India. The Lancet, 377(9764), 505–515.
Barik, D., & Desai, S. (2013). Determinants of private healthcare utilisation and expenditure patterns in India, India Infrastructure Report 2013/14. http://www.ihds.info/sites/default/files/publications/papers/barik%20and%20desai%202014%20health%20expenditure.pdf Accessed 13 April 2016.
Baru, R., Acharya, A., Acharya, S., Shiva Kumar, A. K., & Nagaraj, K. (2010). Inequities in access to health services in India: Caste, class and region. Economic and Political Weekly, 45(38), 49–58.
Benerji, D. (2005). Politics of rural health in India. Indian Journal of Public Health, 49(3), 113–122.
Berman, P., Ahuja, R., & Bhandari, L. (2010). The Impoverishing effect of healthcare payments in India: New methodology and findings. Economic and Political Weekly, 14(16), 65–71.
Bhojani, U., Thriveni, B. S., Devadasan, R., Munegowda, C. M., Devadasan, N., Kolsteren, P., & Criel, B. (2012). Out-of-pocket healthcare payments on chronic conditions impoverish urban poor in Bangalore, India. BMC Public Health, 12(1), 1.
Bonu, S., Bhushan, I., Rani, M., & Anderson, I. (2009). Incidence and correlates of ‘catastrophic’ maternal health care expenditure in India. Health Policy and Planning, 24(6), 445–456.
Census of India. (2011). Houselisting and housing census data highlights, Ministry of Home Affairs, Government of India. http://censusindia.gov.in/2011census/hlo/Data_sheet/India/Drinking_Water.pdf. Accessed February 25, 2016.
Daivadanam, M., Thankappan, K. R., Sarma, P. S., & Harikrishnan, S. (2012). Catastrophic health expenditure and coping strategies associated with acute coronary syndrome in Kerala, India. Indian Journal of Medical Research, 136(4), 585–592.
De Costa, A., Al-Muniri, A., Diwan, V. K., & Eriksson, B. (2009). Where are healthcare providers? Exploring relationships between context and human resources for health Madhya Pradesh province, India. Health Policy, 93(1), 41–47.
De Costa, A., & Johannson, E. (2011). By ‘default or design’? The expansion of the private health care sector in Madhya Pradesh, India. Health Policy, 103(2), 283–289.
Deb, P., Munkin, M. K., & Trivedi, P. K. (2006). Bayesian analysis of the two-part model with endogeneity: Application to health care expenditure. Journal of Applied Econometrics, 21(7), 1081–1099.
Denton, F. T., & Spencer, B. G. (2010). Chronic health conditions: changing prevalence in an aging population and some implications for the delivery of health care services. Canadian Journal of Aging, 29(1), 11–21.
Doorslaer, E. V., O’Donnel, O., Rannan-Eliya, R. P., Somanathan, A., Adhikari, S. R., Garg, C. C., et al. (2006). Effect of payments for health care on poverty estimates in 11 Countries in Asia: An analysis of household survey data. The Lancet, 368(9544), 1357–1364.
Duggal, R. (2007). Healthcare in India: Changing the financing strategy. Social Policy and Administration, 41(4), 386–394.
Duraisamy, P., & Mahal, A. (2005). Health, poverty and economic growth in India (Section 1). Background papers of the National Commission on Macroeconomics and Health, Ministry Of Health And Family Welfare, Government of India. http://www.who.int/macrohealth/action/Background%20Papers%20report.pdf. Accessed April 10, 2016.
Engelgau, M. M., Karan, A., & Mahal, A. (2012). The Economic impact of non-communicable diseases on households in India. Globalization and Health, 8(1), 1–10.
Flores, G., Krinshnakumar, J., O’Donnell, O., & Van Doorslaer, E. (2008). Coping with health care costs: Implication for the measurement of catastrophic expenditures and poverty. Health Economics, 17(12), 1393–1412.
Garg, C. C., & Karan, A. K. (2009). Reducing out-of-pocket expenditures to reduce poverty: A disaggregated analysis at rural-urban and state level in India. Health Policy and Planning, 24(2), 116–128.
Ghosh, S. (2011). Catastrophic payments and impoverishment due to out-of-pocket health spending. Economic and Political Weekly, 46(47), 63–70.
Government of India. (2013). The Twelfth five year plan (2012–17),social sectors volume III. planning commission. New Delhi: Sage.
Hammer, J., Aiyar, Y., & Samji, S. (2007). Understanding government failure in public health services. Economic and Political Weekly, 42(40), 4049–4057.
Hooda, S. K. (2013). Changing patterns of public expenditure on health: Issues and challenges, ISID-PHFI collaborative research programme. Institute for studies in industrial development, working paper series. http://isidev.nic.in/pdf/WP154.pdf. Accessed April 13 2016.
Hooda, S. K. (2015). Health insurance, health access and financial risk protection. Economic and Political Weekly, 50(50), 63–72.
Howitt, P., Darzi, A., Yang, G. Z., Ashrafian, H., Atun, R., Barlow, J., et al. (2012). Technologies for global health. The Lancet, 380(9840), 507–535.
Kankeu, H. T., Saksena, P., Xu, K., & Evans, D. B. (2013). The financial burden from non-communicable diseases in low-and middle-income countries: A literature review. Health Research Policy and Systems, 11, 31.
Ladusingh, L., & Pandey, A. (2013). Health expenditure and impoverishment in India. Journal of Health Management, 15(1), 57–74.
Lee, J. T., Hamid, F., Pati, S., Atun, R., & Millett, C. (2015). Impact of non-communicable disease multimorbidity on healthcare utilisation and out-of-pocket expenditures in middle-income countries: Cross sectional analysis. PLoS ONE, 10(7), e0127199.
Leone, T., James, K. S., & Padmadas, S. S. (2013). The burden of maternal health care expenditure in India: Multilevel analysis of national data. Maternal and Child Health Journal, 17(9), 1622–1630.
Mahal, A., Karan, A., & Engelgau, M. (2010). The economic implications of non-communicable Disease for India. Washington, DC: World Bank.
Maher, D., & Ford, N. (2011). Action on noncommunicable diseases: balancing priorities for prevention and care. Bulletin of the World Health Organization, 89(8), 547.
Matsaganis, M., Mitrakos, T., & Tsakloglou, P. (2009). Modelling health expenditure at the household level in Greece. The European Journal of Health Economics, 10(3), 329–336.
Mohanty, S. K., & Srivastava, A. (2012). Out-of-pocket expenditure on institutional delivery in India. Health Policy and Planning, 28(3), 247–262.
Moreno Serra, R., & Smith, P. C. (2012). Does progress towards universal health coverage improve population health? The Lancet, 380(9845), 917–923.
National Sample Survey Office (NSSO). (2014). Key Indicators of Social Consumption of Health. 71st Round (January–June 2014). Ministry of Statistics and Programme Implementation: New Delhi, Government of India.
Pal, R. (2010). Borrowing for hospitalization in India. MPRA Paper 29404. Germany, University Library of Munich. https://mpra.ub.uni-muenchen.de/29404/1/MPRA_paper_29404.pdf. Accessed April 04 2016.
Pal, R. (2013). Out-of-pocket health expenditure: Impact on the consumption of Indian households. Oxford Development Studies, 41(2), 258–279.
Park, K. (2011). Textbook of Preventive and Social Medicine (21st ed.). Jabalpur: Banarsidas Bhanot.
Pati, S., Agrawal, S., Swain, S., Lee, J. T., Vellakkal, S., Hussain, M. A., et al. (2014). Non communicable disease multimorbidity and associated health care utilization and expenditures in India: cross-sectional study. BMC Health Services Research, 14(1), 1.
Planning Commission (2012). Press Note on Poverty Estimates, 2009–2010, 19 March http://planningcommission.nic.in/news/press_pov1903.pdf. Accessed April 13 2016.
Quintussi, M., Van de Poel, E., Panda, P., & Rutten, F. (2015). Economic consequences of ill-health for households in northern rural India. BMC Health Services Research, 15(1), 1.
Reddy, K. S., Patel, V., Jha, P., Paul, V. K., Kumar, A. S., Dandona, L., et al. (2011). Towards achievement of universal health care in India by 2020: A call to action. The Lancet, 377(9767), 760–768.
Reddy, K. S., Shah, B., Varghese, C., & Ramadoss, A. (2005). Responding to the threat of chronic diseases in India. The Lancet, 366(9498), 1744–1749.
Selvaraj, S., & Karan, A. K. (2009). Deepening health insecurity in India: Evidence from national sample surveys since 1980s. Economic and Political Weekly, 44(40), 55–60.
Selvaraj, S., & Karan, A. K. (2012). Why publicly-financed health insurance schemes are ineffective in providing financial risk protection. Economic and Political Weekly, 47(11), 61–68.
Shahrawat, R., & Rao, K. D. (2012). Insured yet vulnerable: out of pocket payments and India’s poor. Health Policy and Planning, 27(3), 2013–2221.
Sharma, D. C. (2015). Concern over private sector tilt in India’s new health policy. The Lancet, 385(9965), 317.
Singh, P., & Kumar, V. (2016). Insurance coverage under different health schemes in Uttar Pradesh, India. Clinical Epidemiology and Global Health,. doi:10.1016/j.cegh.2016.03.002.
Sodhi, C., & Rabbani, A. (2014). Health service system in India. Is insurance the way forward. Economic and Political Weekly, 49(35), 26–28.
Srivastava, R. K., & Bachani, D. (2011). Burden of NCDs, policies and programme for prevention and control of NCDs in India. Indian Journal of Community Medicine, 36(5), 7.
Srivastava, A., & Mohanty, S. K. (2012). Poverty among elderly in India. Social Indicators Research, 109(3), 493–514.
Thakur, J. S., Prinja, S., Garg, C. C., Mendis, S., & Menabde, N. (2011). Social and economic implications of non-communicable diseases in India. Indian Journal of Community Medicine, 36(5), 13.
Wagstaff, A., & Doorslaer, E. V. (2003). Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993–1998. Health Economics, 12(11), 921–933.
Walley, J., Graham, K., Wei, X., Kain, K., & Weston, R. (2012). Getting research into practice: primary care management of non-communicable diseases in low-and middle-income countries. Bulletin of the World Health Organization, 90(6), 402.
WHO, UNICEF, UNFPA, World Bank, United Nation Population Division. (2015). Trends in Maternal Mortality 1990 to 2015: Estimates by WHO, UNICEF, World Bank, UNFPA and United Nations Population Division. Geneva,WHO. http://apps.who.int/iris/bitstream/10665/194254/1/9789241565141_eng.pdf?ua=1. Accessed March 13 2016.
Yeravdekar, R., Yeravdekar, V. R., Tutakne, M. A., Bhatia, N. P., & Tambe, M. (2013). Strengthening of primary health care: Key to deliver inclusive health care. Indian Journal of Public Health, 57(2), 59–64.
Acknowledgments
We would like to thank Dr. Falguni Pattanaik and the reviewers for his valuable suggestions.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None.
Additional information
The original version of this article was revised. The formula in section 2.2.1.1 Multivariate Analysis and the figure missing the full name of the variables. The correct formula and figures are given in this erratum.
An erratum to this article is available at https://doi.org/10.1007/s11205-017-1667-4.
Rights and permissions
About this article
Cite this article
Singh, P., Kumar, V. The Rising Burden of Healthcare Expenditure in India: A Poverty Nexus. Soc Indic Res 133, 741–762 (2017). https://doi.org/10.1007/s11205-016-1388-0
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11205-016-1388-0