Financial burden of seeking diabetes mellitus care in India: Evidence from a Nationally Representative Sample Survey

Abstract

BackgroundDiabetes mellitus (DM) is a major public health concern in India, and entails a severe burden in terms of disability, death, and economic cost. This study examined the out‐of‐pocket health expenditure (OOPE) and financial burden associated with DM care in India.MethodsThe study used data from the latest round of the National Sample Survey on health, which covered 555,115 individuals from 113,823 households in India. In the present study, data of 1216 individuals who sought inpatient treatment and 6527 individuals who sought outpatient care for DM were analysed.ResultsIn India, 10.04 per 1000 persons reported having DM during the last 15 days before the survey date, varying from 6.94/1000 in rural areas to 17.45/1000 in urban areas. Nearly 38% of Indian households with diabetic members experienced catastrophic health expenditure (at the 10% threshold) and approximately 10% of DM‐affected households were pushed below the poverty line because of OOPE, irrespective of the type of care sought. 48.5% of households used distressed sources to finance the inpatient costs of DM. Medicines constituted one of the largest proportion of total health expenditure, regardless of the type of care sought or type of healthcare facility visited. The average monthly OOPE was over 4.5‐fold and 2.5‐fold higher for households who sought inpatient and outpatient care, respectively, from private health facilities, compared with those treated at public facilities. Notably, the financial burden was more severe for households residing in rural areas, those in lower economic quintiles, those belonging to marginalised social groups, and those using private health facilities.ConclusionThe burden of DM and its associated financial ramifications necessitate policy measures, such as prioritising health promotion and disease prevention strategies, strengthening public healthcare facilities, improved regulation of private healthcare providers, and bringing outpatient services under the purview of health insurance, to manage the diabetes epidemic and mitigate its financial impact.

An Examination of Inter-State Variation in Utilization of Healthcare Services, Associated Financial Burden and Inequality: Evidence from Nationally Representative Survey in India

“…We found that utilization of health care services from private health facilities puts an exorbitant burden on households in concordance with previous studies. 31,33,34,53,54,75 We also found deleterious effect of utilizing private health facilities across all states/UTs. However, the burden was more pronounced in poorer states such as Chhattisgarh, Uttar Pradesh, Madhya Pradesh, Manipur, Odisha, and Bihar, where more than 50 percent of households faced CHE incidence and over 20 percent of households were pushed below the poverty line due to seeking care from private health care facilities in the case of both inpatient and outpatient care.…”

“…32–34,38,41 Moreover, much of the noncommunicable diseases care is provided by the private health care sector in India. 33,34,41,53,73–75 Previous studies have also suggested that wealthier states invest more in health, have a vast provision of private health care services, 40,76–78 and their residents usually have more financial resources to spend on health care. 47,79 On the other hand, the outpatient services were heavily concentrated among private health care providers (approximately 70%) in India, as well as across most states.…”