Out-of-Pocket, Catastrophic Health Expenditure and Distress Financing on Non-Communicable Diseases in India: A Systematic Review with Meta-Analysis

Dhankhar, Anushikha; Kumari, Ranjeeta; Bahurupi, Yogesh

doi:10.31557/apjcp.2021.22.3.671

Cited by 22 publications

(7 citation statements)

References 22 publications

(11 reference statements)

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“…Breaking the BBN session into multiple smaller sessions may be particularly appropriate for such patients. For an average Indian family, finances may be the primary determinant of treatment, as studies have revealed extremely high out-of-pocket and catastrophic expenditures for cancer care in India [ 30 , 31 ]. Hence, when the family insists, the oncologist has to speak about some aspects of treatment like finances, without including the patient in the conversation, which might have also contributed to the shorter session times.…”

Section: Discussionmentioning

confidence: 99%

PENS approach for breaking bad news in the oncology outpatient setting: a real-world report

Mailankody

Sherigar

Pai

et al. 2022

Support Care Cancer

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Purpose Breaking bad news (BBN) is a vital part of oncology practice. We conducted this study to assess an abbreviated PENS protocol [Patient preference, Explanation, Next appointment, and Support] for BBN in oncology outpatient (OP) settings. Methods This observational study was conducted in a university teaching hospital, including cancer patients who were unaware of their condition and willing to discuss their disease status. The duration of BBN was the primary outcome. After the BBN session, patients filled a validated questionnaire; response scores of ≤ 13 were classified as content with BBN. Results Fifty patients (mean age 53.7 years, range 28–76) were included in the study. The average duration of BBN was 6.1 (range 2–11) min. Assessed by the response score sum, 43 (86%) patients were satisfied with BBN. Only three (6%) of the discontented patients felt that the BBN duration was too short. Most (94%) of patients reported that they understood the information imparted during the BBN session. After the session, 36 (72%) patients admitted to either feeling the same or reassured compared to before the session. The oncologists also were comfortable with PENS. Conclusions The PENS approach is a practical method for BBN, especially when the oncologists have higher OP workloads. More extensive trials are required to validate the protocol in other settings. Trial registration Clinical Trial Registry of India (CTRI/2021/07/034707).

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Section: Discussionmentioning

confidence: 99%

PENS approach for breaking bad news in the oncology outpatient setting: a real-world report

Mailankody

Sherigar

Pai

et al. 2022

Support Care Cancer

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“…Several studies have attempted to estimate the economic burden of cancer in the past (11)(12)(13)(14)(15)(16)(17)(18)(19). However, there were certain methodological limitations in published studies.…”

Section: Introductionmentioning

confidence: 99%

Financial toxicity of cancer treatment in India: towards closing the cancer care gap

Prinja

Dixit

Gupta

et al. 2023

Front. Public Health

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BackgroundThe rising economic burden of cancer on patients is an important determinant of access to treatment initiation and adherence in India. Several publicly financed health insurance (PFHI) schemes have been launched in India, with treatment for cancer as an explicit inclusion in the health benefit packages (HBPs). Although, financial toxicity is widely acknowledged to be a potential consequence of costly cancer treatment, little is known about its prevalence and determinants among the Indian population. There is a need to determine the optimal strategy for clinicians and cancer care centers to address the issue of high costs of care in order to minimize the financial toxicity, promote access to high value care and reduce health disparities.MethodsA total of 12,148 cancer patients were recruited at seven purposively selected cancer centres in India, to assess the out-of-pocket expenditure (OOPE) and financial toxicity among cancer patients. Mean OOPE incurred for outpatient treatment and hospitalization, was estimated by cancer site, stage, type of treatment and socio-demographic characteristics. Economic impact of cancer care on household financial risk protection was assessed using standard indicators of catastrophic health expenditures (CHE) and impoverishment, along with the determinants using logistic regression.ResultsMean direct OOPE per outpatient consultation and per episode of hospitalization was estimated as ₹8,053 (US$ 101) and ₹39,085 (US$ 492) respectively. Per patient annual direct OOPE incurred on cancer treatment was estimated as ₹331,177 (US$ 4,171). Diagnostics (36.4%) and medicines (45%) are major contributors of OOPE for outpatient treatment and hospitalization, respectively. The overall prevalence of CHE and impoverishment was higher among patients seeking outpatient treatment (80.4% and 67%, respectively) than hospitalization (29.8% and 17.2%, respectively). The odds of incurring CHE was 7.4 times higher among poorer patients [Adjusted Odds Ratio (AOR): 7.414] than richest. Enrolment in PM-JAY (CHE AOR = 0.426, and impoverishment AOR = 0.395) or a state sponsored scheme (CHE AOR = 0.304 and impoverishment AOR = 0.371) resulted in a significant reduction in CHE and impoverishment for an episode of hospitalization. The prevalence of CHE and impoverishment was significantly higher with hospitalization in private hospitals and longer duration of hospital stay (p < 0.001). The extent of CHE and impoverishment due to direct costs incurred on outpatient treatment increased from 83% to 99.7% and, 63.9% to 97.1% after considering both direct and indirect costs borne by the patient and caregivers, respectively. In case of hospitalization, the extent of CHE increased from 23.6% (direct cost) to 59.4% (direct+ indirect costs) and impoverishment increased from 14.1% (direct cost) to 27% due to both direct and indirect cost of cancer treatment.ConclusionThere is high economic burden on patients and their families due to cancer treatment. The increase in population and cancer services coverage of PFHI schemes, creating prepayment mechanisms like E-RUPI for outpatient diagnostic and staging services, and strengthening public hospitals can potentially reduce the financial burden among cancer patients in India. The disaggregated OOPE estimates could be useful input for future health technology analyses to determine cost-effective treatment strategies.

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“…Most of the literature to date linking COVID-19 and financial services has focused on how the pandemic has challenged the financial security of financial sector institutions (e.g., [12][13][14]), of businesses [15][16][17], and of households [18][19][20]. Similarly, the public health literature beyond COVID-19 has focused on how health problems can cause financial risk, including socalled distress financing, the phenomenon of lower-income households coping with health crises and health-related negative income shocks by relying on selling assets and over-indebtedness, in turn begetting further financial risk for the households [21][22][23]. Distress financing tends to be higher where insurance is thin and national systems lack universal healthcare.…”

Section: Introductionmentioning

confidence: 99%

The impact of access to financial services on mitigating COVID-19 mortality globally

Watkins

Nguyen²,

Ali³

et al. 2023

PLOS Glob Public Health

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The COVID-19 pandemic has disproportionately affected different social and demographic groups, deepening the negative health implications of social and economic inequalities and highlighting the importance of social determinants of health. Despite a deep literature on pandemic-related disparities, specifically regarding social determinants and health outcomes, the influence of the accessibility of financial services on health outcomes during COVID-19 remains largely unexplored. Modeling (pre-omicron) COVID-19 mortality across 142 nations, we assess the impact of national-level usage and access to formal financial services. Two financial access indexes constructed through principal component analysis capture (1) usage of and access to formal financial tools and (2) reliance on alternative and informal financial tools. On average, nations with higher pre-pandemic use of and access to formal financial services had substantially lower population mortality risk from COVID-19, controlling for key population health, demographic, and socioeconomic covariates. The scale of effect is similar in magnitude—but opposite in direction—to major risk factors identified in previous literature, such as lung cancer, hypertension, and income inequality. Findings suggest that financial services deserve greater attention both in the public health literature related to COVID-19 and more broadly in policy discussions about fostering better public health overall.

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Out-of-Pocket, Catastrophic Health Expenditure and Distress Financing on Non-Communicable Diseases in India: A Systematic Review with Meta-Analysis

Abstract: the insurance coverage is limited and health expenditures are not covered for approximately 80% of the population (Government of India, NSSO, 2020). Therefore, the treatment cost often results in financial catastrophe and

Cited by 22 publications

References 22 publications

PENS approach for breaking bad news in the oncology outpatient setting: a real-world report

PENS approach for breaking bad news in the oncology outpatient setting: a real-world report

Financial toxicity of cancer treatment in India: towards closing the cancer care gap

The impact of access to financial services on mitigating COVID-19 mortality globally

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