Out-of-pocket expenditure and catastrophic health expenditure for hospitalization due to injuries in public sector hospitals in North India

English version

Autoři: Shankar Prinja ^aff001; Jagnoor Jagnoor ^aff002; Deepshikha Sharma ^aff001; Sameer Aggarwal ^aff001; Swati Katoch ^aff001; P. V. M. Lakshmi ^aff001; Rebecca Ivers ^aff003
Působiště autorů: Post Graduate Institute of Medical Education and Research, Chandigarh, India ^aff001; The George Institute for Global Health, New Delhi, India ^aff002; The George Institute for Global Health, University of Sydney, Sydney, Australia ^aff003
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0224721

Souhrn

Background

Injuries are a major public health problem, resulting in high health care demand and economic burden. They result in loss of disability adjusted life years (DALYs) and high out-of-pocket expenditure. However, there is little evidence on the economic burden of injuries in India. We undertook this study to report out-of-pocket expenditure and the prevalence of catastrophic health expenditure for injuries related hospitalizations in public sector hospitals in North India. Further, we also evaluate the determinants of catastrophic health expenditure.

Methods and analysis

A prospective observational study was conducted. Participants were recruited from three hospitals for all injury cases. Data were collected via face-to-face baseline interviews and follow-up interviews over the phone at 1, 2, 4 and 12 months post-injury. Prevalence of catastrophic health expenditure (more than 30% of consumption expenditure) and impoverishment (International dollar 1.90) were estimated.

Results

Road traffic injuries (57%) were the leading cause of injury. Direct out-of-pocket expenditure for hospitalizations was INR 16,768 (USD 263) while indirect productivity loss was INR 8,164 (USD 128). The prevalence of catastrophic expenditure was 22.2% with 12.2% slipping below poverty line. Prevalence of catastrophic health expenditure and impoverishment was higher and significantly associated with poorest quintile, tertiary care hospital and increased duration of hospitalization (p< 0.001).

Conclusion

The economic impact of injuries is notably high both in terms of out-of-pocket expenditure and productivity loss. A high proportion of households experienced catastrophic expenditure and impoverishment following an injury, highlighting need for programs to prevent injuries.

Klíčová slova:

Health economics – Economics – Socioeconomic aspects of health – India – Health insurance – Hospitalizations – Burns – Indirect costs

Zdroje

1. Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, et al. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016; 388:1459–544. doi: 10.1016/S0140-6736(16)31012-1 27733281

2. World Health Organization. Global status report on road safety. Geneva: World Health Organization, 2015

3. Vos T, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. 2017 Sep 16; 390(10100):1211–59.

4. World Health Organization. Injuries and violence: the facts 2014. 2014. Geneva: World Health Organization; 2014. 20p.

5. Kassebaum NJ, Arora M, Barber RM, Bhutta ZA, Brown J, Carter A, et al. Global, regional, and national disability-adjusted life years (DALYs) for 315 diseases and injuries and healthy life expectancy(HALE) for 195 countries and territories, 1990–2015: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors (GBD) 2015 Study. Lancet. 2016; 388: 1603–58. doi: 10.1016/S0140-6736(16)31460-X 27733283

6. Mohan D. The road ahead: traffic injuries and fatalities in India. Delhi: Indian Institute of Technology, Transportation Research and Injury Prevention Programme. 2004.

7. NSSO. Key Indicators of Social Consumption in India Health. NSS 71st Round (January-June 2014). New Delhi: National Sample Survey Organization, Ministry of Statistics and Programme Implementation, Government of India; 2015.

8. Reddy G, Negandhi H, Singh D, Singh AJ. Extent and determinants of cost of road traffic injuries in an Indian city. Indian J MedSci. 2009; 63(12):549–56.

9. Kumar GA, Dilip TR, Dandona L, Dandona R. Burden of out-of-pocket expenditure for road traffic injuries in urban India. BMC Health Serv Res. 2012; 12(1):285

10. Aeron-Thomas A, Jacobs GD, Sexton B, Gururaj G, Rahman F. The involvement and impact of road crashes on the poor: Bangladesh and India case studies. Transport research laboratory, published project report, PPR010. 2004.

11. Prinja S, Jagnoor J, Chauhan AS, Aggarwal S, Ivers R. Estimation of the economic burden of injury in north India: a prospective cohort study. Lancet. 2015; 385:S57.

12. Sharma D, Prinja S, Aggarwal AK, Bahuguna P, Sharma A, Rana S. Out-of-pocket expenditure for hospitalization in Haryana state of India: Extent, determinants and financial risk protection. Indian J Med Res. 2017 Dec; 146(6):759. doi: 10.4103/ijmr.IJMR_2003_15 29664035

13. Jagnoor J, Prinja S, Lakshmi PV, Aggarwal S, Gabbe B, Ivers RQ. The impact of road traffic injury in North India: a mixed-methods study protocol. BMJ open. 2015;5(8):e008884. doi: 10.1136/bmjopen-2015-008884 26289452

14. Wesson HK, Boikhutso N, Bachani AM, Hofman KJ, Hyder AA. The cost of injury and trauma care in low-and middle-income countries: a review of economic evidence. Health Policy Planning. 2014;29(6):795–808. doi: 10.1093/heapol/czt064 24097794

15. Gururaj G. Road traffic deaths, injuries and disabilities in India: current scenario. Natl Med J India. 2008 Jan 1;21(1):14. 18472698

16. Chandran A, Hyder AA, Peek-Asa C. The global burden of unintentional injuries and anyagenda for progress. Epidemiol Rev. 2010; 32(1): 110–20.

17. Van Beeck EF, Larsen CF, Lyons RA, Meerding WJ, Mulder S, Essink-Bot ML. Guidelines for the conduction of follow-up studies measuring injury-related disability. J Trauma Acute Care Surg. 2007 Feb 1;62(2):534–50.

18. NSSO. Concepts and Definitions Used in NSS. New Delhi: National Sample Survey Organization, Ministry of Statistics and Programme Implementation, Government of India; 2001.

19. Huffman M, Rao K, Pichon-Riviere A, Zhao D, Harikrishnan S, Ramaiya K, et al. A cross-sectional study of the microeconomic impact of cardiovascular disease hospitalization in four low-and middle-income countries. PloS One.2011;6:e20821. doi: 10.1371/journal.pone.0020821 21695127

20. Heeley E, Anderson CS, Huang Y, Jan S, Li Y, Liu M, et al. Role of health insurance in averting economic hardship in families after acute stroke in China. J Cereb Circ. 2009; 40:2149–56.

21. Rocha-García A, Hernández-Peña P, Ruiz-Velazco S, Avila-Burgos L, Marín-Palomares T, Lazcano-Ponce E. Out-of-pocket expenditures during hospitalization of young leukemia patients with state medical insurance in two Mexican hospitals. Salud Pública México2003, 45, 285–292.

22. Jan S, Lee SW, Sawhney JP, Ong TK, Chin CT, Kim HS, et al. Catastrophic health expenditure on acute coronary events in Asia: a prospective study. Bulletin of the World Health Organization. 2016 Mar 1;94(3):193. doi: 10.2471/BLT.15.158303 26966330

23. Alvarez-Hernandez E, Pelaez-Ballestas I, Boonen A, Vázquez-Mellado J, Hernández-Garduño A, Rivera FC, et al. Catastrophic health expenses and impoverishment of households of patients with rheumatoid arthritis. Reumatol Clin.2012; 8:168–73. doi: 10.1016/j.reuma.2012.05.002 22704914

24. The OECD List of Social Indicators. Paris; Organisation for Economic Co-operation and Development. 1982

25. Greene WH. Econometric analysis. Pearson Education. 2003.

26. Rice DP, Hodgson TA, Kopstein AN. The economic cost of illness: a replication and update. Health Care Financ Rev. 1985;7:61–8. 10311399

27. Papola TS and Kanan KP. ILO-Asia Pacific Working paper series. Towards an India Wage Report. DWT for South Asia and Country Office for India. 2017 Oct. 185p.

28. Koopmanschap MA, Rutten FF, van Ineveld BM, Van Roijen L. The friction cost method for measuring indirect costs of disease. J Health Econ. 1995;14(2):171–89. 10154656

29. Gupta SK. Proposed Pharmacoeconomics Guidelines For India (PEG-I). Second International Conference of Pharmacoeconomics and Outcomes Research; 2013 Oct 9 and 10; New Delhi, India. New Delhi, India: ISPOR–India Chapter. 2013.79–117.

30. Gopalakrishnan S. A public health perspective of road traffic accidents. J Fam Med Primary Care. 2012;1(2):144.

31. Nguyen H, Ivers R, Jan S, Martiniuk A, Pham C. Catastrophic household costs due to injury in Vietnam. Injury. 2013 May 31;44(5):684–90. doi: 10.1016/j.injury.2012.05.006 22658420

32. Nguyen H, Ivers RQ, Jan S, Martiniuk AL, Li Q, Pham C. The economic burden of road traffic injuries: evidence from a provincial general hospital in Vietnam. Injury prevention. 2013 Apr 1;19(2):79–84. doi: 10.1136/injuryprev-2011-040293 22729166

33. Dror D, van Putten-Rademaker O, Koren R. Cost of illness: evidence from a study in five resource-poor locations in India. Indian J Med Res. 2008;127(4):347–61. 18577789

34. Engelgau M, Karan A, Mahal A. The Economic impact of Non-communicable diseases on households in India. Glob Health. 2012.

35. Joshipura MK: Trauma care in India: current scenario. World J Surg. 2008; 32(8):1613–17. doi: 10.1007/s00268-008-9634-5 18553048

36. Prinja S, Kanavos P, Kumar R. Health care inequities in north India: Role of public sector in universalizing health care. Indian J Med Res. 2012; 136(3): 421–31. 23041735

37. Brinda EM, Kowal P, Attermann J, Enemark U. Health service use, out-of-pocket payments and catastrophic health expenditure among older people in India: The WHO Study on global AGEing and adult health (SAGE). J Epidemiol Community Health. 2015 May 1;69(5):489–94. doi: 10.1136/jech-2014-204960 25576563

38. Organisation for Economic Co-operation and Development. Measuring productivity: OECD manual measurement of aggregate and industry-level productivity growth. OECD; 2001

39. Prinja S, Chauhan AS, Karan A, Kaur G, Kumar R. Impact of publicly financed health insurance schemes on healthcare utilization and financial risk protection in India: a systematic review. PloS one. 2017 Feb 2;12(2):e0170996. doi: 10.1371/journal.pone.0170996 28151946

40. Chatterjee P. India launches Ayushman Bharat's secondary care component. The Lancet. 2018 Sep 22;392(10152):997.

41. Prinja S, Sharma D, Katoch S, Kaur M, Jagnoor J. Final Report 2016: Evaluation of cashless scheme for road accident victims. Chandigarh: School of Public Health, Post-graduate Institute of Medical Education and Research; 2016 Dec. 123p.

42. Maharashtra government may soon put Rs 50,000 in mishap victims’ pocket. Available from: http://www.dnaindia.com/india/report-maharashtra-government-may-soon-put-rs-50000-in-mishap-victims-pockets-2124737. (accessed on 5 January 2017)

43. Karnataka launches Mukhyamantri Santwana Harish Yojana for free treatment to accident victims. Available from: https://www.google.co.in/amp/currentaffairs.gktoday.in/karnataka-launchesmukhyamantri-santwana-harish-yojana-free-treatment-accident-victims03201631236.html/amp?client=safari (accessed on 5 January 2017)

44. Scott K, Steele D, Temesgen T. Living Standards Measurement Study Surveys: Household Sample Surveys in Developing and Transition Countries. Available online: http://unstats.un.org/unsd/hhsurveys/pdf/Chapter_23.pdf (accessed on 24 November 2016).