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Cancer and heart disease biggest debt traps

5 min read

G.S. Mudur
May 14, 2018 00:00 IST

New Delhi: Indian households are at greatest risk of indebtedness from their spending on hospital care when facing cancers, heart diseases and genitourinary disorders, in that order, the first study to analyse disease-specific health-care expenditure has found.

Over 42 per cent of households seeking hospital care for cancer resort to "distress financing", which means borrowing from relatives or friends or selling assets such as ornaments or property, according to the study by the International Institute of Population Sciences, Mumbai.

Over one-third of households with patients admitted to hospitals for cardiovascular, genitourinary, neurological or gastrointestinal diseases also turn to distress financing. (See chart)

The findings were published on Friday in the research journal PLOS One.

The Union health ministry's National Health Policy document had estimated two years ago that health-care expenses drive about 60 million people in the country into poverty every year.

Earlier studies too had suggested that personal, or out-of-pocket, expenditure accounted for 70 per cent of total health spending in India.

"Hospitalisation imposes a financial burden on many households. We have tried to find out which diseases cause the greatest financial distress," said Sanjay Kumar Mohanty, a professor at the IIPS who had led the new study. The findings could, Mohanty said, help guide the distribution of funds for various health-care services and assess the impact over time.

"We find that hospitalisation for genitourinary, neurological and gastrointestinal diseases is almost as burdensome for households as treatment for heart diseases," said Anshul Kastor, a research scholar and co-author of the study.

The researchers used the latest available data from the government's National Sample Survey Organisation, covering 65,932 households across the country and analysing about 42,000 hospitalisation cases.

Among all households that reported hospitalisation, 49 per cent incurred catastrophic expenditure, defined as having to spend at least 10 per cent of the monthly household income on the hospital services.

"When over 10 per cent goes into health-care, a household is almost always forced to squeeze money away from some other routine monthly spending, maybe food or education or something else," Mohanty said. The next step is distress financing.

The study found that the highest incidence of catastrophic spending was associated with cancers - 79 per cent of households - compared with 63 per cent for genitourinary disorders and 60 per cent for heart diseases.

"Delays in the proper diagnosis of genitourinary disorders may lead to the need for hospitalisation or longer hospital stay," said Nita Thakre, a gynaecologist in Ahmedabad and chairperson of the urogynaecology panel of the Federation of Obstetrics and Gynaecological Societies of India, who was not associated with the study.

The analysis has also revealed declines between 2004 and 2014 in the proportions of households resorting to distress financing across all clusters of diseases.

Distress financing, for instance, fell from 74 per cent in 2004 to 42 per cent in 2014 for cancers, from 58 per cent to 34 per cent for gastrointestinal disorders and from 69 per cent to 30 per cent for tuberculosis.

"These decreases in distress financing may have been the result of various government programmes and schemes that are helping reduce households' expenditure on treatment," Kastor said.

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