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Health costs make Indians financially sick

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Cancer, genito-urinary conditions and heart diseases are the biggest reasons why millions of Indians are pushed into extreme poverty every year, the first-ever disease-specific analysis of out-of-pocket and catastrophic health expenditure on hospitalisation has found, reported The New Indian Express (India).

The other diseases that force a large number of people to sell properties or land or borrow huge amounts of money include gastrointestinal disorders, neurological and musculoskeletal conditions, injuries, jaundice, diabetes, respiratory diseases, asthma and tuberculosis.

The study carried out by researchers at the Mumbai based International Institute of Population Sciences also reveals that mean cost of hospitalisation in India is Rs 19,210 and it is the highest for cancer at Rs 57,232 followed by heart diseases at Rs 40, 947.

According to a WHO-World Bank report released last year, India accounts for about half of the estimated 100 million people pushed into poverty worldwide every year due to out-of-pocket expenses on health care.

The Union Ministry of Health and Family Welfare’s data says that almost 4.9 crore Indians are impacted by catastrophic healthcare expenses annually but there was no dissection done on which are the diseases that lead to the situation.

“There have been many studies to examine variation in disease patterns so we thought, it would be relevant to analyse disease-specific out-of-pocket expenditure, catastrophic health expenditure and distress health financing,” said Anshul Kastor, co-author of the study.

The study, which has used unit data from the National Sample Survey Organisation (2014), notes that India is experiencing the triple burden of diseases, that is, rising non-communicable diseases, increasing injuries and the unfinished agenda of infectious diseases.

“The disease pattern is changing rapidly, with non-communicable diseases like cardiovascular diseases, cancer, chronic respiratory diseases, diabetes becoming the leading cause of mortality,” it says.

It has also highlighted that NCDs in India accounted 50 per cent of total deaths in 2004 which increased to 60 per cent by 2014.

“Similarly, hospitalisation due to NCDs accounted for 29 per cent of total hospitalisation in 2004 and increased to 38 per cent by 2014.

The share of out-of-pocket expenditure on total health spending has remained stagnant during the period (71 per cent in 2004 and 69 per cent in 2014,” said the study.

The analysis has recommended that free treatment for cancer and heart diseases should be provided for the vulnerable sections of the society.

Experts pointed out that much of the findings were expected as not only cancer and cardiovascular disease but many conditions like neurological disorders lead to distress financing by families.

“Neurological disorders common in elderly include stroke, dementia, Parkinson’s disease,” said Pettrusp Wadia, a consultant neurologist in Jaslok Hospital in Mumbai.

Priya Balasubramaniam, an expert with Delhi-based Public Health Foundation of India said that covering more and more people for NCDs along with a robust primary health care is the only way to reduce catastrophic health burden on millions of Indians.

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It was at the beginning of this year that Padmavathi, 33, of Vembaloor, Ariakode, jumped with her two children, aged 10 and 7, into a pond and committed suicide. Around the same time, Sarada, a homemaker from Nellikalkad in Alathur, took the extreme step. Chandran, also from Nellikalkad, decided to end his life by hanging himself at his house nearly a month ago, reported The New Indian Express (India).

Then there were two more similar tragedies, all in the past five months, within 1km. The reason for their suicide was the same — they wilted under pressure after availing loan from micro-finance companies, whose passbooks do not even carry the companies’ name or seal.

Nine of them are functioning in this small area alone. According to social activist Aboobacker Siddique, they give a loan of Rs 1 lakh for a group of 10 women. Each one will get Rs 8,800, which will have to be paid in weekly instalments over a period of 52, 75 or 104 weeks. When the loan nears completion, the same group will be offered Rs 2 lakh. “Not all members need the money, but are made liable for the total amount availed,” said Siddique.

Padmavathi reportedly could not withstand the pressure from the members of her group and the company’s employees. The interest charged is 16 per cent flat which works out at 32 per cent at a diminishing rate. A processing fee of Rs 2,700 is deducted for a Rs 40,000 loan given to a 20-member group. Siddique said when restrictions were imposed by the RBI, capping the interest rate at 24.5 per cent, the processing fee was hiked.

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