Study reveals economic toll of non-communicable diseases on households of Punjab

Chandigarh: As the burden of non-communicable diseases (NCDs) continues to rise across Punjab, their economic impact on households is becoming increasingly severe.

A recent study found that out-of-pocket healthcare expenses are pushing many families into catastrophic health expenditure (CHE), with the burden falling disproportionately on lower-income groups and those with specific socioeconomic vulnerabilities.

Households with larger family sizes and lower levels of education were particularly at risk of financial hardship due to medical costs.

With NCDs recognised as a public health priority due to their significant contribution to disability, illness, and mortality, the study aimed to estimate out-of-pocket expenditures, catastrophic health expenditures (CHE), and income loss among affected households.

The data was collected from 576 individuals across various healthcare facilities in Punjab.

The majority of respondents diagnosed with NCDs were male, and most were from urban areas. These diseases were largely classified as lifestyle-related, and a significant proportion of respondents fell within the 41-60 and above 60 age groups.

Notably, 54 per cent reported a family history of NCDs. Among the various conditions identified, diabetes was the most prevalent (31 per cent), followed by hypertension (24 per cent), cardiovascular disease (19 per cent), stroke (15 per cent), and chronic obstructive pulmonary disease (11 per cent).

The study also examined healthcare-seeking behaviour and revealed that 76 per cent of respondents relied on allopathic treatment. This was followed by home remedies (18 per cent), ayurveda (5 per cent), and homoeopathy (1 per cent).

In terms of healthcare facility usage, 48 per cent accessed private care, 26 per cent relied on public facilities, 19 per cent consulted chemists, and 7 per cent turned to homoeopathy care providers.

Regarding insurance coverage, 259 individuals held private insurance, 34 per cent were covered under the govt scheme Ayushman Bharat-Mukh Mantri Sehat Bima Yojana (AB-MMSBY), and 21% were unaware of their insurance status. On average, respondents travelled 5.49 km to access healthcare services.

The cost analysis revealed that cardiovascular disease patients incurred the highest mean direct outpatient expenses at Rs 48,000 (ranging from Rs 3,800 to Rs 90,000), along with an average indirect cost of Rs 6,000 (Rs 500-Rs 7,500).

Stroke patients followed, with an average direct outpatient cost of Rs 40,300 (Rs 4,000-Rs 85,000). COPD patients incurred the second-highest mean indirect cost at Rs 4,909.

In contrast, patients with hypertension experienced the lowest direct and indirect outpatient costs. Medicine costs represented the largest share of expenses across all NCDs, followed by diagnostic tests, consultation fees, and transportation.

Inpatient treatment data showed that only 209 of the 576 respondents utilised such care. Cardiovascular disease again accounted for the highest mean direct inpatient cost at Rs 90,000 (Rs 2,500-Rs 1,50,000), followed by COPD, hypertension, stroke, and diabetes.

Under indirect inpatient expenses, COPD patients incurred the highest mean cost at Rs 5,000 (Rs 500-Rs 10,000), followed by cardiovascular disease, diabetes, stroke, and hypertension.

The study also analysed the incidence and intensity of catastrophic healthcare expenditure. Diabetes patients experienced the highest incidence of CHE at all threshold levels, while COPD patients reported the lowest at the 20 and 30% thresholds.

The intensity or overshoot of CHE for diabetes and hypertension patients exceeded 8% at the 5% threshold. Stroke patients showed the lowest overshoot across all thresholds.

Hypertension patients experienced the second-highest overshoot and the highest average positive overshoot at both 5 and 10% thresholds.

The study, titled 'Out-of-pocket payments and catastrophic healthcare expenditure for non-communicable diseases: Results of a State-wide STEPS survey in north India', was conducted by researchers Pooja Kansra, Sumit Oberoi, and Anurag Garg. The findings have been published in the Indian Journal of Medical Research.

In light of these findings, the researchers recommended that the govt health insurance scheme AB-MMSBY be expanded to cover outpatient as well as pre- and post-diagnostic expenses for patients with cardiovascular disease, COPD, and diabetes. They also highlighted the urgent need to include individuals with type-1 diabetes under existing health insurance benefits.