Tuberculosis care a financial strain on households

KOCHI: Under the national TB programme, diagnosis and treatment facilities are provided free of cost to all TB patients. However, the reality is that almost 50% TB patients are going through ‘catastrophic’ health expenditure due to which a patient’s household is forced to cuts its basic expenses, shows a new study - “Rising healthcare expenditure on tuberculosis: Can India achieve the end TB goal?”

Handling of TB cases is also crucial during the pandemic as there are concerns that Covid is flaring up TB cases in the country. India has the highest number of TB cases (27% of the global share) in the world. Currently, there are about 24,500-plus TB patients seeking treatment in the state, with two-thirds of the cases reported among the economically productive age group (14–59 years).

To examine the out-of-pocket expenditure (OOPE), healthcare burden, catastrophic health expenditure, hardship financing and impoverishment effects of TB treatment in India, the authors studied data from three rounds of national statistical surveys — 2004-05, 2013-14 and 2017-18. The present analysis helps understand the financial burden TB treatment causes on households for the past 15 years. It provides evidence to policymakers for more effective channelling of resources in order to achieve a TB-free India by 2025.

The analysis shows that OOPE, healthcare burden, hardship financing and catastrophic health expenditure are considerably higher for those utilising private hospital services and among poor, rural households. Overall, 49% of hospitalised patients and 52% of OPD patients with TB in 2018 were exposed to catastrophic healthcare expenditure.

Incidentally, males were affected by TB more than females and this also has an impact on family’s earning. In 2004, the ratio of men and women seeking outpatient TB care was almost the same, whereas in 2014 and 2018, it was 80% to 20%. In the case of hospitalisation, the number of male patients is higher than females.

“End TB strategy milestones for 2025 and 2035 has an objective that no affected families face catastrophic costs due to TB. Based on our analysis using various rounds of NSSO, this is far from achieving a reality in India,” said Denny John, adjunct assistant professor, Amrita Institute of Medical Sciences & Research Centre, and co-author of the study.