Out-of-pocket payments & catastrophic healthcare expenditure for non-communicable diseases: Results of a State-wide STEPS survey in north India.

Abstract

Background & objectives Non-communicable diseases have been designated as 'public health priority' globally, and they are accountable for debility, morbidity, and mortality. Thus, the present study aims to estimate the out-of-pocket payment, catastrophic healthcare expenditures and household wage loss. Methods Field research was conducted with an adapted survey questionnaire. Data from 576 individuals from various healthcare facilities in Punjab were collected using a convenience sampling approach. The out-of-pocket and catastrophic healthcare expenditures (CHE) were estimated using descriptive statistics and indices, viz., headcount overshoot and mean positive overshoot. Lastly, logistic regression models were applied to identify determinants of catastrophic health expenditure. Results The study findings showed that most respondents incurred a high out-of-pocket payment for inpatient care. Further, at any threshold level, the incidence of catastrophic health was highest among diabetic patients. The intensity of catastrophic healthcare expenditure with diabetes and hypertension exceeded the five per cent threshold bracket. Logistic regression results revealed that the odds of incurring catastrophic healthcare expenditure were highest among respondents diagnosed with diabetes, chronic obstructive pulmonary disease (COPD), and stroke. Interpretation & conclusions The study recommends that the government health insurance scheme 'Ayushman Bharat-Mukh Mantri Sehat Bima Yojana (AB-MMSBY)' must include outpatient and pre- and post-diagnostic costs incurred by respondents diagnosed with cardiovascular disease (CVD), COPD, and diabetes in Punjab. Therefore, respondents with diabetes mellitus (i.e., specifically type-1 patients) must be covered under health insurance benefits.