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Chronic diseases driving untold numbers into poverty

Healthcare expenditure for NCDs is overwhelmingly paid for out of pocket, driving many into poverty. With NCD rates and risk factors such as obesity rising considerably in India, a considerable bill is being footed by the public.

Obese people are at significantly greater risk of health conditions such as heart disease and diabetes

A recent study published in The Lancet estimates a total expenditure on diabetes healthcare of $31 billion in 2017. Of this 86% of rural and 82% of urban households paid the cost of their healthcare out of pocket.

Out of pocket expenditure is a considerable issue in India, with a potential 55 million people — a population group larger than that of many countries — are driven into poverty through out of pocket healthcare bills.

Despite having a public health sector in which many services are provided free of charge, lack of reach of infrastructure drives vast numbers into the private sector. For services where cost is still placed with the patient, private sector equivalents are typically of a far higher price than in public health facilities.

One study, published in the British Medical Journal this June — conducted by Sakthivel Selvaraj, Habib Hasan Farooqui and Anup Karan from Public Health Foundation of India — found that of the 55 million people driven into poverty through medical payments, 38 million were placed into this impoverished status exclusively due to the out of pocket payments.

These numbers are backed up by numerous other studies. Data from the last National Sample Survey Office health survey conducted in 2013-14 indicated that 36 million households incurred health expenses that exceeded the annual per capita consumption of those households.

To put the 36 million household figure in perspective, Uttar Pradesh — India’s most populous state — consisted of 33 million households when the last census was conducted in 2011. The data would indicate that the equivalent of the entire population of the state were forced into debt through medical expenses.

Rural locations were found to account for 25 million of these out of pocket cases. This highlights the ongoing issue of the lack of access to public health facilities in rural areas.

Government programmes have had little effect in curbing out of pocket poverty. Rashtriya Swasthya Bima Yojana (National Health Insurance Programme), or RSBY, has been in place since 2008. The ambitious — and costly — programme states that households in participating areas that are found to be below the poverty line are entitled to coverage of up to Rs 30,000 for hospital charges annually.

Overall, out of pocket expenditure has not reduced to any significant degree claims a study, published in Social Science & Medicine. This is despite RSBY being in place for nearly a decade – a damning finding for a programme that has so far run costs to the government of around Rs 5,000 crore.

This month, the government will roll out the Ayushman Bharat National Health Protection Mission. The scheme aims to give the poorest forty percent of Indians medical insurance cover of up to Rs five lakh a year. If the scheme is successful, it could make great strides in reducing out of pocket expenditure among India’s poorest groups.

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