Samik Chowdhury

Economic burden of malaria in India: The need for effective spending

About 95%of India’s population resides in malaria-endemic areas and, according to government sources, 80%of malaria reported in the country is confined to populations residing in tribal, hilly, difficult and inaccessible areas. Using a nationally representative sample, this study has estimated the economic burden of malaria in India by applying the cost-of-illness approach, using the information on cost of treatment, days lost and earnings foregone, from the National Sample Survey data. A sensitivity analysis was carried out, by presenting two alternative scenarios of deaths. The results indicate that the total economic burden from malaria in India could be around US

Financing for Health Coverage in India: Issues and Concerns

1940 million. The major burden comes from lost earnings (75%), while 24%comes from treatment costs. Since mortality is low, this is not a major source of economic burden of malaria. An analysis of the trend and patterns in public expenditure by the National Vector Borne Disease Control Programme shows a declining focus of the central government on vector-borne diseases.Also, allocation of financial resources among states does not reflect the burden of malaria, the major vector-borne disease in the country.

Out-of-Pocket Spending on Out-Patient Care in India: Assessment and Options Based on Results from a District Level Survey

The paper explores the trends, composition, and incidence of out-of-pocket health expenditure (OOPHE) in India, which has been the predominant means of financing its health care needs. Unit-level data from the National Sample Survey on Household Consumer Expenditure for the years 1993–94, 2004–05, and 2011–12 are used.

Household Microenvironment and Its Impact on Infectious Diseases in India—Evidence from the National Sample Surveys

Out-of-pocket spending at out-patient departments (OPD) by households is relatively less analyzed compared to hospitalization expenses in India. This paper provides new evidence on the levels and drivers of expenditure on out-patient care, as well as choice of providers, using household survey data from 8 districts in 3 states of India. Results indicate that the economically vulnerable spend more on OPD as a proportion of per capita consumption expenditure, out-patient care remains overwhelmingly private and switches of providers—while not very prevalent—is mostly towards private providers. A key result is that choice of public providers tend to lower OPD spending significantly. It indicates that an improvement in the overall quality and accessibility of government facilities still remain an important tool that should be considered in the context of financial protection.

Does Access to Basic Amenities Influence Health Status? Evidence from a Household Survey in Three States of India

Household microenvironment like water and sanitation are among some of the key determinants of communicable and infectious diseases like diarrhea, cholera, malaria. This paper analyzes the burden of infectious diseases from household level data and attempts to establish the link between selected diseases and household microenvironmental characteristics. It also studies the treatment-seeking behavior and expenditure on treatment to gauge the potential financial burden for households. The importance of microenvironment for preventing infectious diseases is clear from the findings, and an approach that recognizes the multi-sectoral character of the interventions is suggested to tackle the unfinished agenda of prevention and control of infectious diseases.

Finances for Health in India: Are New Sources the Way to Go?

Social determinants of health (SDH) are extremely important for a developing country like India that is battling a double burden of disease with exceptionally low levels of resources allocated for the health sector. This article adds to the evidence on the linkages between health status and SDH, with special focus on basic amenities, such as housing, water and sanitation. Based on data collected through a large sample household survey covering eight districts in three states of India, the study reports the status of basic amenities, disease burden and explores a link between the two. The study finds that access to basic amenities does affect the likelihood of a communicable disease in a statistically significant manner. The policy implication is that any successful communicable disease prevention agenda must take into account cross-cutting interventions involving multiple sectors, such as housing, water and sanitation. A sustained focus on these can rein in a lot of avoidable morbidity and mortality. In addition, it also has the potential for direct and indirect cost savings for the individual as well as the state.

Correlates of out-of-pocket spending on health in Nepal: implications for policy

The Government of India has proposed the National Health Assurance Mission (NHAM) to move the country rapidly towards universal health coverage (UHC), by providing all citizens with specified drugs, diagnostics, and services. Currently, Indias public spending on health is one of the lowest in the world. Recent pronouncements from the government indicate a further cut in the health budget, indicating a serious discrepancy between policy intentions and necessary financial provisions. Against this backdrop, this paper offers two broad options to enhance fiscal space for health in India: (a) superior utilisation of the existing resource envelope through reprioritisation and reallocation within the social sector, including pooling of fragmented allocations; and (b) identification of new revenue handles for the health sector and choice of the most sustainable of these.

Public Financing for Health Coverage in India Who Spends, Who Benefits and At What Cost?

Background: A key objective of universal health coverage is to address inequities in the financial implications of health care. This paper examines the level and trend in out-of-pocket spending (OOPS) on health, and the consequent burden on Nepalese households. Methods: Using data from the Nepal Living Standard Survey for 1995–1996 and 2010–2011, the paper looks at the inequity of this burden and its changes over time; across ecological zones or belts, development regions, places of residence, or consumption expenditure quintiles; and according to the gender of the head of the household. Results: The average per capita OOPS on health in Nepal increased sevenfold in nominal terms between 1995–1996 and 2010–2011. The share of OOPS in household consumption expenditure also increased during the same period, primarily as a result of higher health spending by poorer households. Thirteen per cent of all households were found to incur catastrophic health expenses in 2010–2011. This proportion of households incurring such expenditure rose between the two time periods most sharply in the Terai belt, eastern region and poorest quintile. Conclusion: The health-financing system in Nepal has become regressive over the years, as the share of the bottom two quintiles in the total number of households facing catastrophic burden increased by 14% between the two periods.