Morbidity Patterns, Burden, and Healthcare Utilisation of Major Non-communicable Diseases in India

Abstract

The escalating burden of non-communicable diseases (NCDs) is presently being experienced by all countries across the globe. However, the disproportionate concentration of this burden is well documented in the case of low- and middle-income countries, which contribute 77% to the total deaths because of NCDs, out of which 86% are premature deaths. The adverse impact of NCDs is a growing concern for developing countries, particularly India, where public spending on NCDs is relatively scant, and people have limited resources to accommodate their healthcare needs. As per the estimation by World Health Organisation (WHO), in the year 2018, NCDs account for 63% of all deaths, out of which 27% of the deaths are from cardiovascular disease (CVD), 9% from cancer, 3% from diabetes, and 11% from chronic respiratory disease in India. Nevertheless, there is a dearth of research providing a comprehensive assessment of the economic impact of NCDs on both households and the overall economy within the Indian context. The present study aims to address this gap by quantifying the impact of NCDs on households through the assessment of out-of-pocket expenditure (OOPE), catastrophic health expenditure (CHE), and impoverishment effect. In addition, the study also highlights the coping mechanism of households to finance health expenditures. A significant contribution of this study is the realm of equity in healthcare utilisation associated with NCDs. Besides, the study also estimates the macroeconomic burden of NCDs in terms of Gross Domestic Product (GDP) loss in India. The study uses secondary data from the National Sample Survey Office, the World Bank, and the Institute of Health Metric and Evaluation. For empirical analysis, the study has used logistic regression, generalised ordered logit model (gologit), multinomial logit model, and generalised linear model. In addition, it has used concentration curves, the Wagstaff decomposition method, and horizontal and vertical inequity index to analyse inequity. The present study also incorporates insights from economic theories, including the epidemiological transition theory, Grossman's model of demand for health capital, and Andersen's behavioural model of healthcare utilisation. The results show that during the past three decades, the years of life lost due to premature death (YLL) and the years of life lived with disability (YLD) for each of the four NCDs under consideration have increased consistently. Among all the NCDs, cancer and CVD causes more losses due to premature death than disability, whereas diabetes and Chronic Respiratory Diseases (CRD) cause greater losses due to disability than premature death. The economic loss in terms of GDP shows that in 2019, CVD accounted for a loss of 3445 billion rupees for India, the highest among all other NCDs. Similarly, the burden of NCDs on households shows that 59% of rural households are reporting OOPE share in excess of 10% of their total expenditure, whereas it is 49% of urban households for availing treatment of NCDs. The expenditure incurred on doctor’s fees and bed charges are troublesome for households with NCDs treated in private hospitals. The result from vertical inequity shows that the poorest quintile is paying a higher proportion of their total consumption expenditure for NCDs hospitalisation than the richest quintile, indicating that the payment for NCDs is regressive in nature. The result of the gologit model shows that household size, cooking fuel, and region significantly affect CHE at the 40% threshold level. Similarly, the level of poverty due to healthcare payments is higher among Muslims, SC/ST, rural residents, the poorest quintile, more than 7 family members in a household, and casual labourers. The result of inequity in healthcare utilisation shows a significantly pro-rich pattern. The findings of this study could help the policy maker to tackle the burden of NCDs in India by ensuring affordable, equitable, and universal care for all the population, especially for socioeconomically disadvantaged populations.