Economic Burden(cont...)

Financing of Care

Still, direct quantitative evidence of specific chronic NCDs, pushing households or individuals below the poverty line in a strict causal sense is missing. However, several studies have assessed whether medical expenditures for chronic NCD are high in proportion to overall household expenditures.

In India, the risk of distress borrowing and distress selling of assets increases significantly for hospitalized patients if they are smokers (Bonu et al. 2005). Surprisingly, the risk is even higher for those who do not smoke themselves but belong to households in which other people smoke or drink (or both).

A potential explanation might be that smokers who are hospitalized are more likely to stop smoking (thereby saving money), while household members who are not hospitalized are less likely to relinquish their habits (but continue to expose others). A recent cross-country study including Bangladesh, Nepal, and Sri Lanka found that while many of the poor are pushed further into poverty, on the whole it is the better-off who are more likely to spend a large fraction of total household resources on health care (van Doorslaer et al. 2005).

This somewhat surprising result may be explained by the inability of the poor to divert resources from basic needs (thereby simply forgoing health care), and by some protection of the poor from user charges. O'Donnell et al. (2008) give a similar a nalysis of the same set of countries, showing that in most Asian low- and middle-income countries, the better-off not only pay more, they also get more health care.

The finding that better off households spend a larger fraction of their resources than the poor was confirmed by the recent findings of Mahal et al. (2010) who estimated the amount of out-of-pocket expenditures attributable to NCD treatment in India in 12 months in 1995–96, and again in 2004. They also found that between the two study periods the share of NCDs in total out-of-pocket health expenditures increased from 31.6 percent to 47.3 percent in 2004, suggesting a growing importance of NCDs in India in terms of their financial impact on households.

he authors also found that NCDs generally incurred significantly higher treatment costs (about double) in terms of out-of-pocket expenditures than other conditions and diseases, and hence implied a higher financial risk burden on ffected individuals and households. Interestingly, Mahal et al. (2010) found that about 40 percent of ousehold expenditures for treating NCDs were financed by household borrowing and sales of assets, trengthening the evidence for significant levels of financial vulnerability to NCDs.

Mahal et al. 2010 investigated further detail of the financial burden imposed by health care payments or NCD treatment and found that the odds of incurring catastrophic hospitalization expenditures7 were early 160 percent higher with cancer than when hospitalization is due to a communicable disease. The dds of incurring catastrophic hospital spending due to CVD or injuries turned out to be about 30 ercent greater than for communicable conditions that result in hospital stays.