This has been revealed in a detailed survey carried out in two districts - Shimla in Himachal Pradesh and Udaipur in Rajasthan - on the awareness levels, prevalence and treatment of the three NCDs. The survey was carried out by the NGO, MAMTA Health Institute for mother and child with the support of the state and central health ministries and the World Health Organisation (WHO) using a grant from Medtronic Foundation, the philanthropic arm of the medical devices company Medtronic.
According to the survey, for hypertension treatment, a poor family earning less than Rs 5,000 per month would spend over 16% of their monthly income while the middle class earning Rs 10,000-20,000 would spend 4-8%. A poor family with a diabetic would spend 31% of their monthly income in Shimla and 23% in Udaipur on diabetes treatment. The middle class in the two districts would spend anything between 6% and 16% of their income with Shimla always accounting for higher expenditure. Treating heart disease can consume 60% and 38% of a poor family's income in Shimla and Udaipur respectively. For a middle class family earning Rs 10,000-20,000, this could be 10% to 30% of their income.
Almost 60% of the expenditure is met by families from their own pockets. About 40% of the treatment expense is with the help of family members or by borrowing money. Less than 1% of the respondents in the survey met the expense through any sort of health insurance in Shimla. In Udaipur, about 5% of the respondents had health insurance to cover the treatment of diabetes and heart disease.
Of the expenditure on the three NCDs, medication accounted for the biggest chunk followed by the expense on regular laboratory tests and, in the case of heart disease, the expense on ECG and other advanced investigations too. Other expenses include transportation costs to visit the doctor and the fees charged by the doctor for the visit.
Well over half the patients diagnosed with hypertension and diabetes in Shimla received their diagnosis from a government-run tertiary facility. Hardly any respondent said the diagnosis happened at the secondary level. However in Udaipur there was higher use of private facilities for diagnosis. An important reason for choosing a particular kind of facility was the quality of services and also referral from a doctor.
While Himachal claims high usage of public health facilities, Rajasthan claims to have an effective system for free distribution of medicines from public health facilities. Yet, out-of-pocket expenditure remains high in both districts. According to Dr Ruchi Sogarwal of MAMTA, the data on expenditure indicated that the Rashtriya Swasthya Bima Yojana has had a limited impact. However she cautioned that since the study was more for prevalence of NCDs than expenditure, a more specific study would be needed to examine whether health schemes like RSBY were reaching people.
Dr Kavindra Lal, state program officer for NCDs in Himachal Pradesh said that in Shimla and surrounding areas, even if people used the public health facilities for consultation, they preferred to buy medicines and get diagnostic tests done in the private sector as they were not so badly off and did not like the delay and queuing up in government facilities. He added that the government was studying the survey results to understand why expenses were so high if people depended more on public health facilities.
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