One in four patients affected by Tuberculosis (TB) has to spend out of his/her own pocket to access treatment, which should otherwise be anyway available for free.

‘Out of pocket expenditure on TB in India: Do households face hardship financing?’ published in Indian Journal of Tuberculosis is the first-ever analysis of how much TB patients in India spend for treatment.

According to Denny John, a Delhi-based Health Economist, and co-author of the paper, “25.9 per cent of the general population had to sell assets or borrow for financing TB hospitalisation expenses. This even after promises of free care for TB are made by the government.”

Hardship financing includes borrowing on interest and/or sale of physical assets to fund treatment. The authors referred to the 71st round of National Sample Survey Office (NSSO) data that focusses on the ‘Cost of Treatment,’ to analyse data of 799 individuals who were afflicted with TB during the survey.

Direct medical expenses

According to the paper, those in the productive age group of 36 to 59 spent the most on hospitalisation at ₹18,213.60 and on direct medical expenses such as buying drugs and consumables (up to ₹15,997.20 or 87 per cent) and the rest on non-medical expenses and transport with an average of ten work days lost.

Among the findings in the paper was that patients admitted to ‘free,’ wards ended up paying for their treatment. Further, the paper states that a patient admitted in a paying special ward spent as much as eight times more than those in free wards of public hospitals. ‘Out of pocket’ expenditure for TB includes doctors’ fees, medicines, diagnostic tests, bed charges, attendant charges, physiotherapy, personal medical appliances, blood and oxygen. Non-medical expenses include food, transport, and lodging.

“Though majority received free hospitalisation, some still ended up spending an average of ₹6,155.20. Also, on average, patients utilising private hospital care spent three times more than those using public facilities (₹24,288.50 in private facilities against ₹8,345.50 in public facilities),” states the paper.

Also, 51 per cent of the patients surveyed went to private facilities. “My own relative who was afflicted with TB needed a lot of convincing before she was willing to access government care. Patients tend to think private hospitals are good and that is because they lack proper information, but the standard of care in government hospitals as far as TB goes is far better and economical,” said John.

The most affected

John said the poorest are hit the most and end up spending 21 per cent of their annual household income on TB treatment. The poorest family that earns barely ₹50,955 a year, bears TB treatment expenses of ₹9,923.20 (10 per cent) compared to the richest who spend 6.64 per cent (₹21,385.50 of ₹3,21,811.30 annual income on TB treatment).

And among the Scheduled Castes/Scheduled Tribes population, 35.2 per cent of the hospitalised cases sold assets or borrowed money on interest for financing TB hospitalisation. This in spite of the annual expenditure by the government for TB exceeding ₹1,300 crore, according to the Annual TB report 2018.

Also, patients in urban areas spend as much as ₹16,874.50 on hospital treatment for TB. “In addition to this, if a patient goes to a dispensary or a Primary Health Care centre, she/he may end up spending ₹3,094.80 towards treatment, while in a government hospital, the patient incurs ₹8,330 and in a private hospital ₹24,264.60 and only 0.12 per cent of the average amount spent on hospitalisation was reimbursed through any kind of insurance,” said John.

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