Economic Effect of Coronary Heart Disease on Households – A study in Mumbai

Abstract

Context: Coronary Heart Disease is the leading cause of mortality worldwide and in India with younger populations increasingly affected. The out-of-pocket (OOP) payment for health care being high in India, the burden of CHD expenditure falls on the households. The study aims to quantify the economic costs due to CHD, their effect on the household's economic status and financial coping mechanisms. Methods: A descriptive quantitative cross-sectional study among 204 households with CHD patients in Mumbai during April-May and October-November 2013. Non-probability sampling technique was used and data collection done using semi-structured interview schedule. Results: The total annual costs were INR 10180918 and annual direct costs contributed INR9736631. Major costs were on hospitalization (66%) and medicines (19%) of the total household health expenditure on CHD. About 44% households had suffered catastrophic health expenditure (CHE) due to CHD according to the 40% threshold criteria. Catastrophic Health Expenditure was 3.5 times more likely in the Lower income group (p<0.05); 4.4 times more likely when visiting a public hospital (p<0.05) and 20.6 times more likely when visiting a private hospital (p<0.01) as compared to no hospitalisation; 50% less likely for those with health insurance (p<0.05). Distress financing i.e. borrowing and selling assets was seen in 26% of the households to cover their costs for CHD treatment. Conclusions: Coronary Heart Disease puts significant economic burden on household in an urban city like Mumbai. All income groups incurred CHE implying that CHD is an expensive disease for the rich as well as poor households.