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Cost and economic burden of illness over 15 years in Nepal: A comparative analysis

Author

Listed:
  • Khin Thet Swe
  • Md Mizanur Rahman
  • Md Shafiur Rahman
  • Eiko Saito
  • Sarah K Abe
  • Stuart Gilmour
  • Kenji Shibuya

Abstract

Background: With an increasing burden of non-communicable disease in Nepal and limited progress towards universal health coverage, country- and disease-specific estimates of financial hardship related to healthcare costs need to be evaluated to protect the population effectively from healthcare-related financial burden. Objectives: To estimate the cost and economic burden of illness and to assess the inequality in the financial burden due to catastrophic health expenditure from 1995 to 2010 in Nepal. Methods: This study used nationally representative Nepal Living Standards Surveys conducted in 1995 and 2010. A Bayesian two-stage hurdle model was used to estimate average cost of illness and Bayesian logistic regression models were used to estimate the disease-specific incidence of catastrophic health payment and impoverishment. The concentration curve and index were estimated by disease category to examine inequality in healthcare-related financial hardship. Findings: Inflation-adjusted mean out-of-pocket (OOP) payments for chronic illness and injury increased by 4.6% and 7.3%, respectively, while the cost of recent acute illness declined by 1.5% between 1995 and 2010. Injury showed the highest incidence of catastrophic expenditure (30.7% in 1995 and 22.4% in 2010) followed by chronic illness (12.0% in 1995 and 9.6% in 2010) and recent acute illness (21.1% in 1995 and 7.8% in 2010). Asthma, diabetes, heart conditions, malaria, jaundice and parasitic illnesses showed increased catastrophic health expenditure over time. Impoverishment due to injury declined most (by 12% change in average annual rate) followed by recent acute illness (9.7%) and chronic illness (9.6%) in 15 years. Inequality analysis indicated that poorer populations with recent acute illness suffered more catastrophic health expenditure in both sample years, while wealthier households with injury and chronic illnesses suffered more catastrophic health expenditure in 2010. Conclusion: To minimize the economic burden of illness, several approaches need to be adopted, including social health insurance complemented with an upgraded community-based health insurance system, subsidy program expansion for diseases with high economic burden and third party liability motor insurance to reduce the economic burden of injury.

Suggested Citation

  • Khin Thet Swe & Md Mizanur Rahman & Md Shafiur Rahman & Eiko Saito & Sarah K Abe & Stuart Gilmour & Kenji Shibuya, 2018. "Cost and economic burden of illness over 15 years in Nepal: A comparative analysis," PLOS ONE, Public Library of Science, vol. 13(4), pages 1-14, April.
    • Handle: RePEc:plo:pone00:0194564
    DOI: 10.1371/journal.pone.0194564
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    References listed on IDEAS

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    1. Nicola J. Cooper & Paul C. Lambert & Keith R. Abrams & Alexander J. Sutton, 2007. "Predicting costs over time using Bayesian Markov chain Monte Carlo methods: an application to early inflammatory polyarthritis," Health Economics, John Wiley & Sons, Ltd., vol. 16(1), pages 37-56, January.
    2. Augustine Asante & Jennifer Price & Andrew Hayen & Stephen Jan & Virginia Wiseman, 2016. "Equity in Health Care Financing in Low- and Middle-Income Countries: A Systematic Review of Evidence from Studies Using Benefit and Financing Incidence Analyses," PLOS ONE, Public Library of Science, vol. 11(4), pages 1-20, April.
    3. Michael Maurice Engelgau & Sameh El-Saharty & Preeti Kudesia & Vikram Rajan & Sandra Rosenhouse & Kyoko Okamoto, 2011. "Capitalizing on the Demographic Transition : Tackling Noncommunicable Diseases in South Asia," World Bank Publications - Books, The World Bank Group, number 2343, December.
    4. Owen O'Donnell & Eddy van Doorslaer & Adam Wagstaff & Magnus Lindelow, 2008. "Analyzing Health Equity Using Household Survey Data : A Guide to Techniques and Their Implementation," World Bank Publications - Books, The World Bank Group, number 6896, December.
    5. Angus Deaton & Salman Zaidi, 2002. "Guidelines for Constructing Consumption Aggregates for Welfare Analysis," World Bank Publications, The World Bank, number 14101, April.
    6. Michael Maurice Engelgau & Sameh El-Saharty & Preeti Kudesia & Vikram Rajan & Sandra Rosenhouse & Kyoko Okamoto, 2011. "Capitalizing on the Demographic Transition: Tackling Noncommunicable Diseases in South Asia," Working Papers id:3595, eSocialSciences.
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    Cited by:

    1. Md Mahfuzur Rahman & Cherri Zhang & Khin Thet Swe & Md Shafiur Rahman & Md Rashedul Islam & Md Kamrujjaman & Papia Sultana & Md Zakiul Hassan & Md Shahinul Alam & Md Mizanur Rahman, 2020. "Disease-specific out-of-pocket healthcare expenditure in urban Bangladesh: A Bayesian analysis," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-11, January.
    2. Xiaocang Xu & Haoran Yang, 2022. "Elderly chronic diseases and catastrophic health expenditure: an important cause of Borderline Poor Families’ return to poverty in rural China," Palgrave Communications, Palgrave Macmillan, vol. 9(1), pages 1-10, December.

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