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The financial burden from non-communicable diseases in low- and middle-income countries: a literature review

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  • Kankeu Tchewonpi, Hyacinthe
  • Saksena, Priyanka
  • Xu, Ke
  • Evans, David B

Abstract

Non-communicable diseases (NCDs) were previously considered to only affect high-income countries. However, they now account for a very large burden in terms of both mortality and morbidity in low- and middle-income countries (LMICs), although little is known about the impact these diseases have on households in these countries. In this paper, we present a literature review on the costs imposed by NCDs on households in LMICs. We examine both the costs of obtaining medical care and the costs associated with being unable to work, while discussing the methodological issues of particular studies. The results suggest that NCDs pose a heavy financial burden on many affected households; poor households are the most financially affected when they seek care. Medicines are usually the largest component of costs and the use of originator brand medicines leads to higher than necessary expenses. In particular, in the treatment of diabetes, insulin – when required – represents an important source of spending for patients and their families. These financial costs deter many people suffering from NCDs from seeking the care they need. The limited health insurance coverage for NCDs is reflected in the low proportions of patients claiming reimbursement and the low reimbursement rates in existing insurance schemes. The costs associated with lost income-earning opportunities are also significant for many households. Therefore, NCDs impose a substantial financial burden on many households, including the poor in low-income countries. The financial costs of obtaining care also impose insurmountable barriers to access for some people, which illustrates the urgency of improving financial risk protection in health in LMIC settings and ensuring that NCDs are taken into account in these systems. In this paper, we identify areas where further research is needed to have a better view of the costs incurred by households because of NCDs; namely, the extension of the geographical scope, the inclusion of certain diseases hitherto little studied, the introduction of a time dimension, and more comparisons with acute illnesses.

Suggested Citation

  • Kankeu Tchewonpi, Hyacinthe & Saksena, Priyanka & Xu, Ke & Evans, David B, 2013. "The financial burden from non-communicable diseases in low- and middle-income countries: a literature review," MPRA Paper 54534, University Library of Munich, Germany.
  • Handle: RePEc:pra:mprapa:54534
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    References listed on IDEAS

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    1. Laurens M Niëns & Alexandra Cameron & Ellen Van de Poel & Margaret Ewen & Werner B F Brouwer & Richard Laing, 2010. "Quantifying the Impoverishing Effects of Purchasing Medicines: A Cross-Country Comparison of the Affordability of Medicines in the Developing World," PLOS Medicine, Public Library of Science, vol. 7(8), pages 1-8, August.
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    Cited by:

    1. Ruwan Jayathilaka & Sheron Joachim & Venuri Mallikarachchi & Nishali Perera & Dhanushika Ranawaka, 2020. "Do chronic illnesses and poverty go hand in hand?," PLOS ONE, Public Library of Science, vol. 15(10), pages 1-19, October.
    2. Brendon Stubbs & Kamran Siddiqi & Helen Elsey & Najma Siddiqi & Ruimin Ma & Eugenia Romano & Sameen Siddiqi & Ai Koyanagi, 2021. "Tuberculosis and Non-Communicable Disease Multimorbidity: An Analysis of the World Health Survey in 48 Low- and Middle-Income Countries," IJERPH, MDPI, vol. 18(5), pages 1-15, March.
    3. Anupa Rijal & Tara Ballav Adhikari & Jahangir A M Khan & Gabriele Berg-Beckhoff, 2018. "The economic impact of non-communicable diseases among households in South Asia and their coping strategy: A systematic review," PLOS ONE, Public Library of Science, vol. 13(11), pages 1-23, November.
    4. Philipp Hessel & Paul Rodríguez-Lesmes & David Torres, 2020. "Socio-economic inequalities in high blood pressure and additional risk factors for cardiovascular disease among older individuals in Colombia: Results from a nationally representative study," PLOS ONE, Public Library of Science, vol. 15(6), pages 1-12, June.
    5. Caijun Yang & Shuchen Hu & Yanbing Zhu & Wenwen Zhu & Zongjie Li & Yu Fang, 2019. "Evaluating access to oral anti-diabetic medicines: A cross-sectional survey of prices, availability and affordability in Shaanxi Province, Western China," PLOS ONE, Public Library of Science, vol. 14(10), pages 1-13, October.
    6. Darius Erlangga & Marc Suhrcke & Shehzad Ali & Karen Bloor, 2019. "The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-20, August.
    7. Juan Pablo Gutierrez & Sebastian Garcia-Saiso & Belkis M Aracena, 2018. "Mexico’s household health expenditure on diabetes and hypertension: What is the additional financial burden?," PLOS ONE, Public Library of Science, vol. 13(7), pages 1-11, July.
    8. Wendy Janssens & Jann Goedecke & Godelieve J de Bree & Sunday A Aderibigbe & Tanimola M Akande & Alice Mesnard, 2016. "The Financial Burden of Non-Communicable Chronic Diseases in Rural Nigeria: Wealth and Gender Heterogeneity in Health Care Utilization and Health Expenditures," PLOS ONE, Public Library of Science, vol. 11(11), pages 1-19, November.
    9. J E Alcalde-Rabanal & E Orozco-Núñez & O E Espinosa-Henao & A Arredondo-López & L Alcayde-Barranco, 2018. "The complex scenario of obesity, diabetes and hypertension in the area of influence of primary healthcare facilities in Mexico," PLOS ONE, Public Library of Science, vol. 13(1), pages 1-17, January.
    10. Nikolaos Grigorakis & Christos Floros & Haritini Tsangari & Evangelos Tsoukatos, 2017. "Combined social and private health insurance versus catastrophic out of pocket payments for private hospital care in Greece," International Journal of Health Economics and Management, Springer, vol. 17(3), pages 261-287, September.
    11. Qun Wang & Alex Z Fu & Stephan Brenner & Olivier Kalmus & Hastings Thomas Banda & Manuela De Allegri, 2015. "Out-of-Pocket Expenditure on Chronic Non-Communicable Diseases in Sub-Saharan Africa: The Case of Rural Malawi," PLOS ONE, Public Library of Science, vol. 10(1), pages 1-15, January.
    12. Kumara, Ajantha Sisira & Samaratunge, Ramanie, 2017. "Impact of ill-health on household consumption in Sri Lanka: Evidence from household survey data," Social Science & Medicine, Elsevier, vol. 195(C), pages 68-76.
    13. Shrinivas, Aditya & Jalota, Suhani & Mahajan, Aprajit & Miller, Grant, 2023. "The importance of wage loss in the financial burden of illness: Longitudinal evidence from India," Social Science & Medicine, Elsevier, vol. 317(C).
    14. Grigorakis, Nikolaos & Floros, Christos & Tsangari, Haritini & Tsoukatos, Evangelos, 2016. "Out of pocket payments and social health insurance for private hospital care: Evidence from Greece," Health Policy, Elsevier, vol. 120(8), pages 948-959.
    15. Tien Thanh, Pham & Bao Duong, Pham, 2022. "The economic burden of non-communicable diseases on households and their coping mechanisms: Evidence from rural Vietnam," World Development, Elsevier, vol. 151(C).
    16. Ebaidalla Mahjoub Ebaidalla & Mohammed Elhaj Mustafa Ali, 2018. "Chronic Illness and Labor Market Participation in Arab Countries: Evidence from Egypt and Tunisia," Working Papers 1229, Economic Research Forum, revised 10 Oct 2018.
    17. Asankha Pallegedara, 2018. "Impacts of chronic non-communicable diseases on households’ out-of-pocket healthcare expenditures in Sri Lanka," International Journal of Health Economics and Management, Springer, vol. 18(3), pages 301-319, September.
    18. Ahmadou M Jingi & Jean Jacques N Noubiap & Arnold Ewane Onana & Jobert Richie N Nansseu & Binhuan Wang & Samuel Kingue & André Pascal Kengne, 2014. "Access to Diagnostic Tests and Essential Medicines for Cardiovascular Diseases and Diabetes Care: Cost, Availability and Affordability in the West Region of Cameroon," PLOS ONE, Public Library of Science, vol. 9(11), pages 1-8, November.
    19. Sedona Sweeney & Anna Vassall & Nicola Foster & Victoria Simms & Patrick Ilboudo & Godfather Kimaro & Don Mudzengi & Lorna Guinness, 2016. "Methodological Issues to Consider When Collecting Data to Estimate Poverty Impact in Economic Evaluations in Low‐income and Middle‐income Countries," Health Economics, John Wiley & Sons, Ltd., vol. 25(S1), pages 42-52, February.
    20. Pushpendra Singh & Virendra Kumar, 2017. "The Rising Burden of Healthcare Expenditure in India: A Poverty Nexus," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 133(2), pages 741-762, September.
    21. Biplab Kumar Datta & Muhammad Jami Husain & Sohani Fatehin & Deliana Kostova, 2018. "Consumption displacement in households with noncommunicable diseases in Bangladesh," PLOS ONE, Public Library of Science, vol. 13(12), pages 1-12, December.

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    More about this item

    Keywords

    Financial burden; Low- and middle-income countries; Non-communicable diseases; Review;
    All these keywords.

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • I10 - Health, Education, and Welfare - - Health - - - General
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development
    • I3 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty

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