IDEAS home Printed from https://ideas.repec.org/a/plo/pntd00/0006181.html
   My bibliography  Save this article

Household expenditure on leprosy outpatient services in the Indian health system: A comparative study

Author

Listed:
  • Anuj Tiwari
  • Pramilesh Suryawanshi
  • Akash Raikwar
  • Mohammad Arif
  • Jan Hendrik Richardus

Abstract

Background: Leprosy is a major public health problem in many low and middle income countries, especially in India, and contributes considerably to the global burden of the disease. Leprosy and poverty are closely associated, and therefore the economic burden of leprosy is a concern. However, evidence on patient’s expenditure is scarce. In this study, we estimate the expenditure in primary care (outpatient) by leprosy households in two different public health settings. Methodology/Principal findings: We performed a cross-sectional study, comparing the Union Territory of Dadra and Nagar Haveli with the Umbergaon block of Valsad, Gujrat, India. A household (HH) survey was conducted between May and October, 2016. We calculated direct and indirect expenditure by zero inflated negative binomial and negative binomial regression. The sampled households were comparable on socioeconomic indicators. The mean direct expenditure was USD 6.5 (95% CI: 2.4–17.9) in Dadra and Nagar Haveli and USD 5.4 (95% CI: 3.8–7.9) per visit in Umbergaon. The mean indirect expenditure was USD 8.7 (95% CI: 7.2–10.6) in Dadra and Nagar Haveli and USD 12.4 (95% CI: 7.0–21.9) in Umbergaon. The age of the leprosy patients and type of health facilities were the major predictors of total expenditure on leprosy primary care. The higher the age, the higher the expenditure at both sites. The private facilities are more expensive than the government facilities at both sites. If the public health system is enhanced, government facilities are the first preference for patients. Conclusions/Significance: An enhanced public health system reduces the patient’s expenditure and improves the health seeking behaviour. We recommend investing in health system strengthening to reduce the economic burden of leprosy. Author summary: Leprosy leads to low quality of life even after cure. The anaesthetic hands and feet leading to ulcers and deformities, stigma and poor mental health are just a few challenges. After declaration of leprosy elimination at global level, the research activities reduced significantly, and the health economics aspect was not an exception. The knowledge on economic burden of a disease helps in prioritization, policy making and advocacy. Our study is a step towards quantifying the economic burden of leprosy. Currently the aim is to eliminate leprosy at national level, therefore the countries need more information to plan high impact activities. Moreover, the patient’s perspective is important as they are the end-point recipients. Our study explores the patient’s financial burden due to leprosy (outpatient services), which is a significant indicator of a public health program’s success. If invested properly, the public health system has potential to reduce the economic burden of public health diseases. Our study is an attempt to link the patient’s perspective with the health system performance. This will help to encourage health systems strengthening.

Suggested Citation

  • Anuj Tiwari & Pramilesh Suryawanshi & Akash Raikwar & Mohammad Arif & Jan Hendrik Richardus, 2018. "Household expenditure on leprosy outpatient services in the Indian health system: A comparative study," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 12(1), pages 1-13, January.
  • Handle: RePEc:plo:pntd00:0006181
    DOI: 10.1371/journal.pntd.0006181
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0006181
    Download Restriction: no

    File URL: https://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0006181&type=printable
    Download Restriction: no

    File URL: https://libkey.io/10.1371/journal.pntd.0006181?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Tarricone, Rosanna, 2006. "Cost-of-illness analysis: What room in health economics?," Health Policy, Elsevier, vol. 77(1), pages 51-63, June.
    2. David J Chandler & Kristian S Hansen & Bhabananda Mahato & Joydeepa Darlong & Annamma John & Diana N J Lockwood, 2015. "Household Costs of Leprosy Reactions (ENL) in Rural India," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 9(1), pages 1-13, January.
    3. Foster, Andrew D, 1994. "Poverty and Illness in Low-Income Rural Areas," American Economic Review, American Economic Association, vol. 84(2), pages 216-220, May.
    4. Surendra Uranw & Filip Meheus & Rob Baltussen & Suman Rijal & Marleen Boelaert, 2013. "The Household Costs of Visceral Leishmaniasis Care in South-eastern Nepal," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 7(2), pages 1-8, February.
    5. Inge Wagenaar & Lisanne van Muiden & Khorshed Alam & Robert Bowers & Md Anwar Hossain & Kolpona Kispotta & Jan Hendrik Richardus, 2015. "Diet-Related Risk Factors for Leprosy: A Case-Control Study," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 9(5), pages 1-15, May.
    6. Charles Ezenduka & Erik Post & Steven John & Abdulkarim Suraj & Abdulahi Namadi & Obinna Onwujekwe, 2012. "Cost-Effectiveness Analysis of Three Leprosy Case Detection Methods in Northern Nigeria," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 6(9), pages 1-8, September.
    7. Sabiena G Feenstra & Quamrun Nahar & David Pahan & Linda Oskam & Jan Hendrik Richardus, 2011. "Recent Food Shortage Is Associated with Leprosy Disease in Bangladesh: A Case-Control Study," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 5(5), pages 1-7, May.
    8. Willemijn J Idema & Istvan M Majer & David Pahan & Linda Oskam & Suzanne Polinder & Jan Hendrik Richardus, 2010. "Cost-Effectiveness of a Chemoprophylactic Intervention with Single Dose Rifampicin in Contacts of New Leprosy Patients," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 4(11), pages 1-6, November.
    9. Tsutsumi, Atsuro & Izutsu, Takashi & Md Islam, Akramul & Maksuda, A.N. & Kato, Hiroshi & Wakai, Susumu, 2007. "The quality of life, mental health, and perceived stigma of leprosy patients in Bangladesh," Social Science & Medicine, Elsevier, vol. 64(12), pages 2443-2453, June.
    10. Tsuchiya, Aki, 1999. "Age-related preferences and age weighting health benefits," Social Science & Medicine, Elsevier, vol. 48(2), pages 267-276, January.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Anuj Tiwari & David J Blok & Mohammad Arif & Jan Hendrik Richardus, 2020. "Leprosy post-exposure prophylaxis in the Indian health system: A cost-effectiveness analysis," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 14(8), pages 1-12, August.
    2. Martin Heidinger & Elisa Simonnet & Sr. Francina Karippadathu & Markus Puchinger & Johann Pfeifer & Andrea Grisold, 2018. "Analysis of Social Determinants of Health and Disability Scores in Leprosy-Affected Persons in Salem, Tamil Nadu, India," IJERPH, MDPI, vol. 15(12), pages 1-13, December.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Anuj Tiwari & David J Blok & Mohammad Arif & Jan Hendrik Richardus, 2020. "Leprosy post-exposure prophylaxis in the Indian health system: A cost-effectiveness analysis," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 14(8), pages 1-12, August.
    2. Puneet Anantharam & Lisa E Emerson & Kassahun D Bilcha & Jessica K Fairley & Annisa B Tesfaye, 2021. "Undernutrition, food insecurity, and leprosy in North Gondar Zone, Ethiopia: A case-control study to identify infection risk factors associated with poverty," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 15(6), pages 1-11, June.
    3. Salma Oktaria & Norma Sofisa Hurif & Wardiansyah Naim & Hok Bing Thio & Tamar E C Nijsten & Jan Hendrik Richardus, 2018. "Dietary diversity and poverty as risk factors for leprosy in Indonesia: A case-control study," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 12(3), pages 1-15, March.
    4. Joanna M Charles & Deirdre M Harrington & Melanie J Davies & Charlotte L Edwardson & Trish Gorely & Danielle H Bodicoat & Kamlesh Khunti & Lauren B Sherar & Thomas Yates & Rhiannon Tudor Edwards, 2019. "Micro-costing and a cost-consequence analysis of the ‘Girls Active’ programme: A cluster randomised controlled trial," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-17, August.
    5. Mira Johri & Laura J. Damschroder & Brian J. Zikmund‐Fisher & Peter A. Ubel, 2005. "The importance of age in allocating health care resources: does intervention‐type matter?," Health Economics, John Wiley & Sons, Ltd., vol. 14(7), pages 669-678, July.
    6. Kuangnan Fang & Yefei Jiang & BenChang Shia & Shuangge Ma, 2012. "Impact of Illness and Medical Expenditure on Household Consumptions: A Survey in Western China," PLOS ONE, Public Library of Science, vol. 7(12), pages 1-8, December.
    7. Chien-Yuan Sher & Ho Ting Wong & Yu-Chun Lin, 2020. "The Impact of Dengue on Economic Growth: The Case of Southern Taiwan," IJERPH, MDPI, vol. 17(3), pages 1-12, January.
    8. Hanna Gyllensten & Michael Wiberg & Kristina Alexanderson & Anders Norlund & Emilie Friberg & Jan Hillert & Olivia Ernstsson & Petter Tinghög, 2018. "Costs of illness of multiple sclerosis in Sweden: a population-based register study of people of working age," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(3), pages 435-446, April.
    9. Arnesen, Trude & Kapiriri, Lydia, 2004. "Can the value choices in DALYs influence global priority-setting?," Health Policy, Elsevier, vol. 70(2), pages 137-149, November.
    10. Richardson, Jeff & Sinha, Kompal & Iezzi, Angelo & Maxwell, Aimee, 2012. "Maximising health versus sharing: Measuring preferences for the allocation of the health budget," Social Science & Medicine, Elsevier, vol. 75(8), pages 1351-1361.
    11. Karine Chevreul & Coralie Gandré & Karen Berg Brigham & Julio López-Bastida & Renata Linertová & Juan Oliva-Moreno & Pedro Serrano-Aguilar & Manuel Posada-de-la-Paz & Domenica Taruscio & Arrigo Schiep, 2016. "Social/economic costs and health-related quality of life in patients with fragile X syndrome in Europe," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(1), pages 43-52, April.
    12. Jamison Pike & Scott D. Grosse, 2018. "Friction Cost Estimates of Productivity Costs in Cost-of-Illness Studies in Comparison with Human Capital Estimates: A Review," Applied Health Economics and Health Policy, Springer, vol. 16(6), pages 765-778, December.
    13. Liesbet Wetering & Job Exel & Ana Bobinac & Werner Brouwer, 2015. "Valuing QALYs in Relation to Equity Considerations Using a Discrete Choice Experiment," PharmacoEconomics, Springer, vol. 33(12), pages 1289-1300, December.
    14. Hazo, Jean-Baptiste & Gandré, Coralie & Leboyer, Marion & Obradors-Tarragó, Carla & Belli, Stefano & McDaid, David & Park, A-La & Maliandi, Maria Victoria & Wahlbeck, Kristian & Wykes, Til & van Os, J, 2017. "National funding for mental health research in Finland, France, Spain and the United Kingdom," LSE Research Online Documents on Economics 82339, London School of Economics and Political Science, LSE Library.
    15. Susanne Mayer & Jonah Spickschen & K Viktoria Stein & Richard Crevenna & Thomas E Dorner & Judit Simon, 2019. "The societal costs of chronic pain and its determinants: The case of Austria," PLOS ONE, Public Library of Science, vol. 14(3), pages 1-18, March.
    16. Lan Gao & Hao Hu & Fei-Li Zhao & Shu-Chuen Li, 2016. "Can the Direct Medical Cost of Chronic Disease Be Transferred across Different Countries? Using Cost-of-Illness Studies on Type 2 Diabetes, Epilepsy and Schizophrenia as Examples," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-17, January.
    17. Bugge, Christoffer & Sæther, Erik Magnus & Brustugun, Odd Terje & Kristiansen, Ivar Sønbø, 2021. "Societal cost of cancer in Norway –Results of taking a broader cost perspective," Health Policy, Elsevier, vol. 125(8), pages 1100-1107.
    18. Shah, Koonal K., 2009. "Severity of illness and priority setting in healthcare: A review of the literature," Health Policy, Elsevier, vol. 93(2-3), pages 77-84, December.
    19. Karine Chevreul & Morgane Michel & Karen Berg Brigham & Julio López-Bastida & Renata Linertová & Juan Oliva-Moreno & Pedro Serrano-Aguilar & Manuel Posada-de-la-Paz & Domenica Taruscio & Arrigo Schiep, 2016. "Social/economic costs and health-related quality of life in patients with cystic fibrosis in Europe," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(1), pages 7-18, April.
    20. Paul Hanly & Rebecca Maguire & Frances Drummond & Linda Sharp, 2019. "Variation in the methodological approach to productivity cost valuation: the case of prostate cancer," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(9), pages 1399-1408, December.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pntd00:0006181. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosntds (email available below). General contact details of provider: https://journals.plos.org/plosntds/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.