Household expenditure on leprosy outpatient services in the Indian health system: A comparative study
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...
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| description | 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.
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.
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. |
| doi_str_mv | 10.1371/journal.pntd.0006181 |
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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.
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.</description><identifier>ISSN: 1935-2735</identifier><identifier>ISSN: 1935-2727</identifier><identifier>EISSN: 1935-2735</identifier><identifier>DOI: 10.1371/journal.pntd.0006181</identifier><identifier>PMID: 29300747</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Age ; Analysis ; Care and treatment ; Comparative analysis ; Comparative studies ; Diagnosis ; Disability ; Disease ; Economics ; Expenditures ; Health ; Health care ; Health care costs ; Health care facilities ; Health care policy ; Health care reform ; Health economics ; Households ; Leprosy ; Medicine and Health Sciences ; Mental disorders ; Mental health ; Pain ; Patients ; People and Places ; Poverty ; Primary care ; Public health ; Quality of life ; Social Sciences ; Socioeconomic factors ; Stigma ; Surveying ; Surveys ; Territory ; Tropical diseases</subject><ispartof>PLoS neglected tropical diseases, 2018-01, Vol.12 (1), p.e0006181-e0006181</ispartof><rights>COPYRIGHT 2018 Public Library of Science</rights><rights>2018 Public Library of Science. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Tiwari A, Suryawanshi P, Raikwar A, Arif M, Richardus JH (2018) Household expenditure on leprosy outpatient services in the Indian health system: A comparative study. PLoS Negl Trop Dis 12(1): e0006181. https://doi.org/10.1371/journal.pntd.0006181</rights><rights>2018 Tiwari et al 2018 Tiwari et al</rights><rights>2018 Public Library of Science. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Tiwari A, Suryawanshi P, Raikwar A, Arif M, Richardus JH (2018) Household expenditure on leprosy outpatient services in the Indian health system: A comparative study. PLoS Negl Trop Dis 12(1): e0006181. https://doi.org/10.1371/journal.pntd.0006181</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c624t-a730f95ecdec3058727f503a37ece9e2ee2f044a9487be8e7b465f73512793183</citedby><cites>FETCH-LOGICAL-c624t-a730f95ecdec3058727f503a37ece9e2ee2f044a9487be8e7b465f73512793183</cites><orcidid>0000-0003-4819-2905</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5771634/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5771634/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2100,2919,23857,27915,27916,53782,53784,79361,79362</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29300747$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Lockwood, Diana N. J.</contributor><creatorcontrib>Tiwari, Anuj</creatorcontrib><creatorcontrib>Suryawanshi, Pramilesh</creatorcontrib><creatorcontrib>Raikwar, Akash</creatorcontrib><creatorcontrib>Arif, Mohammad</creatorcontrib><creatorcontrib>Richardus, Jan Hendrik</creatorcontrib><title>Household expenditure on leprosy outpatient services in the Indian health system: A comparative study</title><title>PLoS neglected tropical diseases</title><addtitle>PLoS Negl Trop Dis</addtitle><description>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.
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.
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.</description><subject>Age</subject><subject>Analysis</subject><subject>Care and treatment</subject><subject>Comparative analysis</subject><subject>Comparative studies</subject><subject>Diagnosis</subject><subject>Disability</subject><subject>Disease</subject><subject>Economics</subject><subject>Expenditures</subject><subject>Health</subject><subject>Health care</subject><subject>Health care costs</subject><subject>Health care facilities</subject><subject>Health care policy</subject><subject>Health care reform</subject><subject>Health economics</subject><subject>Households</subject><subject>Leprosy</subject><subject>Medicine and Health Sciences</subject><subject>Mental disorders</subject><subject>Mental health</subject><subject>Pain</subject><subject>Patients</subject><subject>People and Places</subject><subject>Poverty</subject><subject>Primary care</subject><subject>Public health</subject><subject>Quality of life</subject><subject>Social Sciences</subject><subject>Socioeconomic factors</subject><subject>Stigma</subject><subject>Surveying</subject><subject>Surveys</subject><subject>Territory</subject><subject>Tropical diseases</subject><issn>1935-2735</issn><issn>1935-2727</issn><issn>1935-2735</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>DOA</sourceid><recordid>eNptkl9v0zAUxSMEYmPwDRBYQkK8tPhvHe8BqZqATZrECzxbrnPTukrsYDsV_fa4NJtaNOUh0c3vnut7fKrqLcFzwiT5vA1j9KabDz43c4zxgtTkWXVJFBMzKpl4fvJ9Ub1KaYuxUKImL6sLqhjGksvLCm7DmGATugbBnwF84_IYAQWPOhhiSHsUxjyY7MBnlCDunIWEnEd5A-iu4MajDZgub1Dapwz9NVoiG_rBxNK0A5Ty2OxfVy9a0yV4M72vql_fvv68uZ3d__h-d7O8n9kF5XlmJMOtEmAbsAyLWlLZCswMk2BBAQWgLebcKF7LFdQgV3wh2rIfoVIxUrOr6v1Rd-hC0pNDSVOMabGH0kUh7o5EE8xWD9H1Ju51ME7_K4S41iZmZzvQwBQWZaBhYsFXXK2MMKK1lDFbCsIWrS_TtHHVQ2OLRdF0Z6Lnf7zb6HXYaSElWTBeBD5NAjH8HiFl3btkoeuMh3ItmqhaCc65EAX98B_69HYTtTZlAefbUObag6heCioUkcWkQs2foMrTQO9s8NC6Uj9r-HjScLzuFLoxu-DTOciPoC3RSRHaRzMI1ofUPpxaH1Krp9SWtnenRj42PcSU_QXs0Ol4</recordid><startdate>20180101</startdate><enddate>20180101</enddate><creator>Tiwari, Anuj</creator><creator>Suryawanshi, Pramilesh</creator><creator>Raikwar, Akash</creator><creator>Arif, Mohammad</creator><creator>Richardus, Jan Hendrik</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7SS</scope><scope>7T2</scope><scope>7T7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>F1W</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>H95</scope><scope>H97</scope><scope>K9.</scope><scope>L.G</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>P64</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0003-4819-2905</orcidid></search><sort><creationdate>20180101</creationdate><title>Household expenditure on leprosy outpatient services in the Indian health system: A comparative study</title><author>Tiwari, Anuj ; Suryawanshi, Pramilesh ; Raikwar, Akash ; Arif, Mohammad ; Richardus, Jan Hendrik</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c624t-a730f95ecdec3058727f503a37ece9e2ee2f044a9487be8e7b465f73512793183</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Age</topic><topic>Analysis</topic><topic>Care and treatment</topic><topic>Comparative analysis</topic><topic>Comparative studies</topic><topic>Diagnosis</topic><topic>Disability</topic><topic>Disease</topic><topic>Economics</topic><topic>Expenditures</topic><topic>Health</topic><topic>Health care</topic><topic>Health care costs</topic><topic>Health care facilities</topic><topic>Health care policy</topic><topic>Health care reform</topic><topic>Health economics</topic><topic>Households</topic><topic>Leprosy</topic><topic>Medicine and Health Sciences</topic><topic>Mental disorders</topic><topic>Mental health</topic><topic>Pain</topic><topic>Patients</topic><topic>People and Places</topic><topic>Poverty</topic><topic>Primary care</topic><topic>Public health</topic><topic>Quality of life</topic><topic>Social Sciences</topic><topic>Socioeconomic factors</topic><topic>Stigma</topic><topic>Surveying</topic><topic>Surveys</topic><topic>Territory</topic><topic>Tropical diseases</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tiwari, Anuj</creatorcontrib><creatorcontrib>Suryawanshi, Pramilesh</creatorcontrib><creatorcontrib>Raikwar, Akash</creatorcontrib><creatorcontrib>Arif, Mohammad</creatorcontrib><creatorcontrib>Richardus, Jan Hendrik</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Virology and AIDS Abstracts</collection><collection>ProQuest Health and Medical</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>ASFA: Aquatic Sciences and Fisheries Abstracts</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Aquatic Science & Fisheries Abstracts (ASFA) 1: Biological Sciences & Living Resources</collection><collection>Aquatic Science & Fisheries Abstracts (ASFA) 3: Aquatic Pollution & Environmental Quality</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Aquatic Science & Fisheries Abstracts (ASFA) Professional</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PLoS neglected tropical diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tiwari, Anuj</au><au>Suryawanshi, Pramilesh</au><au>Raikwar, Akash</au><au>Arif, Mohammad</au><au>Richardus, Jan Hendrik</au><au>Lockwood, Diana N. J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Household expenditure on leprosy outpatient services in the Indian health system: A comparative study</atitle><jtitle>PLoS neglected tropical diseases</jtitle><addtitle>PLoS Negl Trop Dis</addtitle><date>2018-01-01</date><risdate>2018</risdate><volume>12</volume><issue>1</issue><spage>e0006181</spage><epage>e0006181</epage><pages>e0006181-e0006181</pages><issn>1935-2735</issn><issn>1935-2727</issn><eissn>1935-2735</eissn><abstract>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.
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.
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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>29300747</pmid><doi>10.1371/journal.pntd.0006181</doi><orcidid>https://orcid.org/0000-0003-4819-2905</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Age Analysis Care and treatment Comparative analysis Comparative studies Diagnosis Disability Disease Economics Expenditures Health Health care Health care costs Health care facilities Health care policy Health care reform Health economics Households Leprosy Medicine and Health Sciences Mental disorders Mental health Pain Patients People and Places Poverty Primary care Public health Quality of life Social Sciences Socioeconomic factors Stigma Surveying Surveys Territory Tropical diseases |
| title | Household expenditure on leprosy outpatient services in the Indian health system: A comparative study |
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