Illness not only affects a patient’s health but also financially paralyses an entire family, be it poor or middle class, according to a study by the premier AIIMS. The study conducted by the department of gastroenterology and human nutrition showed that out-of-pocket expenses on heathcare forced families to reduce expenditure on food, education and health. Some even had to sell land, cattle or compromise on education of their children to meet medical expanses. The study was published in the National Medical Journal of India last month. The study covered 374 patients, who had undergone treatment at the All India Institutes of Medical Sciences (AIIMS), New Delhi, and Comprehensive Rural Health Services Project Hospital of AIIMS in Haryana’s Ballabgarh. Of the respondents, 51.3 per cent among the rural and 65.5 per cent among the urban patients were employed before illness but after illness only 24.4 per cent among the rural and 23.4 per cent among the urban patients remained in employment.
“The proportion of rural households of different socio-economic categories that experienced decrease in expenditure on food, education and health, and those who had to sell land or cattle, and the education of whose children suffered was statistically significant. “The proportion of indebted families in different socio- economic classes was also statistically significant among both rural and urban patients,” said Anoop Saraya, the head of the department of gastroenterology and human nutrition. The questions included changes in household dietary intake in the wake of illness, per capita income of the household, illness expenditure, changes in the employment status due to illness, indebtedness, sale of movable and immovable property, changes in household expenditure on food, education and health among others. The change in household expenditure on food, education and health on account of illness in the family was elicited in terms of ‘increased’ and ‘decreased’ or ‘remained same’ rather than as actual expenditure in rupees. After treatment on illness, 63.5 per cent of rural and 44.9 per cent of urban families decreased their expenditure on food, the study found. Among the lowest socio-economic classes, 28.3 per cent of rural and 26 per cent of urban families faced similar difficulties.
Similarly, the proportion of families from the upper socio-economic classes that had to sell land to meet treatment-related expenses was much higher than the proportion of other socio-economic classes, Saraya said. Bank loans were accessed more often by the upper socio- economic classes and money lenders were the most common source of loan for the upper and middle classes, the study found. The lower socio-economic classes depended upon financial support of their friends to tide over the financial crisis. High out-of-pocket expenses on illness of a patient can not only impoverish the family, but can make the economic recovery challenging. “This has been variously described as a ‘poverty ratchet’ or ‘medical poverty trap’. The WHO estimates put nearly a 2100 million people around the world who are poor due to healthcare costs while another 150 million suffer due to catastrophic expenditure on health. “Many studies from India have shown that people have been pushed into poverty on account of out-of-pocket expenses on healthcare,” Saraya said.