RÉSUMÉ
Background: Patients with multidrug-resistant tuberculosis (MDR-TB) incur huge expenditures for diagnosis and treatment; these costs can be reduced through a well-designed and implemented social health insurance mechanism. The State of Chhattisgarh in India successfully established a partnership between the Revised National TB Control Programme (RNTCP) and the Health Insurance Programme, to form a universal health insurance scheme for all, by establishing Rashtriya Swasthya Bima Yojna (RSBY) and Mukhyamantri Swasthya Bima Yojana (MSBY) MDR-TB packages. The objective of this partnership was to absorb the catastrophic expenses incurred by patients with MDR-TB, from diagnosis to treatment completion, in the public and private sector. This paper documents the initial experience of a tailor-made health insurance programme, linked to covering catastrophic health expenditure for patients with MDR-TB. Methods: In this descriptive study, data on uptake of insurance claims through innovative MDR-TB packages from January 2013 to April 2014 were collected. A simple survey of costs for clinical investigation and inpatient care was conducted across two major urban districts in Chhattisgarh. In these selected districts, three health facilities from the private sector and one medical college from the public sector with a functional drug-resistant tuberculosis (DR-TB) centre were chosen by the RSBY and MSBY State Nodal Agency to complete a simple, structured questionnaire on existing market rates. The mean costs for clinical investigations and hospital stay were calculated for an individual patient with MDR-TB who would seek services from the private or public sector. Results: A total of 207 insurance claims for RSBY and MSBY MDR-TB packages were processed, of which 20 were from private and 187 from public health establishments, covered under the health insurance programme, free of charge. An estimated catastrophic expenditure, of approximately US$ 20 000, was saved through the RSBY and MSBY health insurance mechanism during the study period. Conclusion: The innovative RSBY and MSBY MDR-TB insurance package is a step towards reducing catastrophic expenses associated with treatment for MDRTB.
RÉSUMÉ
BACKGROUND: India is in the midst of an epidemiological transition with non-communicable diseases increasing in importance. Targeting the risk factors for non-communicable diseases is recognized as an essential preventive strategy. There is lack of good quality data on prevalence of risk factors. The present study addresses this challenge in urban population of Ballabgarh town in Faridabad district of Haryana. METHODS: A total of 1263 male and 1326 female respondents were selected using multistage systematic random sampling, in 5 age groups of 10 years (15-24, 25-34, 35-44, 45-54 and 55-64). The World Health Organization's STEPS approach entails stepwise collection of the risk factor data based on standardized questionnaires (step 1), basic physical measures in step 2 and finally in 3rd step, basic biochemical investigations such as blood sugar and cholesterol. The prevalence was adjusted to the age and sex strata of urban Faridabad as per census 2001. RESULTS: The prevalence of current daily use of smoked tobacco was 22.2% (95% CI7colon; 20.0-24.6) for males and 1.4% (95% CI: 0.9-2.2) for females. In males the prevalence of current alcohol consumption was 28.9% (95% CI: 26.4-31.5). Physical inactivity was reported by 23.2% (95% CI: 20.9-25.6) of males and 52.4% (95% CI: 49.7-55.1) of female respondents. Only 8.6% of males and 4.4% of females were consuming adequate portions of the fruits and vegetables. 23.1% (95% CI: 20.8-25.5) males and 15.7% (95% CI: 13.87ndash;17.8) females were either in Stage 1 and 2 hypertension (JNC VII) or were taking anti-hypertensives. Among males, 25.4% (95% CI: 23.0-27.9) and, among females 34.9% (95% CI: 32.3-37.6) were overweight. CONCLUSION: The prevalence of tobacco and alcohol use among males and physical inactivity among females was high. Low consumption of fruits and vegetables, hypertension and overweight was equally common among both the sexes in the population studied. Thus there is an urgent need for initiating measures at the risk factor level to counter this modern day epidemic of non-communicable disorders, within this urban community.