RESUMO
The authors have measured the health expenditure-induced removable poverty in India using nationally representative consumer expenditure surveys of three quinquennial rounds conducted by the National Sample Survey Organization (NSSO). This study has also focused on the reflections of Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the world's largest Government-funded health insurance scheme, on these poverty rates in the country. The study has used headcount, payment gap, and concentration index to measure the economic burden and impoverishment impact of out-of-pocket (OOP) health expenditure. The analysis shows that the incidence and depth of poverty are substantially understated because of overlooking OOP health expenditure in the country's standard poverty measure. Outpatient care contributes almost four times more than inpatient care to health expenditure-induced impoverishment in India, though this care has not been covered in the AB-PMJAY. Muslims, among all religious groups, Scheduled Castes among social groups, and casual labourers among different household types are more vulnerable to OOP health expenditure-induced removable poverty in the country. Poverty, in general, has dropped significantly, but the share of health expenditure-induced poverty in general poverty has increased substantially. It has risen considerably in rural areas and among India's most vulnerable sections of society in the past 20 years. We emphasised that universal health insurance coverage is needed in India. Implementing comprehensive health insurance schemes that cover both inpatient and outpatient care can help alleviate the financial burden of healthcare expenses on households and contribute to reducing poverty rates.
RESUMO
BACKGROUND: Most households in developing countries like India are not able to afford to get the services of efficient energy for cooking and lighting. Therefore, they rely mostly on solid fuels (firewood, dung cakes, crop residue, coal/coke/lignite). Such fuels cause respiratory diseases like tuberculosis, asthma respiratory cancer. Hence, this study aims to estimate the association between different types of energy used and the prevalence of respiratory diseases in India where more than 50% of the population relies on solid fuels for cooking. METHODS: The study is based on 117,752 respondents who were diagnosed with various chronic diseases such as diabetes, chronic heart diseases, leprosy, chronic renal diseases, tuberculosis, asthma etc. from District Level Household Survey (DLHS-4) which was conducted in 2012-13. Individuals who were diagnosed with a chronic illness after a proper medical examination have been considered as a dependent variable. Exposure to the type of cooking fuel is the main exposure variable, which recognises the dependence on energy. Logistic regression has been utilized to understand the association between the use of solid fuels for cooking and the prevalence of respiratory diseases. RESULTS: The dependence on solid fuels is very high in rural areas (72.22%) as compared to urban areas (21.43%). Among different castes, the reliance on solid fuels for cooking is highest among Scheduled Castes (61.79%) and Scheduled Tribes (70.46%). Individuals living in households where crop residue and coal/lignite is used for cooking suffer from asthma/chronic respiratory failure in the higher proportion as compared to others. Results further revealed that the use of solid fuels for cooking has a strong association with respiratory diseases. Individuals living in households where solid fuels like firewood [OR: 1.27 (0.001); C.I.: 1.19-1.35], crop residue [OR: 1.33 (0.001); C.I.:1.19-1.48], and coal [OR: 1.60 (0.001); C.I.:1.32-1.93] are used as primary fuel for cooking are 17 to 60% more likely to suffer from respiratory diseases. CONCLUSION: Use of solid fuels is associated with respiratory diseases like asthma, tuberculosis and cancer of the respiratory system. Assuming these associations are causal, therefore, about 17 to 60% of the respiratory diseases in India could be prevented by providing access to clean cooking fuel to the individuals.
