Innovative social protection mechanism for alleviating catastrophic expenses on multidrug-resistant tuberculosis patients in Chhattisgarh, India

ABSTRACT

Background: Patients with multidrug-resistant tuberculosis (MDR-TB) incur hugeexpenditures for diagnosis and treatment; these costs can be reduced through awell-designed and implemented social health insurance mechanism. The State ofChhattisgarh in India successfully established a partnership between the RevisedNational TB Control Programme (RNTCP) and the Health Insurance Programme,to form a universal health insurance scheme for all, by establishing RashtriyaSwasthya Bima Yojna (RSBY) and Mukhyamantri Swasthya Bima Yojana(MSBY) MDR-TB packages. The objective of this partnership was to absorbthe catastrophic expenses incurred by patients with MDR-TB, from diagnosis totreatment completion, in the public and private sector. This paper documents theinitial experience of a tailor-made health insurance programme, linked to coveringcatastrophic health expenditure for patients with MDR-TB.Methods: In this descriptive study, data on uptake of insurance claims throughinnovative MDR-TB packages from January 2013 to April 2014 were collected.A simple survey of costs for clinical investigation and inpatient care was conductedacross two major urban districts in Chhattisgarh. In these selected districts, threehealth facilities from the private sector and one medical college from the publicsector with a functional drug-resistant tuberculosis (DR-TB) centre were chosenby the RSBY and MSBY State Nodal Agency to complete a simple, structuredquestionnaire on existing market rates. The mean costs for clinical investigationsand hospital stay were calculated for an individual patient with MDR-TB who wouldseek services from the private or public sector.Results: A total of 207 insurance claims for RSBY and MSBY MDR-TB packageswere processed, of which 20 were from private and 187 from public healthestablishments, covered under the health insurance programme, free of charge.An estimated catastrophic expenditure, of approximately US$ 20 000, was savedthrough the RSBY and MSBY health insurance mechanism during the study period.Conclusion: The innovative RSBY and MSBY MDR-TB insurance package is astep towards reducing catastrophic expenses associated with treatment for MDRTB.