Financial Impact of Complex Cancer Surgery in India: A Study of Pancreatic Cancer.

PURPOSE: The rapidly increasing burden of cancer in India has profound impacts on health care costs for patients and their families. High out-of-pocket (OOP) expenditure, lack of insurance, and low government expenditure create a vicious cycle, leading to household impoverishment. Complex cancer surgery is now increasingly important for emerging countries; however, little is understood about the macro- and microeconomics of these procedures. After the Lancet Oncology Commission on Global Cancer Surgery, we evaluated the OOP expenditure for patients undergoing pancreatico-duodenectomy (PD) at a government tertiary cancer center in India. METHODS: Prospective data from 98 patients who underwent PD between January 2014 and June 2015 were collected and analyzed. The time frame for consideration of expenses, including all preoperative investigations, was from the first hospital visit to the day of discharge. Catastrophic expenditure was calculated by assessing the percentage of households in which OOP health payments exceeded 10% of the total household income. RESULTS: The mean expenditure for PD by patients was Rs.295,679.57 (US$74,420, purchasing power parity corrected). This amount was significantly higher among those admitted to a private ward and those with complications. Only 29.6% of the patients had insurance coverage. A total of 76.5% of the sample incurred catastrophic expenditure, and 38% of those with insurance underwent financial catastrophe compared with 93% of those without insurance. The percentage of patients facing catastrophic impact was highest among those in semiprivate wards, at 86.7%, followed by those in public and private wards. CONCLUSION: The cost of PD is high and is often unaffordable for a majority of India's population. A review of insurance coverage policies for better coverage must be considered

Understanding the “Cash-Less” Nature of Government-Sponsored Health Insurance Schemes

The public health spending in India has been hovering around 1% of gross domestic product (GDP), and it contributes only 28% of total health expenditure. Hence, out-of-pocket (OOP) payments continue to be the dominant source of health care financing in India. However, for providing protection from the economic effects of health shocks, last few years have seen a plethora of central and state government–sponsored private health insurance schemes for the deprived groups, particularly those working in the unorganized sector. The latest is the Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY), launched by the Government of Maharashtra in 2012. This study is an attempt to assess the extent to which RGJAY protects the families from making OOP expenditure while availing the tertiary care from the RGJAY accredited facilities. Both primary and secondary data were utilized for this study. Despite being enrolled in RGJAY, more than three fifths (63%) of the beneficiaries still incurred OOP payments for services when admitted in the hospital, and more worryingly, it was found that a significantly higher proportion of persons from Below Poverty Line (BPL) families (88.23%) reported paying for diagnostics, medications, or consumables. Furthermore, our study found that about a third of the beneficiaries experienced financial catastrophe if indirect expenditure is taken into consideration. This also implies that for the poor, ill-health has further deepened the existing poverty

Patterns of tobacco use and quit attempts in rural India

Background India is the second largest consumer of tobacco and accounts for about 1/6 th of the global deaths due to tobacco. The objectives of this study were to determine the patterns of tobacco use and the association of tobacco use and quit attempts with socio-demographic variables in a rural community. Methods The study was carried out among 580 men and women aged 15 years and above who visited rural health care centres in two districts of Karnataka, India during July-August 2015 and reported ever using tobacco. Primary data was collected using a semi-structured interview schedule, administered by a trained medical professional after taking informed consent. Univariate and bivariate analysis, and multiple logistic regressions were carried out using SPSS. Results Majority of our respondents (73.4%) were Current daily users of Tobacco. The most common form of tobacco used in both genders was smokeless tobacco but a significantly higher proportion of women (97%) used smokeless tobacco compared to men (45%). The most popular tobacco product among both genders was betel quid with tobacco. Age of initiation of tobacco use was highest in the 20-34 age groups for both genders. About 29% of the respondents reported attempting to quit tobacco while 62.4% said they were not interested in quitting tobacco. Conclusions Most Public Service announcements and media campaigns in India are centred around the concept of 'Smoking Kills' and only target men but as seen from our study the burden of smokeless tobacco in the community is higher than smoking tobacco, more so among women. The low proportion of people wanting to quit tobacco indicates that people may still be unaware about the ill-effects of tobacco. For tobacco prevention and control highlighting the ill-effects of smoking as well as smokeless tobacco among both genders and providing cessation support are advised

Effectiveness of Tobacco Cessation Training Program for primary health care physicians of a South Indian district

Introduction Tobacco Cessation is one of the least attended components of Tobacco Control strategies worldwide. Although there is a felt need by tobacco users to quit the use and Tobacco Cessation Services can be provided in low-resource healthcare settings, lack of adequate training in tobacco cessation among health care physicians acts as a major deterrent to provide the services. Objective To determine the effectiveness of training medical officers in providing tobacco cessation services. Methods Study design: Cross Sectional Study. Study method: Self-scored questionnaire, self-administered pre and post one-day training on tobacco cessation. Study area: Dakshina Kannada, Karnataka, India. Sample size: Universal sample of 55 Medical Officers. Study period: 1 month. Results None of the Medical Officers were earlier trained in tobacco cessation services. Among the 55 medical officers, 23 were females. Mean number of years of experience of respondents was 8.2±6.99 years. Mean pre-test score for overall ability to provide tobacco cessation services was 46.31±9.41 and post-test score was 54.40±8.67 which showed a statistically significant difference (t= -7.58; p<0.05). The overall mean of pre and post test scores for ability to counsel the respondents using 5A's were 19.73±3.47 and 21.87±3.37 respectively which showed a statistically significant difference (t= -5.29; p<0.0005). A moderate positive correlation was observed between the overall pre and post test scores (r=0.62; p<0.01). Conclusions The study revealed that there was a significant improvement in the perceived ability to provide tobacco cessation services after the conduct of the Workshop. Funding District Tobacco Control Cell, Dakshina Kannada, Karnataka, India

Trends of tobacco cultivation in India: Boon or bane for supply reduction?

Introduction Flue-cured Virginia Tobacco is an important commercial crop grown in India. It occupies the third position in the world with an annual production of about 800 Million Kgs and 5th in exports. Tobacco contributes to over Rupees 340 Billion astax revenue to the national exchequer and approximately Rs.50 Billion by foreign exchange every year. Objective of the study To determine the trends of tobacco cultivation and tobacco revenue in India. Data sources: Data on tobacco production, crop target, crop price etc were collected for the years 2012-2016 from Annual reports of Tobacco Board, Ministry of Trade and Commerce, India. Study method: Secondary data-based Cross-Sectional Study Data analysis: Data were analyzed using percentage, proportion and Pearsonn's Correlation Coefficient on SPSS version 16. Results were considered significant at 95% level of significance. Results The mean Flue-cured virginia production between 2012 and 2016 was 270.35 million kg (± 51.52) with a percentage reduction of 27% from the baseline year. Flue-cured virginia had a mean target of 259.5 million kg (±26.55) during this period which showed 18% reduction in the target between base and end year. As FCV crop target increased, production also increased with a strong positive correlation (r= 0.96; p≤0.05) which was statistically significant. Excise duty and foreign exchange in million rupees between 2012 and 2016 showed a percentage increase of 8% and 22% respectively. Conclusions The study depicts that FCV crop target is correlated to the production positively. Hence, reducing crop target is an effective supply reduction measure

Psychosocial status and economic dependence for healthcare and nonhealthcare among elderly population in rural coastal Karnataka

Introduction: The elderly who will constitute 10% of the Indian population by 2021 face problems such as deteriorating healthcare status, loneliness, and economic constraints among others. All these factors together may affect the psychosocial status of the elderly and their health-seeking behavior. With this background, the current study tried to evaluate the psychosocial status, economic dependence for health and nonhealth expenses and awareness regarding geriatric welfare services (GWS) among elderly patients. Materials and Methods: The study was carried out among 599 men and women aged above 60 who visited rural healthcare centers in two districts of Karnataka during September–December 2016. A semi-structured interview schedule was administered by a trained medical professional after taking informed consent. Results: Majority of the respondents said that they had company at home, interacted with people outside home and that their advice was honored. About 75.8% of the respondents reported that they were either partially or completely financially dependent on someone else. The mean cost of hospitalization was reported to be Rs. 11,086. Majority of those hospitalized depended on their children to pay for healthcare (66.9%), whereas 16.9% had availed government insurance schemes and 14.6% paid out of pocket. Nearly 64.9% of the respondents were aware of the GWS while 32.6% had used them. Conclusion: The absence of financial risk pooling mechanisms and social support may cause elderly to forego treatment because of the need to pay for healthcare and further deteriorate their psychosocial status. Government initiatives to improve healthcare and social services to the elderly maybe advocated

Correlates of tobacco use and disease burden - an analysis of the World Health Organisation South East Asian Countries

Background World Health Organisation´s South-East Asia Region is home to about one fourth of the world's population. Of this, there are about 246 million smokers and 290 million smokeless tobacco users. In addition to the human toll, the effects of tobacco are felt significantly in the economy of a country. The World Bank has declared that, when effects of poverty due to loss of income, spending on tobacco and costs of illness are taken into account, tobacco use is a net loss to an economy. Methods Objective of the study: To determine the correlation of tobacco use with tobacco related disease burden and developmental indicators of South East Asian countries. Study method: Secondary data-based Cross-Sectional Study Data sources: Data on tobacco prevalence, cancer prevalence, human development index, tobacco economics and poverty indicators during the year 2014-2015 were collected from various sources such as WHO Report on Global Tobacco Epidemic 2015, World Bank data, Tobacco Atlas and World Life Expectancy 2014 reports. Data analysis: Data were analyzed using Pearsonn´s Correlation Coefficient on SPSS version 16. Results were considered significant at 95% level of significance. Results The Study represented data of 11 Countries of the WHO South East Asia Region. Current smoking prevalence ranged between 2.80% and 39.80% with a mean prevalence of 20.7% (± 9.24). Both prevalence of smoking and number of cigarettes smoked per year per ca-pita in the 11 countries had a positive moderate correlation with the number of deaths per 100000 population due to lung cancer (r= 0.62 &amp; 0.76; P=0.04 &amp; 0.01). Oral Cancer increased with prevalence of smokeless tobacco use (r=0.07; P=0.07). [Correlates between tobacco use and tobacco burden] Conclusions The study findings suggest that tobacco prevalence, tobacco related deaths and tobacco economics can be correlated with the health profile of countries in the region. These countries show positive correlation between tobacco use and related diseases