Triple burden of disease and out of pocket healthcare expenditure of women in India

<div><p>Aim</p><p>Women, unlike men, are subjected to triple burden of disease, namely, non-communicable and communicable diseases and reproductive health related diseases. To assess prevalence of triple burden of disease of currently married women and to contrast out of pocket maternal care expenditure of these diseases in India.</p><p>Subject and methods</p><p>This study uses nationally representative unit level data from the 71st round (2014) of the National Sample Survey Organisation. Descriptive statistics and bivariate analysis are employed to assess triple burden of diseases by background of currently married women. Mean out of pocket (OOP) expenditure for healthcare care by demographic and household characteristics of women are also compared by type of diseases. Two parts model is adopted for assessment of determents of out of pocket healthcare expenditure of women.</p><p>Results</p><p>Overall medical and non-medical expenses of non–communicable disease are much higher than those of other disease and disability, reproductive health related and communicable diseases. OOP expenditure for treatment of non-communicable diseases, reproductive health and related diseases and other disease and disability are significantly higher than the inpatient treatment of communicable diseases and the differences are statistically significant.</p><p>Conclusion</p><p>Out of pocket expenditure for treatment of non-communicable diseases is the highest, followed by that of other diseases & disability, then reproductive health related diseases and the least is for communicable diseases. OOP expenditures for maternal healthcare in private health facilities are much higher than in public health facilities regardless of types of disease. Women from households having insurance of any member spent less than that of women from households not having health insurance. There is an urgent need to expand the outreach of the public health system in India to rural areas.</p></div

Annual out of pocket maternal healthcare expenditure (in INR) by type of diseases and background characteristics of currently married women in India, 2014.

<p>Annual out of pocket maternal healthcare expenditure (in INR) by type of diseases and background characteristics of currently married women in India, 2014.</p

Estimates of coefficients of two part model for out of pocket expenditure of women in India, 2014.

<p>Estimates of coefficients of two part model for out of pocket expenditure of women in India, 2014.</p

Itemize mean annual OOP expenditure in last 365 days by type of diseases and health facilities in India.

<p>Itemize mean annual OOP expenditure in last 365 days by type of diseases and health facilities in India.</p

Burden of communicable, non-communicable, other & disability and reproductive health related diseases by background characteristics among currently married women in India, 2014.

<p>Burden of communicable, non-communicable, other & disability and reproductive health related diseases by background characteristics among currently married women in India, 2014.</p

Histogram and density of out of pocket expenditure for healthcare (in log scale).

<p>Histogram and density of out of pocket expenditure for healthcare (in log scale).</p

Box plot of annual OOP healthcare expenditure (log scale) by type of diseases.

<p> Note: CD–Communicable Disease, NCD- Non Communicable Disease, ODAD- Other disease & disability, RHRH- Reproductive health related disease.</p

Unadjusted percent and adjusted odds ratio and corresponding 95% confidence interval predicting the odds of risky sex among female sex workers with their socio-demographic and behavioral characteristics as predictor variables in Karnataka, India, 2007

1<p><b>Risky sex:</b> Had unprotected sex with any partner and either had anal sex or consumed alcohol before sex or had concurrent sexual partnerships.</p>2<p>AOR: Adjusted Odds Ratio, CI: Confidence Interval.</p>$<p>Unweighted numbers.</p

Percent of female sex workers reporting unprotected sex, concurrent sexual relationships, anal sex and consumption of alcohol prior to sex in Karnataka, India, 2007.

<p><b>Note:</b> The P-values were arrived at using Pearson’s Chi-square test and indicates the strength of association between background characteristics and HIV-related sexual risk factors.</p>$<p>Unweighted numbers.</p

Socio-demographic and sex work related characteristics of female sex workers, Karnataka, India, 2007.

*<p>SD: Standard Deviation.</p>$<p>Unweighted numbers.</p>1<p>A traditional form of sex work where females are married to God in childhood and at puberty they start selling sex.</p