International Journal of Public Health and Epidemiology Research IJPHER

Vol. 6(1), pp. 138-146, May, 2020. © www.premierpublishers.org. ISSN: 1406-089X

Research Article

Out of Pocket Expenditure on Non-Communicable Diseases

among Households: Evidence from a State of India
Munmee Das1, *Shubhabrata Das2
1Health & Family Welfare, Assam, India
2Translational Health Science and Technology Institute-PBC, NCR Biotech Science cluster, Haryana, India

Background: The economic impact of non-communicable diseases in the states of India is

expected to differ because of variable disease burden as well as varying socio-economic
conditions and health system inequalities. There is paucity of studies on the economic
implications in those states of India which have high prevalence of non-communicable diseases.
Thus, this study aims to estimate the economic burden in the state of Punjab which one of the
states of India with high prevalence of non-communicable diseases. Method: Unit level data from
household survey data of 71st round of National Sample Survey Organization (NSSO) of India was
used. Data was analyzed to estimate the out of pocket expenditure, share of such expenditure in
total household consumption expenditure and the financial strategies used to cope up with such
expenditure. All the analysis was performed using STATA 13.1. Results: Our results indicate that
the state of Punjab incurred high out of pocket expenditure than all India levels for management
of non-communicable diseases. Also per capita monthly out of pocket expenditure is high and
the share of out of pocket expenditure in total household consumption expenditure is highest for
the poorest quintiles. Conclusion: The result of this study indicates that because of high out of
pocket expenditures which are incurred for care of non-communicable diseases, the state of
Punjab faces huge economic burden.

Keywords: Economic burden, non-communicable diseases, National Sample Survey Organization, out of pocket
expenditure, coping strategies.

INTRODUCTION

Health care system in India is characterized by households
bearing the major share of health expenditure in the form
of high out of pocket expenditure (OOPE) (Pradhan J &
Dwivedi R. 2017); (Singh P & Kumar V. 2017). As per
2013-14- National Health Accounts(India), OOPE
spending accounts for 64.2% of total health spending
(MoHFW 2016).Because the health financing system in
India is weak and does not provide adequate financial
protection, majority of households resort to selling assets,
taking loans, borrowing money from friends and relatives
to meet their health care expenses (Sauerborn R, Adams
A & Hien M. 1996);( Kruk ME, Goldmann E & Galea
S.2009).This high share of OOPE expenditure on health
care could drastically affect the economic condition of a
household leading to a situation of distress health
financing which has been defined as a situation when a
household has to borrow money or sell their
property/assets or when it gets contributions from
Out of Pocket Expenditure on Non-Communicable Diseases among Households: Evidence from a State of India
friends/relatives to meet its health care expenses. In order
to meet the cost of illness, households in India use various
coping strategies to avert financial hardship (Berman P,
Ahuja R & Bhandari L. 2010); (O’Donnell et al 2008);
(Kastor A & Mohanty SK 2018); (Flores G, KrishnakumarJ,
O’Donnell, & VanDoorslaer E 2008);( Leive A & Xu
K.2008).
Managing non communicable diseases (NCD) is not only
expensive; it also requires specialized treatment and
frequent hospitalizations. Thus, high OOPE on health care
when diseases are chronic in nature can cause
households to cut back on other expenses which are vital
*Corresponding Author: Dr. Shubhabrata Das,
Translational Health Science and Technology Institute-
PBC, NCR Biotech Science cluster, Haryana, India.
E-mail: drshubha2016@gmail.com
Das and Das. 139
for quality of life. Currently India is undergoing major
epidemiological transition and the disease patterns have
shifted as evident from various studies reporting wide
interstate variations in the NCD burden in India, with some
states reporting largest dominance of NCD and injuries in
total disease burden. It has been shown previously that
OOPE varies enormously by type of disease, as well as by
the health care provider and this is in addition to the large
variations present due to varying socio-economic
conditions, negligible financial risk protection and health
system inequalities within different geographical areas of
India. Often such interstate differences are overlooked by
researchers and policymakers while studying economic
impact of non-communicable diseases (Sharma D et al
2017); (ICMR, PHFI, & IHME 2017).
While majority of past studies have estimated the
economic impact of non-communicable diseases at the all
India (national) level, with few focusing randomly on one
or two states of India; studies on the high non
communicable disease prevalent states of India are
negligible or almost nonexistence. Analysis of the
economic impact of NCD in high prevalent states of India
will reflect the true picture of the costs associated with their
management and its impact on households. Further the
results of this study would help provide empirical evidence
in support of the need for prioritized protection against
financial risks from NCD in high prevalence states as they
face huge economic burden from such diseases as
compared to states with lower prevalence of NCD.
From a policy point of view, it is necessary to assess the
magnitude of economic impact of NCD in those states
Table 1: Key health financing indicators for Punjab
Total Health Expenditure (THE) Government Health Expenditure
In INR Per capita in As % of In INR Per capita in As % of
crore INR GSDP crore INR
15138 5220 4.1% 2578 889
Source: National Health Systems Resource Centre (2017); National Health Accounts Estimates for India (2014-15)
Our study aims to provide estimation of economic impact
of non-communicable diseases by estimating the out of
pocket expenditure, share of such expenditure in total
household consumption expenditure and the financial
strategies used to cope up with such expenditure in high
non communicable disease prevalent state of Punjab,
India.
METHODS
Study design and Data: This is a cross sectional study
involving secondary data analysis. The data source is the
unit level data from the household health survey of the 71st
round of NSSO titled as ‘Social consumption: Health’
which was conducted from January 2014 to June 2014. A
nationally representative survey, the survey period was of
six months. A stratified multi stage design was used and
the survey covered a total of 65,932 households all over
Out of Pocket Expenditure on Non-Communicable Diseases among Households: Evidence from a State of India
which have high prevalence of such diseases as ‘health’ is
a state subject in India, so majority of the public spending
on health needs to be borne by the state governments.
The measure and distribution of out of pocket expenditure
(OOPE) have been widely used as key indicator in
understanding health sector reforms by various authors.
And with this backdrop, the present study estimates OOPE
on treatment and hospitalization of NCD and its impact on
households in one of the high NCD prevalent state of India.
As most of government health programmes of India
encourage decentralized health planning process, it is
important to generate evidence on out of pocket
expenditure and distress financing at state level.
Therefore, we estimated out of pocket expenditures due to
non-communicable diseases as well as various financing
mechanisms and coping strategies used by households to
meet such expenditures in the state of Punjab, one of the
high NCD prevalent states of India. The state of Punjab
has 157 percent higher per person burden from diabetes
and 134 percent higher burden from ischemic heart
disease than most other states, indicating high NCD
burden (ICMR, PHFI, & IHME 2017).
Punjab is a state in northwest region of India. As per
census 2011, the population of Punjab is 27,743,338, with
62.5 percent rural population and 37.4 percent urban
population. For better understanding of the health
systems, information on health financing is needed. The
following table gives information on the key indicators of
health financing in the state of Punjab (Table 1).
Out of pocket expenditure
In INR Per capita in As % of
THE crore INR THE
17.0% 12001 4138 79.3%
India. First stage units were census villages in rural areas
and urban frame survey blocks in urban areas. The survey
collected details from households regarding any aliments
in the last 15 days amongst the members of the household,
whether admitted in hospital in last 365 days, type of health
care sought i.e. public or private, the expenditures incurred
as a result of ill health and financing of such expenditures.
Further with regards to cost of treatment, information was
collected on expenses incurred, separately for outpatient
(15 days recall) and inpatient treatment (365 days recall).
In the state of Punjab, the survey covered 1,529
households amongst which 768 were rural households
and 761 were urban households. In terms of number of
persons, a total of 7,797 persons were covered in the
survey, out of which 4044 were from rural areas and 3753
were from urban areas of Punjab. Detailed information can
be found in the survey report which is freely available in
the website of Indian Ministry of Statistics and Program
Implementation.

Disease and condition classification: The health conditions
provided in the household survey are self-reported. We
matched the health condition categories in the survey to
board ICD-10 classification to distinguish between major
non communicable disease conditions and communicable
diseases (Annexure I). As some of the disease categories
in the survey could include both non communicable
diseases and communicable diseases, so this study
focused on the categories that were clearly non
communicable diseases.
Next in order to find out the states with high prevalence of
non-communicable disease conditions, the prevalence of
self-reported morbidity was calculated based on the
information available in the survey. Prevalence of
morbidity was calculated per thousand populations. The
following formula was used.
Prevalence of morbidity (Pi) = Ai/Ti * 1000
Where,
Ai= Number of ailing persons and
Ti= total population in the sample
On the basis of results of prevalence of morbidity, the
states which have prevalence of NCD conditions higher
than the all India average are considered as high
prevalence states. This study purposively selected the
state of Punjab as it has high prevalence of NCD (Refer to
Annexure II) and there is paucity of studies analyzing
economic burden of non-communicable diseases.
Outpatient visits and hospital stays (Inpatient): Information
about all hospital stays during the last 365 days preceding
the survey and outpatient visits during last 15 days for
NCD were calculated. In case of outpatient visits query
was made about aliments during the 15 days prior to the
survey. In order to estimate the annual number of
outpatient visits for the population, the number of visits
reported in the last 15 days reference period were
multiplied by 24.33(=365/15) following the method of
Engelgau, Karan A & Mahal A(2012).
Financing of healthcare services for non-communicable
diseases:
Different studies have defined out of pocket expenditure
(OOPE) as expenditure on outpatient or inpatient care net
of reimbursement. Estimation was made regarding how
households financed their overall health expenses related
to NCD. For in patient, each episode of hospitalization was
considered for calculating expenses. In case of outpatient,
expenses were calculated irrespective of the number of
spells of aliment. Thus, the expenses included
expenditures on doctor’s/surgeon’s fees, costs of
medicines, diagnostic tests, bed charges and any other
charges like on medical appliances, blood, oxygen etc.
and it was termed as “medical expenditures”. Calculation
of any other expenses other than medical expenses was
also undertaken and it included transport charges, food,
lodging charges during the reference period and referred
Out of Pocket Expenditure on Non-Communicable Diseases among Households: Evidence from a State of India
Int. J. Public Health Epidemiol. Res. 140
to as ‘non-medical expenditure’. The estimate of total
expenditure for health care (both outpatient and inpatient)
was arrived at as the sum of ‘medical expenditure’ and
‘non-medical expenditure’.
Estimation of how the households financed their health
expenses related to NCD was also made. The burden of
such financing across different economic groups was also
analyzed. For analyzing the burden of NCD across
different economic groups the entire population was
divided into 5 groups (quintiles) ranked by monthly per
capita household expenditure. Assessment was made of
how health spending varied across quintiles. To find out
how out of pocket spending affected the household’s other
consumption, the share of out of pocket spending on total
on total household spending was calculated. The analyses
were carried out by applying sampling weights provided by
the NSSO.
The indicators for analysis of the economic implications of
non-communicable diseases were selected on the basis of
information collected in the survey.
Statistical analysis: All the analysis was performed using
STATA 13.1.
Ethical considerations
This study used anonymous survey data collected by the
National Sample Survey Organization (NSSO). It is a
department of the Indian Ministry of Statistics and Program
Implementation. The data is openly available and is
available to the public free of cost. The study was
approved by Institutional Ethical Committee.
RESULTS
Analysis of unit data from the NSSO 71st survey showing
number of persons reporting chronic ailments,
hospitalization rate and type of care at the all India level
and in the state of Punjab are presented in Figure 1 & 2.
Figure 1: Prevalence of non-communicable diseases and
hospitalization rate (reference period-365 days) in India
and Punjab- 2014
Note: * Prevalence calculated per thousand population
Das and Das. 141

India Punjab
Public Public
Private Private
28.83%
36.3%
63.6% 71.17%

Figure 2: Percentage distribution of inpatient treatment for non communicable diseases (365 days recall) by public and
private-India and Punjab, 2014

Next the estimates of expenditures on non-communicable diseases as well as for different components like
diseases were analyzed. Estimations were made for both expenditure on drugs, diagnostics, fees (Table 2 & 3).
outpatient and inpatient treatment of non-communicable

Table 2: Mean cost of treatment per ailing person on different items related to outpatient treatment (reference period-15
days) of non communicable diseases- India and Punjab, 2014; in INR (USD)
*Cons **Exp medicine Exp ^Exp #Exp medical Exp Exp Exp Insurance
fees diagnostics Others transport non-medical Total Reimbursement
Punjab 47.08 505.05 96.36 25.81 674.32 34.97 9.24 718.55 0.021
(0.65) (7.04) (1.34) (0.36) (9.41) (0.48) (0.12) (10.02) (0.00)
All 75.71 458.43 62.68 22.78 619.61 51.78 28.90 700.30 3.4
India (1.05) (6.39) (0.87) (0.31) (8.64) (0.72) (0.40) (9.77) (0.04)
*Cons-consultation;**Exp-expenditure; #Exp medical sums up expenditure on consultation fees, medicine/drugs ,
diagnostics ;^Exp others includes-all expenses relating to treatment of an ailment incurred by the household other than
the medical expenditure proper like food and lodging charges for escort, cost of transport other than ambulance.
$USD; exchange rate-71.65

Table 3: Per episode cost of treatment on different items

related to hospitalized treatment of non communicable
diseases-India and Punjab, 2014; in INR (USD)
Items Cost in INR(USD)
Punjab All India
Consultation 5,001.64(69.80) 4,241.61(59.20)
fees
Expenditure 6,079.19(84.84) 5,550.23(77.46)
medicine
Expenditure 3,235.22((45.15) 2,237.95(31.23) Figure 3: Per person monthly out-of-pocket expenditure
diagnostics on outpatient treatment for non-communicable diseases
Bed charges 3,054.18(42.62) 2,256.02(31.48) (last 15 days recall) by sector -Punjab and All India, 2014;
Expenditure 2,509.4(35.02) 2,119.96(29.58) in INR (USD)
other
Expenditure 35,451.13(494.78) 23,919.00(333.83)
medical
Expenditure 688.37(9.60) 799.91(11.16)
transport
Expenditure non- 1,833.17(25.58) 1,713.76(23.91)
medical
Hospital 37,972.68(529.97) 26,432.67(368.92)
expenditure
Insurance 1,233.73(17.21) 1,763.03(24.60)
reimbursement Figure 4: Per person monthly out-of-pocket expenditure
Next, we analyzed the out of pocket expenditure for on in-patient treatment for non-communicable diseases
outpatient and inpatient treatment of NCD (Figure 3& 4). (last 365 days recall) by sector- Punjab and All India, 2014;
in INR (USD)

Out of Pocket Expenditure on Non-Communicable Diseases among Households: Evidence from a State of India
 Int. J. Public Health Epidemiol. Res. 142

When faced with OOPE, the financing strategies used by Analysis of OOPE by income quintiles showed that in
households show a similar pattern for outpatient and Punjab, the poorest income quintile’s share of out of
inpatient expenditures (Figure 5&6). pocket expenditure for outpatient care in total household
expenditure is nearly 14.3 percent.

Table 5: Per person monthly out-of-pocket (OOPE)

expenditure on outpatient and inpatient treatment of non-
communicable diseases for income quintile groups-
Punjab, 2014; in INR (USD)
Punjab Mean OOPE Mean OOPE
Quintiles Outpatient Inpatient
poorest 147.03(2.05) 34.64(0.48)
2nd poorest 134.02(1.87) 64.25(0.89)
middle 229.05(3.19) 69.96(0.97)
Figure 5: Percentage distribution of major sources of 2nd richest 306.31(4.27) 106.82(1.49)
financing for outpatient treatment of non-communicable richest 448.38(6.25) 213.49(2.97)
diseases- Punjab 2014
*Others source of financing includes-contribution from friends & Table 6: Out of pocket expenditure (outpatient) on non-
relatives and sale of ornaments and other physical assets,
communicable diseases as percentage share of total
draught animals.
household consumption expenditure across income
quintiles- Punjab, 2014
Punjab Percent share in Percent share in
Quintiles total household total household
consumption- consumption-
Outpatient (in %) Inpatient (in %)
poorest 14.3 3.3
2nd poorest 7.7 3.6
middle 9.6 2.9
2nd richest 10.1 3.5
Figure 6: Percentage distribution of major sources of
richest 8.9 4.2
financing for inpatient treatment of non communicable
diseases by sectors- Punjab 2014
In case of financial strategies for all of the income quintiles
Further we also analyzed income quintiles pattern in using own income or savings is the major source of
utilization of healthcare services, OOPE and financing financing healthcare expenditure with borrowing coming a
strategies (Table 4 and Figure 7). close second as seen from figure 8.

Table 4: Percentage distribution of outpatient treatment for

non-communicable diseases by public and private across
income quintiles -Punjab, 2014
Income Quintiles & Public (in %) Private (in %)
Social groups
Poorest 16.03 83.97
2nd poorest 27.69 72.31
Middle 33.65 66.35
2nd richest 22.45 77.55
Richest 22.62 77.38

Figure 7: Percentage distribution of inpatient treatment of

Figure 8: Percentage distribution of major sources of
non-communicable diseases by public and private across
financing for outpatient and inpatient treatment of non-
income quintiles -Punjab, 2014
communicable diseases across quintiles-Punjab, 2014
Out of Pocket Expenditure on Non-Communicable Diseases among Households: Evidence from a State of India
Das and Das. 143
DISCUSSION
Estimation of the prevalence of non-communicable
diseases and the utilization pattern showed high
prevalence of non-communicable diseases in the state of
Punjab. Studies by Barik &Arokiasamy, 2016 and Paul &
Singh, 2017, using NSSO data also reported high
prevalence of non-communicable diseases in Punjab. In
the type of facilities used for management of NCD, it was
found that predominantly private facilities were visited for
both outpatient and inpatient treatment.
Estimations of financial implications of non-communicable
diseases showed that per person average cost is higher in
Punjab than all India average cost of INR 700.30(USD
9.77). Considering the fact that non communicable
diseases are chronic in nature and require frequent
outpatient medical consultation and long-term
medications, even a fraction of increase in per person
average cost can significantly lead to higher financial
burden. Further in case of inpatient treatment in Punjab,
highest expenditure is found to be incurred on medicines
with approximately INR 6,079.19(USD 84.84) being spent
only on medicines out of the total per episode medical
expenditure of INR 35,451.13(USD 494.79), which
indicates a high financial burden on households with NCD
in Punjab.
Our analyses also pointed out the fact that households in
Punjab overwhelmingly depend on private facilities for
their health care needs. Now as utilization pattern of
healthcare services can act as major driver leading to
increased medical expenditure, the high dependence on
private facilities could be one of the main factors
contributing towards high OOPE in the state of Punjab.
When compared to all India per capita monthly out of
pocket expenditure (INR 114.26; USD1.59) for non-
hospitalized care of NCD, the state of Punjab was found to
have much higher out of pocket expenditure. As expected,
the urban areas had higher per capita OOPE for
hospitalized care as well as outpatient care of NCD. This
could be a significant finding considering the fact that NCD
are mostly long standing in nature and require frequent
medical care which may push up the medical
expenditures. Further it is also seen that the largest
component of expenditure is on medicines.
As medicines play a critical role in treatment and
prevention of complications in case of non-communicable
diseases, if these are forgone because of lack of financial
resources, a higher mortality and morbidity will result from
such diseases. Studies by Engelgau et al, 2012,
Shobhana et al, 2000, Gupta et al, 2006, Murthy& Sastry,
2005, too reported high out of pocket expenditure on NCD
and Kankeu et al, 2013 reported that the expenditure on
medicines is the largest component of OOPE.
Amongst the income quintiles it was found that the poorest
quintile spends the least for hospitalized care, suggesting
Out of Pocket Expenditure on Non-Communicable Diseases among Households: Evidence from a State of India
that the ability to pay is closely linked to utilization of health
care services and expenditure on health care. As
expenditure on healthcare can take up a significant
proportion of household’s financial resources and in order
to understand the extent of financial burden of OOPE, the
share of out of pocket expenditure in total consumption
expenditure of a household was estimated. For the poorest
even the smallest out of pocket expenditure on health care
can drastically alter their overall consumption pattern. Our
analyses showed that the share of OOPE for outpatient
care in households total consumption expenditure is 14.3
percent for the poorest income quintile while for the richest
quintile it is 8.9 percent. Similar economic gradient is seen
in case of out of pocket expenditure for inpatient care of
NCD.
The results of our study also show that majority of the
households in India have to depend upon own income or
savings for financing of healthcare expenses for
management of NCD. Various authors have reported that
coping strategies such as using savings, borrowing, and
the sale of assets are used to finance three‐fourths of the
cost of inpatient care in rural areas and two‐thirds of the
cost in urban areas in India (Dilip T & Duggal R .2002);
(Flores G, Krishnakumar J,O’Donnell & Van Doorslaer E.
2008).
All the income quintiles used income or savings as source
of finance for meeting out of pocket expenditures. The
findings with regards to coping mechanisms are in
concurrence with earlier study by Rao et al, 2011, wherein
income and savings were found to be the most commonly
used financial strategies to meet out of pocket
expenditure. The heavy reliance on income or savings in
the state of Punjab to finance health care expenditure and
to cope up with out of pocket expenses for NCD care
reduces the ability of the households to save and for
capital formation, which can have long term implications
for the economic wellbeing of the households. This
situation can be financially disastrous for the economically
vulnerable sections.
Strengths of the present study include the use of nationally
representative household survey data and being the first
of its kind in focusing on OOPE and financing mechanisms
of non-communicable diseases in one of the highest non
communicable disease prevalent states of Punjab. There
are certain methodological limitations to our study. The
use of self-reported disease conditions and expenditure for
treatment could potentially under or overestimate the
analyses of prevalence and the financial implications of
NCD.
CONCLUSION AND POLICY IMPLICATIONS
The prevalence of non-communicable diseases is much
higher in the state of Punjab with per person average cost
of treatment being more for outpatient care than in patient

care. This finding is important considering that the current
public health protection scheme mainly focuses on
secondary and tertiary level in patient care for different
diseases.
Our study also found that the share of out of pocket
expenditure in total household consumption expenditure is
highest for the poorest income quintiles indicating large
financial burden on the poorest. The results of this study
underline the importance of protecting households with
more focus on poorest households in high non
communicable disease prevalent states of India from the
financial burden associated with NCD in patient care and
treatment. Cost effectiveness and targeting of the poorest
groups need to be primary considerations when prioritizing
services that are included in insurance programs to
achieve universal health coverage, which is a part of
Sustainable Development Goal -3 through financial risk
protection, access to quality essential healthcare services
and essential medicines.
DECLARATION
Funding: No funding sources
Conflict of interest: None
Ethical Approval: The study was approved by IEC. The
study was approved by the Institution Ethics Committee,
Indian Institute of Public Health- Delhi, Gurgaon
Haryana,India.
Acknowledgement: The authors acknowledge the
guidance and support provided for the study by Dr. Anup
Karan, Associate Professor, IIPH-D,PHFI ,Haryana, India.
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APPENDICES

Annexure I: Classifying the NSSO 71st survey response categories into communicable, non communicable and other
conditions
I. Communicable , Gynecological and diseases of children
• Diarrhea ,Dysentery, Gastritis/peptic ulcer, worm infestation, Amoeboisis, Hepatitis/Jaundice
• Malaria, Mumps, Diphtheria, Whooping cough, Fever of unknown origin
• Tetanus
• Filariasis
• Diseases of the skin
• Gynecological disorders
• Under nutrition, anemia
• Sexually transmitted diseases
• Respiratory (including ear/nose/throat)aliments for ages less than 15 years
• Tuberculosis

II. Non communicable diseases

• Heart disease, Hypertension
• Bronchial asthma
• Respiratory (including ear/nose/throat)aliments for ages more than 15 years
• Disorders of joints and bone
• Disorders of kidney /urinary system
• Neurological disorder
• Psychiatric disorder
• Diabetes
• Cancer and other tumors
• Accidents /injuries/burns/fractures/poisonings
III. Other conditions
• Goiter
• Eye aliments
• Disorders of mouth ,teeth ,gum
• Disabilities: locomotor, visual,speech
• Other undiagnosed aliments

Out of Pocket Expenditure on Non-Communicable Diseases among Households: Evidence from a State of India
 Int. J. Public Health Epidemiol. Res. 146

Annexure II Table 1: Number of persons (per 1000) reporting Chronic, other and all aliments during last 15days, major
states &all India, 2014
Major states Chronic Ailment PAP
Delhi 7.27 33.00 40.17
Haryana 24.07 38.99 62.56
Himachal 43.46 36.09 78.97
J&K 29.80 29.52 58.96
Punjab 78.70 90.33 166.32
Rajasthan 28.88 33.61 62.11
Uttarakhand 11.80 74.13 84.19
Assam 8.09 25.35 33.43
NEstates 3.64 31.92 35.57
Chhattisgarh 10.11 31.25 40.53
Madhya Pradesh 20.24 38.38 58.19
Uttar Pradesh 25.08 48.21 72.92
Bihar 18.04 40.61 57.94
Jharkhand 23.49 38.65 61.84
West Bengal 93.53 78.40 166.54
Odisha 29.61 73.97 102.42
Maharashtra 31.36 45.39 75.94
Goa 100.13 80.43 180.56
Gujarat 50.42 49.43 96.40
Andhra Pradesh 123.21 50.72 170.22
Karnataka 50.50 48.65 97.52
Kerala 208.29 117.50 308.15
Tamilnadu 102.89 67.15 164.64
Telangana 54.54 43.59 96.86
UTs 95.15 82.64 169.66
Total 48.38 51.67 97.92
*Proportion of Ailing Persons

Accepted 13 January 2020

Citation: Das M, Das S (2020). Out of Pocket Expenditure on Non-Communicable Diseases among Households:
Evidence from a State of India. International Journal of Public Health and Epidemiology Research, 6(1): 138-148.

Copyright: © 2020 Das and Das. This is an open-access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original
author and source are cited.

Out of Pocket Expenditure on Non-Communicable Diseases among Households: Evidence from a State of India