The financial burden from non-communicable diseases in low- and middle-income countries: a literature review
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The financial burden from non-communicable diseases in low- and middle-income countries: a literature review Hyacinthe Tchewonpi Kankeu1*, Priyanka Saksena2, Ke Xu3 and David B Evans4
Abstract Non-communicable diseases (NCDs) were previously considered to only affect high-income countries. However, they now account for a very large burden in terms of both mortality and morbidity in low- and middle-income countries (LMICs), although little is known about the impact these diseases have on households in these countries. In this paper, we present a literature review on the costs imposed by NCDs on households in LMICs. We examine both the costs of obtaining medical care and the costs associated with being unable to work, while discussing the methodological issues of particular studies. The results suggest that NCDs pose a heavy financial burden on many affected households; poor households are the most financially affected when they seek care. Medicines are usually the largest component of costs and the use of originator brand medicines leads to higher than necessary expenses. In particular, in the treatment of diabetes, insulin – when required – represents an important source of spending for patients and their families. These financial costs deter many people suffering from NCDs from seeking the care they need. The limited health insurance coverage for NCDs is reflected in the low proportions of patients claiming reimbursement and the low reimbursement rates in existing insurance schemes. The costs associated with lost income-earning opportunities are also significant for many households. Therefore, NCDs impose a substantial financial burden on many households, including the poor in low-income countries. The financial costs of obtaining care also impose insurmountable barriers to access for some people, which illustrates the urgency of improving financial risk protection in health in LMIC settings and ensuring that NCDs are taken into account in these systems. In this paper, we identify areas where further research is needed to have a better view of the costs incurred by households because of NCDs; namely, the extension of the geographical scope, the inclusion of certain diseases hitherto little studied, the introduction of a time dimension, and more comparisons with acute illnesses. Keywords: Financial burden, Low- and middle-income countries, Non-communicable diseases, Review
Background The 2010 WHO Global Status report on non-communicable diseases (NCDs) showed that they are now the most important cause of mortality worldwide. Indeed, more than 36 million people died from NCDs in 2008, mainly cardiovascular diseases (48%), cancers (21%), chronic respiratory diseases (12%), and diabetes (3%). Nearly 80% of these deaths occurred in low- and middleincome countries (LMICs), where, on average, they now * Correspondence: [email protected] 1 Aix-Marseille University (Aix-Marseille School of Economics), CNRS & EHESS, Centre de la Vieille Charité, 2 Rue de la Charité, 13236 Marseille, Cedex 2,
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