Abstract
Abstract
Background
Universal health coverage (UHC) has emerged as one of the important health policy discourses under the current sustainable development goals in the world. UHC in individual disease conditions is a must for attaining overall UHC. This study measures progress towards UHC in terms of access to health care and financial protection among individuals with mental disorders in India.
Methods
Data from the 75th Round National Sample Survey (NSS), 2017-18, was used, which is the latest round on health in India. Data collected from 555,115 individuals (rural: 325,232; urban: 229,232), from randomly selected 8077 villages and 6181 urban areas, included 283 outpatient and 374 hospitalization cases due to mental disorders in India. Logistic regression models were used for analyses.
Results
Self-reporting of mental disorders was considerably lower than the actual disease burden in India. However, self-reporting of ailment was 1.73 times higher (95% CI: 1.18–2.52, p < 0.05) among the richest income group population compared to the poorest in India. The private sector was a major service provider of mental health services with a larger share for outpatient (66.1%) than inpatient care (59.2%). Over 63% of individuals with a mental disorder who reported private sector hospitalization noted unavailability or poor service quality at public facilities. Only 23% of individuals hospitalized had health insurance coverage at All India level. However, health insurance coverage among poorest economic class was a meagre 3.4%. Average out-of-pocket expenditure during hospitalization (public: 123 USD; private: 576 USD) and outpatient care (public: 8 USD; private: 37 USD) was significantly higher in the private sector than in the public sector. Chances of facing catastrophic health expenditure at 10% threshold were 23.33 times (95% CI: 10.85–50.17; p < 0.001) higher under private sector than public sector during hospitalization. Expenditure on medicine, as the share of total medical expenditure, was highest for hospitalization (public: 45%, private:39.5%) and outpatient care (public: 74.1%, private:39.7%).
Conclusions
Social determinants play a vital role in access to healthcare and financial protection among individuals with mental disorders in India. For achieving UHC in mental disorders, India needs to address the gaps in access and financial protection for individuals with mental disorders.
Trial registration
Not applicable.
Publisher
Springer Science and Business Media LLC
Subject
Psychiatry and Mental health,Public Health, Environmental and Occupational Health,Health Policy,Pshychiatric Mental Health
Reference59 articles.
1. Boerma T, AbouZahr C, Evans D, Evans T. Monitoring intervention Coverage in the context of Universal Health Coverage. PLoS Med. 2014;11:e1001728.
2. WHO. Tracking universal health coverage: first global monitoring report. World Health Organization; 2015.
3. Sundararaman T, Vaidyanathan G, Vaishnavi SD, Reddy KR, Mokashi T, Sharma J, et al. Measuring Progress towards Universal Health Coverage. Economic & Political Weekly. 2014;49:61.
4. Sagar R, Dandona R, Gururaj G, Dhaliwal RS, Singh A, Ferrari A, et al. The burden of mental disorders across the states of India: the global burden of Disease Study 1990–2017. The Lancet Psychiatry. 2020;7:148–61.
5. Dandona R, Kumar GA, Dhaliwal RS, Naghavi M, Vos T, Shukla DK, et al. Gender differentials and state variations in suicide deaths in India: the global burden of Disease Study 1990–2016. The Lancet Public Health. 2018;3:e478–89.