Borrowing-induced Impoverishment Associated with Non-communicable Diseases among Indian States using Human Development Survey Data

Abstract

Abstract Background In the absence of Universal Health Coverage (UHC) in India, non-communicable disease (NCD) related health expenditure is strongly associated with household borrowing. This mechanism deepens impoverishment in a way that standard impoverishment accounting does not capture. This study introduces a repayment-adjusted consumption measure to capture the effects of NCD-related borrowing. Our study estimates the proportion of households reported as impoverished once repayment obligations are absorbed into consumption measures, and the determinants of such borrowing. Method For households relying on borrowing, post-OOPE poverty was recalculated by subtracting repayment obligations against pre-OOPE headcount, and the difference was used to assess borrowing-adjusted impoverishment. Determinants of borrowing were computed through a multivariate logistic regression model. Results In 2005, the highest incidence of impoverishment associated with NCD-related expenditure was observed in Bihar (0.14%; 95% CI: 0.06–0.22), Madhya Pradesh (0.17%; 0.08–0.26), Uttar Pradesh (0.17%; 0.06–0.28). In 2012, Bihar (1.33%; 1.10–1.55), Uttar Pradesh (0.84%; 0.69–0.99), and Madhya Pradesh (0.85%; 0.64–1.06), reported the highest incidence. Households that are less educated, government-insured, or middle-income are more prone to borrowing for NCDs. Conclusion A significant proportion of households reported impoverishment after accounting for borrowing-related repayment obligations, reflecting the conventional measure does not reveal the actual financial burden of NCDs. Integrating a borrowing module into future survey rounds would help better capture hidden impoverishment. State-level variation suggests the need for state-specific financial protection policies such as more NCDs inclusion into the current insurance scheme, outpatient consultant coverage, regulation of private healthcare pricing, and creating awareness of health insurance among people would reduce impoverishment due NCD-related health expenditure.