Catastrophic impact of multimorbidity on households in India: a cross-section analysis of self-reported morbidity from National Sample Survey 2017

Background: The purpose of this research is to generate new evidence on economic consequences of multimorbidity on households in terms of out-of-pocket (OOP) expenditures and its catastrophic impact. Methods: We analyzed Social Consumption Health data from National Sample Survey Organization (NSSO) 75th round conducted in the year 2017-2018 in India. Prevalence of multimorbidity and related OOP expenditure were estimated. Using Coarsened Exact Matching (CEM) we estimated mean OOP expenditure for individuals reporting multimorbidity and single morbidity for each episode of outpatient visits and hospital admission. We also estimated the catastrophic impact of multimorbidity on households. Results: Our matched sample analysis suggests that that OOP expenditure is invariably lower in case of outpatient treatment of the selected Non Communicable Diseases(NCDs) whereas in case of hospitalization, the OOP expenditures were mostly higher for the same NCD conditions in the presence of multimorbidity as compared with single conditions, except for cancers and cardiovascular disease. Furthermore, around 46.7% (46.674 - 46.676)households reported incurring catastrophic spending (10% threshold) because of any NCD in standalone disease scenario which rose to 63.3% (63.359-63.361) under multimorbidity scenario. The catastrophic impact of cancer among the individual diseases was the highest. Conclusions: Implementing financial risk protection measures to reduce the burden of household OOP expenditure is required at the country level.