The High Cost of Tuberculosis in India, Even With Free Diagnosis and Care

Poorest Households, Patients Requiring Hospitalisation Shoulder the Greatest Burden

December 16, 2024

In states across India, many tuberculosis patients incur burdensome out-of-pocket expenses for their treatment, even though government programs ensure no-charge diagnosis and care. A newly published study has found that about 45% of households with a tuberculosis patient bear costs exceeding one-fifth of their annual incomes.

The poorest households and those requiring hospitalisation face the greatest burden, with median treatment costs ranging from about 11,000 rupees to 74,000 rupees, says the study, featured by IndiaSpend and published in the journal Global Health Research and Policy.

Indirect costs, which include lost wages and reduced productivity, made up about two-thirds of overall expenses, adds the study, conducted by the Indian Council of Medical Research’s National Institute of Epidemiology (ICMR-NIE). Many patients lost income and were forced to accept lesser-paying jobs in the unorganised sector, often without paid leave or employer-offered insurance.

About 12% of patients resorted to “coping costs,” including high-interest loans or selling assets and using up savings, to pay for medical care. Further, expenditures frequently began even before an official diagnosis, particularly for the 60% of presumptive TB patients who first sought help from private healthcare providers, says the study, which surveyed 1,407 patients from 11 states and Union territories between 2022 and 2023.

Further, patients who were admitted spent a median amount of about 74,000 rupees, compared to about 27,000 rupees for those who were never hospitalised.

“In the public health system, we do not have adequate inpatient care facilities in India for TB,” IndiaSpend quoted Prof. Madhavi Bhargava of Yenepoya Medical College, Mangaluru, as saying. Bhargava explained that concerns about disease transmission often prompt hospitals to limit TB admissions, leading patients to seek costlier private care. She added that common problems requiring hospitalisation include low oxygen saturation, severe malnutrition and adverse medication effects.

Although the medication under India’s National Tuberculosis Elimination Programme (NTEP) was free, an individual still incurred costs of about 200,000 rupees, according to an example cited by IndiaSpend. Subsequently, another family member developed TB, and the household faced further financial strain, spending about 150,000 rupees. The family’s challenges continued as a two-year-old relative also contracted TB, initiating yet another cycle of treatment and expenses.

The solution, according to the study, involves improving the way people with tuberculosis are cared for and supported from the very start. This means making sure patients are diagnosed quickly and accurately, providing them with proper hospital care if they need it, and ensuring they get enough nutritious food so their bodies are strong enough to fight the disease.

Researchers also suggest that government health programs should work more closely with private doctors and hospitals to make it easier for patients to get quality care without huge costs, according to IndiaSpend.

In 2022, India recorded the highest number of TB cases globally, accounting for 27% of all cases, according to the WHO’s Global TB Report 2023. The report, released in January, stated that the country had 2.82 million cases, and that 12% of these patients (342,000 individuals) died from the disease.

The United Nations Sustainable Development Goals for health call for ending the TB epidemic by 2030, requiring large reductions in incidence and mortality. India has aimed to meet these targets by 2025, five years ahead of the global deadline, though the country’s containment of TB so far aligns with the global incidence decline of about 2%, which is well below the 10% drop targeted by the World Health Organization by 2025, and the 17% decline projected for the following decade to end TB by 2035, IndiaSpend noted.