Families of coronary heart disease (CHD) patients experience a sharp dip in their living standards, with children’s education suffering as a result, revealed a Tata Institute of Social Science study (TISS).
The study looked at 180 families in Mumbai and 13% said they had to discontinue a child’s education owing to the medical expenses; another 5% reported said children were forced to take up part-time jobs and 4% stated they had to shift their children from private to government schools.
CHD is a condition where the arteries of the heart are clogged or hardened by plaque or cholesterol deposits, causing a heart attack. After a person is detected with hardened arteries, doctors may advise angioplasty or bypass surgery to unblock the arteries and restore the supply of oxygen-rich blood.
The TISS study looked at the cost of treatment incurred by patients between July 2011 and July 2012 at both public and private hospital. It found that, on an average, the gross total cost of treatment for CHD was Rs 2.32 lakh. At public hospitals, the cost could be as low as Rs 5,000 and at private facilities, a similar procedure could cost anywhere between Rs 1.2 lakh and Rs 6 lakh.
The study, authored by Seema Sharma and Varun Sharma from the School of Health System Studies, TISS, was published in a peer reviewed journal, The Health Agenda, in April 2015. The researchers studied patients treated at two hospitals – one private and one public facility in the city. The patients aged between 25 and 65 years had completed at least one year of treatment.
“We wanted to understand the economic impact of heart diseases, which no longer is a rich man’s disease. Sedentary lifestyle is common across all sections of society and so is consumption of unhealthy food items,” said Seema Sharma, lead author of the study. “We even observed that many patients slipped into depression and most found it difficult to go back to their jobs.”
The study also looked at the way patients financed the treatment and the loss in salary / wage owing to hospitalisation and treatment. After taking into account insurance reimbursements, the average total expenditure was Rs 1.25 lakh, including the loss in salary/wage. The average out-of-pocket expenditure to family - direct cost on treatment - was Rs 78,974 and the indirect cost in terms of wage loss was Rs 46,498, the study found.
People belonging to the upper strata of the society spent close to Rs 1,29,520 for procedures, hospitalisation and medicines to manage their cardiac condition, while a person from the lower strata spent Rs 45,924 for the same treatment.
“Cost of treatment was significantly higher among those belonging to higher socio-economic strata. However, higher spending by the rich did not undermine the fact that even those belonging to the lower strata, on an average, spent Rs 45,924 on treatment of CHD,” said Seema Sharma, adding that this reflects CHD is a high-cost disease and is expected to impose severe cost burden on some households.
Despite insurance coverage, the expenditure incurred by families was enormous, leading to some families selling off their assets and taking loans. About 37% of the families said their standard of living dipped owing to the treatment cost. “About 13% families said they discontinued their child’s education with another 5% reported that their children took up part-time jobs with. Another 4% stated they had to shift their children from private to government schools,” she said.
“We calculated two costs as a result of CHD to families - direct and indirect. The direct cost is a result of hospitalisation, medicines and cost of surgery. Indirect cost related to loss of wages,” she added. She said that 62% of the cost incurred by the families is directly related to the condition.
Experts said that comprehensive insurance coverage and standardisation of treatment cost can help such families.
What is worrisome is the rising burden of CHD especially in Mumbai in view of these findings. According to Brihanmumbai Municipal Corporation’s (BMC) health department, 27 people in the city died of heart attack daily over a decade (2001-2010).
Heart attacks have been the leading cause of death irrespective of various interventions by policy makers. Recently, the civic body started a non-communicable disease wing for early detection of hypertension and diabetes, which are known to triggering CHD.
In fact, data from insurance companies also suggest a sharp rise in the number of claims related to cardio vascular disease. Between April 2014 and March this year, Star Health Insurance has paid Rs 97.98 crore for the claims related to heart conditions. In 2012-13, it paid Rs 41.71 crore for settling claims with regards to cardio vascular disease.
“Doctors are crying from the roof top that people need to adopt healthy lifestyle. Not just cardiac conditions, we are seeing a rise in claims related to kidney diseases and other chronic diseases. The general health standards of the population are overall deteriorating,” said V Jagannathan, chairman and managing director, Star Health and Allied Insurance.
Doctors said that with advancements in technology, the cost of treating CHD has come down in the past few years.
“The cost of angioplasty has dropped in most hospitals. Also, the cost depends on the stents that a patient chooses. The angioplasty that cost Rs 2.6 lakh in 2013, now costs Rs 2.10 lakh but again the package depends on the class of the bed where the patient is admitted,” said Dr Vijay Surase, cardiologist.
Shailendra Kale took a month-long leave and spent Rs 6.5 lakh last May – not on a vacation, but on an emergency angioplasty. The 38-year-old was diagnosed with blockages in three major arteries and stents had to put to clear his arteries.
“Only half the cost of the surgery was funded by my workplace; I had to use my savings to pay the remaining amount,” said Kale, adding that the family had to postpone the plan of purchasing a car because of his treatment.
Kale’s heart condition was probably worsened by his lifestyle. “I smoked up to 22 cigarettes a day and my alcohol consumption was also high,” he said. Kale experienced sudden chest pain, making it difficult for him to even walk. He was admitted at a hospital in Thane for the procedure.
“I follow a diet now. I exercise and have got rid of all addictions. This has helped better my personal and professional life in many ways,” said Kale, who recalls shivering when he did not get to smoke. “I make sure that I do not go back to my old eating habits. I eat food which reduces the vulnerability to heart ailments,” he added.
Kale, who works with a private company, said that resuming office after the heart attack was challenging. “I found it difficult to resume work owing to the impact my illness had on me mentally,” he said.
Regular walks and exercise has helped Kale to monitor his health considerably. “Instead of wasting my salary on vices, I could have instead used the money constructively,” he said.
(By Misbaah Mansuri)