Impact of community-based rehabilitation for mental illness on ‘out of pocket’ expenditure in rural South India

• Published in: Asian journal of psychiatry Vol. 44; pp. 138 - 142
• Main Authors: Sivakumar, Thanapal, James, Joseph Wilson, Basavarajappa, Chethan, Parthasarathy, Rajani, Naveen Kumar, Channaveerachari, Thirthalli, Jagadisha
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.08.2019
• Subjects: Adult; Community based rehabilitation; Community Mental Health Services - economics; Female; Health Expenditures - statistics & numerical data; Humans; India; Male; Mental Disorders - economics; Mental Disorders - rehabilitation; Mental illness; Middle Aged; Out-of-pocket expenditure; Psychiatric Rehabilitation - economics; Psychotic Disorders - economics; Psychotic Disorders - rehabilitation; Public health; Rural Population - statistics & numerical data; India; Out-of-pocket expenditure; Mental illness; Public health; Community based rehabilitation
• ISSN: 1876-2018; 1876-2026
• DOI: 10.1016/j.ajp.2019.07.029

•Dramatic fall in ‘Out of pocket’ (OOP) expenditure on switching to community based rehabilitation (CBR).•Before availing CBR, cost of medicines and travel to meet psychiatrist accounted for > 80% annual OOP expenditure.•Required medicines were procured by CBR at 10% cost incurred by families earlier.•Annually, families saved more money than cost incurred to run CBR. In India, expenditure incurred to access mental health services often drives families to economic crisis. Families of Persons with mental illness (PMI) incur ‘out-of-pocket’ (OOP) expenditure for medicines, psychiatrist fee and travel in addition to losing wages on the day of visiting psychiatrist. To describe impact of Community Based Rehabilitation (CBR) on OOP expenditure incurred by families of persons with severe mental illness (PSMI). The sample comprised 95 PSMI who switched from treatment from other mental health facilities to CBR at Jagaluru, India. The PSMI were predominantly male (52%) with mean age 41 years and diagnosed with psychosis (75%). Most of them (84%) were earlier taking treatment from private sector and spent on an average Rs. 15,074 (US $ 215) per PSMI per annum in availing treatment. After availing CBR, the annual expenditure reduced to Rs 492 (US $ 7) on an average per PSMI. OOP expenditure on medicines (largest head of expenditure) and psychiatrist consultation fee dropped to zero. After excluding costs incurred to run the CBR, the net savings for the system for 95 PSMI included in study alone was Rs 3,83,755 (US $ 5,482) per annum. The amount would be much higher on including savings for PSMI initiated on treatment for the first time and PMI on regular follow-up in CBR. Provision of CBR in partnership with public health system and NGO’s leads to dramatic fall in OOP health expenditure of families of PSMI. It is also cost-effective to the system.