Comparative Research for the Healthcare Budget and Burden of Disease in Perspective Resource Allocation

Is State-Wise Healthcare Budget Allocation Consistent With the Disease Burden in India? A Quinquennial Account (2015-2019)

Introduction

Evidence-based resource allocation may help to achieve immense health gains in resource-limited settings like India. Understanding healthcare expenditure and the corresponding disease burden could provide insights to plan optimal allocation of limited resources. Hence, we aimed to investigate the status and trends of state-wise healthcare budget allocation and the corresponding disease burden.

Methods

We retrieved state-wise healthcare budget allocation information in India for the years 2015 to 2019. Corresponding state-wise disability-adjusted-life-year (DALY) estimates from the Global Burden of Disease, injuries, and Risk Factors Study (GBD) was used to measure disease burden. The allocated budget (in rupees) per DALY was calculated for overall, communicable, and non-communicable diseases (NCDs). Descriptive statistics, correlation and graphical representations were used to identify and evaluate the trends and relationships between state-wise health budget allocation and disease burden.

Results

The allocated budget per DALY in 2019 was highest for Goa ( 34,260 or US$ 486.66) and lowest for Bihar ( 2,408 or US $ 34.20). Smaller, less populous states had higher budget allocations per DALY than larger states. Health budget allocation had an inverse relationship with infectious diseases and an identical linear relationship with NCDs. Most state-wise health budget allocations, as well as total disease burden, increased over the years except for Assam, Karnataka, and Himachal Pradesh. Also, such trends are not similar for the injuries and NCD disease burden.

Discussion

The health budget allocation is variable across states as well as between infectious and NCDs. The current increase in the allocated budget is incongruent with the increasing disease burden. There is a need for rapid expansion of healthcare resource allocation guided by evidence in India.

Forecasting of Future Medical Care Expenditure in Japan Using a System Dynamics Model

Background

The aim of this study was to construct a system dynamics (SD) model to estimate the future medical care expenditure and to address the dynamic issues of health care that should be resolved. In particular, the measures for promoting the spread of generic drug (GE drug) usage in Japan and reducing cancer-related medical expenses were investigated regarding their future impact on medical finances.

Methods

The SD model was constructed from FY 2018 to FY 2050. The change in the future GE drug quantity share was analyzed by using a regression equation. The impact of the increase in medical expense for cancer and the change in the future national medical care expenditure were also estimated.

Results

The annual total medical care expenditure in FY 2050 would arrive at 58.9–64.2 trillion JPY (US$ 535.1–584.0 billion) (1.3–1.5 times higher than that in FY 2018) with different trends in age groups. The cumulative total medical care expenditure was expected to decrease by about 787.0–989.4 billion JPY (US$ 7.2–9.0 billion) if the impact of the spread of GE drug usage was considered. On the other hand, due to the continuous increase in the cancer-related medical expense, the cumulative total medical care expenditure was estimated to increase about 7554.3–11715.0 billion JPY (US$ 68.7–106.5 billion).

Conclusions

If the cancer-related medical expense continues to increase in the future, an increase of 686.4–1104.2 billion JPY (US$ 6.2–10.0 billion) in FY 2050 is expected which suggests that this disease field should be prioritized regarding the measures to maintain medical finances.