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Badulescu D, Simut R, Badulescu A, Badulescu AV. The Relative Effects of Economic Growth, Environmental Pollution and Non-Communicable Diseases on Health Expenditures in European Union Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16245115. [PMID: 31847367 PMCID: PMC6949912 DOI: 10.3390/ijerph16245115] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 11/06/2019] [Accepted: 12/12/2019] [Indexed: 02/07/2023]
Abstract
National and global health policies are increasingly recognizing the key role of the environment in human health development, which is related to its economic and social determinants, such as income level, technical progress, education, quality of jobs, inequality, education or lifestyle. Research has shown that the increase of GDP (Gross Domestic Product) per capita can provide additional funds for health but also for environmental protection. However, often, economic growth is associated with the accelerated degradation of the environment, and this in turn will result in an exponential increase in harmful emissions and will implicitly determine the increasing occurrence of non-communicable diseases (NCDs), mainly cardiovascular diseases, cancers and respiratory diseases. In this paper, we investigate the role and effects of economic growth, environmental pollution and non-communicable diseases on health expenditures, for the case of EU (European Union) countries during 2000–2014. In order to investigate the long-term and the short-term relationship between them, we have employed the Panel Autoregressive Distributed Lag (ARDL) method. Using the Pedroni-Johansen cointegration methods, we found that the variables are cointegrated. The findings of this study show that economic growth is one of the most important factors influencing the health expenditures both in the long- and short-run in all the 28 EU countries. With regards to the influence of CO2 emissions on health expenditure, we have found a negative impact in the short-run and a positive impact on the long-run. We have also introduced an interaction between NCDs and environmental expenditure as independent variable, a product variable. Finally, we have found that in all the three estimated models, the variation in environmental expenditure produces changes in NCDs’ effect on health expenditure.
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Affiliation(s)
- Daniel Badulescu
- Department of Economics and Business, Faculty of Economic Sciences, University of Oradea, 410087 Oradea, Romania; (D.B.); (R.S.); (A.B.)
| | - Ramona Simut
- Department of Economics and Business, Faculty of Economic Sciences, University of Oradea, 410087 Oradea, Romania; (D.B.); (R.S.); (A.B.)
| | - Alina Badulescu
- Department of Economics and Business, Faculty of Economic Sciences, University of Oradea, 410087 Oradea, Romania; (D.B.); (R.S.); (A.B.)
| | - Andrei-Vlad Badulescu
- Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Correspondence: ; Tel.: +40-752-304056
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Lartey ST, de Graaff B, Magnussen CG, Boateng GO, Aikins M, Minicuci N, Kowal P, Si L, Palmer AJ. Health service utilization and direct healthcare costs associated with obesity in older adult population in Ghana. Health Policy Plan 2019; 35:199-209. [DOI: 10.1093/heapol/czz147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 12/23/2022] Open
Abstract
Abstract
Obesity is a major risk factor for many chronic diseases and disabilities, with severe implications on morbidity and mortality among older adults. With an increasing prevalence of obesity among older adults in Ghana, it has become necessary to develop cost-effective strategies for its management and prevention. However, developing such strategies is challenging as body mass index (BMI)-specific utilization and costs required for cost-effectiveness analysis are not available in this population. Therefore, this study examines the associations between health services utilization as well as direct healthcare costs and overweight (BMI ≥25.00 and <30.00 kg/m2) and obesity (BMI ≥30.00 kg/m2) among older adults in Ghana. Data were used from a nationally representative, multistage sample of 3350 people aged 50+ years from the World Health Organization’s Study on global AGEing and adult health (WHO-SAGE; 2014/15). Health service utilization was measured by the number of health facility visits over a 12-month period. Direct costs (2017 US dollars) included out-of-pocket payments and the National Health Insurance Scheme (NHIS) claims. Associations between utilization and BMI were examined using multivariable zero-inflated negative binomial regressions; and between costs and BMI using multivariable two-part regressions. Twenty-three percent were overweight and 13% were obese. Compared with normal-weight participants, overweight and obesity were associated with 75% and 159% more inpatient admissions, respectively. Obesity was also associated with 53% additional outpatient visits. One in five of the overweight and obese population had at least one chronic disease, and having chronic disease was associated with increased outpatient utilization. The average per person total costs for overweight was $78 and obesity was $132 compared with $35 for normal weight. The NHIS bore approximately 60% of the average total costs per person expended in 2014/15. Overweight and obese groups had significantly higher total direct healthcare costs burden of $121 million compared with $64 million for normal weight in the entire older adult Ghanaian population. Compared with normal weight, the total costs per person associated with overweight increased by 73% and more than doubled for obesity. Even though the total prevalence of overweight and obesity was about half of that of normal weight, the sum of their cost burden was almost doubled. Implementing weight reduction measures could reduce health service utilization and costs in this population.
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Affiliation(s)
- Stella T Lartey
- Menzies Institute for Medical Research, University of Tasmania, Medical Sciences 2 Building, 17 Liverpool Street, Hobart 7000, Tasmania, Australia
| | - Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Medical Sciences 2 Building, 17 Liverpool Street, Hobart 7000, Tasmania, Australia
| | - Costan G Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Medical Sciences 2 Building, 17 Liverpool Street, Hobart 7000, Tasmania, Australia
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku FI-20014, Finland
| | - Godfred O Boateng
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Moses Aikins
- School of Public Health, University of Ghana, Accra LG 13, Ghana
| | - Nadia Minicuci
- National Research Council, Neuroscience Institute, Via Giustiniani, 2 35128 Padova, Italy
| | - Paul Kowal
- World Health Organization (WHO), Avenue Appia 20, 1211 Genève, Switzerland
- University of Newcastle Research Centre for Generational Health and Ageing, Newcastle, New South Wales 2305, Australia
| | - Lei Si
- The George Institute for Global Health, University of New South Wales, Kensington, NSW 2042, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Medical Sciences 2 Building, 17 Liverpool Street, Hobart 7000, Tasmania, Australia
- Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria 3053, Australia
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Prinja S, Jagnoor J, Sharma D, Aggarwal S, Katoch S, Lakshmi PVM, Ivers R. Out-of-pocket expenditure and catastrophic health expenditure for hospitalization due to injuries in public sector hospitals in North India. PLoS One 2019; 14:e0224721. [PMID: 31697781 PMCID: PMC6837486 DOI: 10.1371/journal.pone.0224721] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 10/21/2019] [Indexed: 11/18/2022] Open
Abstract
Background Injuries are a major public health problem, resulting in high health care demand and economic burden. They result in loss of disability adjusted life years (DALYs) and high out-of-pocket expenditure. However, there is little evidence on the economic burden of injuries in India. We undertook this study to report out-of-pocket expenditure and the prevalence of catastrophic health expenditure for injuries related hospitalizations in public sector hospitals in North India. Further, we also evaluate the determinants of catastrophic health expenditure. Methods and analysis A prospective observational study was conducted. Participants were recruited from three hospitals for all injury cases. Data were collected via face-to-face baseline interviews and follow-up interviews over the phone at 1, 2, 4 and 12 months post-injury. Prevalence of catastrophic health expenditure (more than 30% of consumption expenditure) and impoverishment (International dollar 1.90) were estimated. Results Road traffic injuries (57%) were the leading cause of injury. Direct out-of-pocket expenditure for hospitalizations was INR 16,768 (USD 263) while indirect productivity loss was INR 8,164 (USD 128). The prevalence of catastrophic expenditure was 22.2% with 12.2% slipping below poverty line. Prevalence of catastrophic health expenditure and impoverishment was higher and significantly associated with poorest quintile, tertiary care hospital and increased duration of hospitalization (p< 0.001). Conclusion The economic impact of injuries is notably high both in terms of out-of-pocket expenditure and productivity loss. A high proportion of households experienced catastrophic expenditure and impoverishment following an injury, highlighting need for programs to prevent injuries.
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Affiliation(s)
- Shankar Prinja
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
- * E-mail:
| | - Jagnoor Jagnoor
- The George Institute for Global Health, New Delhi, India
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Deepshikha Sharma
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Aggarwal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Swati Katoch
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P. V. M. Lakshmi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rebecca Ivers
- The George Institute for Global Health, University of Sydney, Sydney, Australia
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Zhang T, Liu J, Liu C. Changes in Perceived Accessibility to Healthcare from the Elderly between 2005 and 2014 in China: An Oaxaca-Blinder Decomposition Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3824. [PMID: 31658753 PMCID: PMC6843178 DOI: 10.3390/ijerph16203824] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/05/2019] [Accepted: 10/07/2019] [Indexed: 11/22/2022]
Abstract
Elderly people are characterized with high needs for healthcare, accompanied by high barriers in access to healthcare. This study aimed to identify temporal changes in access to healthcare and determinants of such changes from the elderly in China, over the period between 2005 and 2014. Two waves (2005 and 2014) of data were extracted from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), measuring changes in perceived accessibility to healthcare when needed by the elderly (≥65 years). The effects of the explanatory variables (need, predisposing and enabling factors) on the changes were divided into two components using the Oaxaca-Blinder decomposition method: (1) the endowment portion as a result of distribution differences of the explanatory variables and (2) the coefficient portion as a result of differential responses of the dependent variable to the explanatory variables. Perceived accessibility to healthcare from the elderly increased from 89.6% in 2005 to 96.7% in 2014. The coefficient portion (82%) contributed more to the change than the endowment portion (63%) after adjustments for a negative interaction effect (-45%) between the two. Lower perceived accessibility was associated with older age, lower income, lower affordability of daily expenses and lower insurance coverage. But the coefficient effects suggested that their impacts on perceived accessibility to healthcare declined over time. By contrast, the impacts of gender and out-of-pocket payment ratio for medical care on perceived accessibility to healthcare increased over time. Perceived accessibility to healthcare from the elderly improved between 2005 and 2014. Gender gaps are closing. But the increased effect of out-of-pocket medical payments on perceived accessibility to healthcare deserves further investigation and policy interventions.
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Affiliation(s)
- Tao Zhang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 43003, China.
| | - Jing Liu
- Department of Health Information Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 43003, China.
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne 3086, Australia.
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Rostam Beigi M, Shamshiri AR, Asadi-Lari M, Hessari H, Jafari A. A crossectional investigation of the relationship between complementary health insurance and frequency of dental visits in 15 to 64 years old of Tehran population, Iran, a secondary data analysis (urban HEART-2). BMC Health Serv Res 2019; 19:678. [PMID: 31533819 PMCID: PMC6751603 DOI: 10.1186/s12913-019-4526-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/10/2019] [Indexed: 02/07/2023] Open
Abstract
Background This study aimed to investigate the relationship between complementary health insurance and frequency of dental visits. Methods The present study was performed using the Urban Health Equity Assessment and Response Tool (Urban HEART). A cross-sectional study was conducted in Tehran (Iran) to assess inequalities in health status among different socioeconomic and ethnic groups, genders, geographical areas, and social determinants of health. Out of 20,320 records retrieved from the original study with dental information, 17,252 had both dental insurance and dental visit information. Complementary health insurance as the main independent variable had three categories (i.e., basic insurance, with complementary medical coverage, and with dental coverage). The frequency of dental visits during the last year as a dependent variable had also three categories (i.e., no visit, one, and two, or more dental visits in the last year). In this study, in addition to investigating the relationship between complementary health insurance and frequency of dental visits, potential covariates that may affect the mentioned relationship were evaluated in the regression model. Statistical analyses included simple and multiple multinomial logistic regression considering the sampling method and sampling weights. Results The meanage of 17,252 participants (Tehran citizens) was 39.36 years; 49.4%were women, 86.0%hadonly basicinsurance, 7.2% had complementary medical insurance, and 6.8% had complementary dental insurance. Of all subjects, 43.8% reported no dental visit, 26.1% reported one, and 30.1% reportedtwoor more dental visits during the lastyear. The frequency of dental visits was lower in people who had basic insurance than others such that that odds ratio (OR) was 0.73 (p-value < 0.001) for one visit and 0.68 (p-value< 0.001) for two or more visits in the last year. The frequency of dental visits was also positively associated with dental brushing, toothpaste use, high educational level, being married, having more than 20 teeth, and having dental pain. Conclusion Having dental insurance increases the frequency of dental visits but the association between dental insurance and dental visits was independently influenced by other predictors.
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Affiliation(s)
- Morteza Rostam Beigi
- Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Shamshiri
- Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.,Research Center for Caries Prevention, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Asadi-Lari
- Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Hessari
- Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.,Research Center for Caries Prevention, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Jafari
- Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran. .,Research Center for Caries Prevention, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Kubiak RW, Sarkar S, Horsburgh CR, Roy G, Kratz M, Reshma A, Knudsen S, Salgame P, Ellner JJ, Drain PK, Hochberg NS. Interaction of nutritional status and diabetes on active and latent tuberculosis: a cross-sectional analysis. BMC Infect Dis 2019; 19:627. [PMID: 31311495 PMCID: PMC6636094 DOI: 10.1186/s12879-019-4244-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 06/30/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Malnutrition and diabetes are risk factors for active tuberculosis (TB), possible risk factors for latent TB infection (LTBI), and may interact to alter their effect on these outcomes. Studies to date have not investigated this interaction. METHODS We enrolled 919 newly diagnosed active TB patients and 1113 household contacts at Primary Health Centres in Puducherry and Tamil Nadu, India from 2014 to 2018. In cross-sectional analyses, we used generalized estimating equations to measure additive and multiplicative interaction of body mass index (BMI) and diabetes on two outcomes, active TB and LTBI. RESULTS Among overweight or obese adults, active TB prevalence was 12-times higher in diabetic compared to non-diabetic participants, 2.5-times higher among normal weight adults, and no different among underweight adults (P for interaction < 0.0001). Diabetes was associated with 50 additional active TB cases per 100 overweight or obese participants, 56 per 100 normal weight participants, and 17 per 100 underweight participants (P for interaction < 0.0001). Across BMI categories, screening 2.3-3.8 active TB patients yielded one hyperglycemic patient. LTBI prevalence did not differ by diabetes and BMI*diabetes interaction was not significant. CONCLUSIONS BMI and diabetes are associated with newly diagnosed active TB, but not LTBI. Diabetes conferred the greatest risk of active TB in overweight and obese adults whereas the burden of active TB associated with diabetes was similar for normal and overweight or obese adults. Hyperglycemia was common among all active TB patients. These findings highlight the importance of bi-directional diabetes-active TB screening in India.
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Affiliation(s)
- Rachel W Kubiak
- Department of Epidemiology, University of Washington, 1959 NE Pacific Street, Health Sciences Building, Box 357236, Seattle, WA, 98195, USA.
| | - Sonali Sarkar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - C Robert Horsburgh
- Department of Epidemiology, Boston University School of Public Health, Boston, USA.,Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, USA
| | - Gautam Roy
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Mario Kratz
- Department of Epidemiology, University of Washington, 1959 NE Pacific Street, Health Sciences Building, Box 357236, Seattle, WA, 98195, USA.,Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington, Seattle, USA.,Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Ayiraveetil Reshma
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Selby Knudsen
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Padmini Salgame
- Center for Emerging Pathogens, Department of Medicine, Rutgers-New Jersey Medical School, Newark, USA
| | - Jerrold J Ellner
- Department of Epidemiology, Boston University School of Public Health, Boston, USA.,Center for Emerging Pathogens, Department of Medicine, Rutgers-New Jersey Medical School, Newark, USA.,Boston Medical Center, Boston, USA
| | - Paul K Drain
- Department of Epidemiology, University of Washington, 1959 NE Pacific Street, Health Sciences Building, Box 357236, Seattle, WA, 98195, USA.,Department of Global Health, University of Washington, Seattle, USA.,Department of Medicine, University of Washington, Seattle, USA
| | - Natasha S Hochberg
- Department of Epidemiology, Boston University School of Public Health, Boston, USA.,Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, USA.,Boston Medical Center, Boston, USA
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Del Pozo-Rubio R, Mínguez-Salido R, Pardo-García I, Escribano-Sotos F. Catastrophic long-term care expenditure: associated socio-demographic and economic factors. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:691-701. [PMID: 30656482 DOI: 10.1007/s10198-019-01031-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 01/04/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE An increasing number of persons across the world require long-term care (LTC). In Spain, access to LTC involves individuals incurring out-of-pocket (OOP) expenditure. There is a large body of literature on the incidence of catastrophic OOP payments in access and participation in health systems, but not in the field of LTC nor the determinants of these expenses. Our aim was to analyse the socio-demographic and economic factors associated with different levels of catastrophic LTC expenditure in the form of private out-of-pocket payments among dependent persons in Spain. MATERIALS AND METHODS The study used the Spanish Disability and Dependency Survey (SDDS) conducted by the Spanish National Statistics Institute to obtain the socioeconomic, demographic and health profiles. The households were classified into those below the poverty threshold and those above the threshold of catastrophe, using measures of impoverishment and catastrophe. We estimated two logistic regression models, one binary (impoverishment) and one ordinal (catastrophe). RESULTS The results show that OOP expenditure on LTC increases the probability of impoverishment by 18.90%. The factors associated with higher probability of experiencing catastrophe were age, being single, widowed or separated, lower levels of household income and education, higher level of dependence and living in an autonomous community with lower per capita income. CONCLUSIONS These findings highlight the need to include exemptions or insurance in the design of LTC policies to protect dependent persons from the risk of financial burden.
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Affiliation(s)
- Raúl Del Pozo-Rubio
- Department of Economics and Finance, University of Castilla-La Mancha, Avda, Los Alfares, 44, 16071, Cuenca, Spain
- Research Group Economy, Food and Society, University of Castilla-La Mancha, Ciudad Real, Spain
| | - Román Mínguez-Salido
- Department of Public Economy, Statistics and Economic Policy, University of Castilla-La Mancha, Avda, Los Alfares, 44, 16071, Cuenca, Spain
| | - Isabel Pardo-García
- Department of Public Economy, Statistics and Economic Policy, University of Castilla-La Mancha, Plaza de la Universidad, s/n, 02071, Albacete, Spain.
- Research Group Economy, Food and Society, University of Castilla-La Mancha, Ciudad Real, Spain.
| | - Francisco Escribano-Sotos
- Department of Economics and Finance, University of Castilla-La Mancha, Plaza de la Universidad, s/n, 02071, Albacete, Spain
- Research Group Economy, Food and Society, University of Castilla-La Mancha, Ciudad Real, Spain
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Hailemichael Y, Hailemariam D, Tirfessa K, Docrat S, Alem A, Medhin G, Lund C, Chisholm D, Fekadu A, Hanlon C. Catastrophic out-of-pocket payments for households of people with severe mental disorder: a comparative study in rural Ethiopia. Int J Ment Health Syst 2019; 13:39. [PMID: 31164919 PMCID: PMC6544918 DOI: 10.1186/s13033-019-0294-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 05/23/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There are limited data on healthcare spending by households containing a person with severe mental disorder (SMD) in low- and middle-income countries (LMIC). This study aimed to estimate the incidence and intensity of catastrophic out-of-pocket (OOP) payments and coping strategies implemented by households with and without a person with SMD in a rural district of Ethiopia. METHODS A comparative cross-sectional community household survey was carried out from January to November 2015 as part of the Emerald programme (emerging mental health systems in low- and middle-income countries). A sample of 290 households including a person with SMD and 289 comparison households without a person with SMD participated in the study. An adapted and abbreviated version of the World Health Organization SAGE (Study on global Ageing and adult health) survey instrument was used. Households were considered to have incurred catastrophic health expenditure if their annual OOP health expenditures exceeded 40% of their annual non-food expenditure. Multiple logistic regression was used to explore factors associated with catastrophic expenditure and types of coping strategies employed. RESULTS The incidence of catastrophic OOP payments in the preceding 12 months was 32.2% for households of a person with SMD and 18.2% for comparison households (p = 0.006). In households containing a person with SMD, there was a significant increase in the odds of hardship financial coping strategies (p < 0.001): reducing medical visits, cutting down food consumption, and withdrawing children from school. Households of a person with SMD were also less satisfied with their financial status and perceived their household income to be insufficient to meet their livelihood needs (p < 0.001). CONCLUSIONS Catastrophic OOP health expenditures in households of a person with SMD are high and associated with hardship financial coping strategies which may lead to poorer health outcomes, entrenchment of poverty and intergenerational disadvantage. Policy interventions aimed at financial risk pooling mechanisms are crucial to reduce the intensity and impact of OOP payments among vulnerable households living with SMD and support the goal of universal health coverage.
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Affiliation(s)
- Yohannes Hailemichael
- Department of Reproductive Health and Health Services Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Damen Hailemariam
- Department of Reproductive Health and Health Services Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kebede Tirfessa
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sumaiyah Docrat
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Atalay Alem
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Girmay Medhin
- Aklilu-Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Crick Lund
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Dan Chisholm
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Abebaw Fekadu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
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Salinas-Escudero G, Carrillo-Vega MF, Pérez-Zepeda MU, García-Peña C. [Out of pocket expenditure on health during the last year of life of Mexican elderly: analysis of the Enasem]. SALUD PUBLICA DE MEXICO 2019; 61:504-513. [PMID: 31314212 DOI: 10.21149/10146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/21/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To estimate the out-of-pocket expenses (OOPE) during the last year of life in Mexican older adults (OA). MATERIALS AND METHODS Estimation of the OOPE corresponding to the last year of life of OA, adjusting by type of management, affiliation and cause of death. Data from the National Health and Aging Study in Mexico (2012) were used. To calculate the total OOPE, the expenses in the last year were used in: medications, medical consultations and hospitalization. The OOPE was adjusted for inflation and is reported in US dollars 2018. RESULTS The mean OOPE was $6 255.3±18 500. In the ambulatory care group, the OOPE was $4 134.9±13 631.3. The OOPE in hospitalization was $7 050.6±19 971.0. CONCLUSIONS The probability of incurre in OOPE is lower when hospitalization is not required. With hospitalization, affiliation to social security and attending to public hospitals plays a protective role.
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Affiliation(s)
| | | | - Mario Ulises Pérez-Zepeda
- Departamento de Epidemiología Geriátrica, Dirección de Investigación, Instituto Nacional de Geriatría. México.,Instituto de Envejecimiento, Facultad de Medicina, Pontificia Universidad Javeriana. Bogotá, Colombia
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Attia-Konan AR, Oga ASS, Touré A, Kouadio KL. Distribution of out of pocket health expenditures in a sub-Saharan Africa country: evidence from the national survey of household standard of living, Côte d'Ivoire. BMC Res Notes 2019; 12:25. [PMID: 30646940 PMCID: PMC6332523 DOI: 10.1186/s13104-019-4048-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/04/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The purpose and objective of our research is to identify the determinants of the out of pocket (OOP) health expenditures in the population of Ivory Coast and the ratios across three different area; Abidjan, the rural and urban area. We used data from the 2015 standard households living survey conducted by the National Institute of Statistic. RESULTS About 6315 (13.3%) of the participants had experienced OOP health expenditure. There was significant differences in the self-reported OOP between these three areas (p < 0.001). The overall mean of OOP expenditure among all participants was 16,034.33 XOF (29 USD). People in Abidjan spent an average of 1.6 and 1.5 times more than those in the rural and urban areas respectively (p < 0.001). Hospitalization is the highest expenditure item in terms of money spent, while drugs are the most common item of expenditure in terms of frequency, regardless of the place of residence. Female gender, high social economic status and large household size increase OOP health expenditure significantly in all areas of residence when insurance reduce it. To reduce the impact of the direct payments there is a need to take into account social demographic factors in addition to economic factor in health policy development.
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Affiliation(s)
- Akissi Régine Attia-Konan
- Department of Public Health, Hydrology and Toxicology, UFR Pharmaceutical and Biological Sciences, University of Félix Houphouet Boigny, BP V34 Abidjan, Côte d’Ivoire
| | - Agbaya Stéphane Serge Oga
- Department of Public Health, Hydrology and Toxicology, UFR Pharmaceutical and Biological Sciences, University of Félix Houphouet Boigny, BP V34 Abidjan, Côte d’Ivoire
| | - Amadou Touré
- National Institute of Statistic of Côte D’Ivoire, Abidjan, Côte d’Ivoire
| | - Kouakou Luc Kouadio
- Department of Public Health, Hydrology and Toxicology, UFR Pharmaceutical and Biological Sciences, University of Félix Houphouet Boigny, BP V34 Abidjan, Côte d’Ivoire
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Kujawski SA, Leslie HH, Prabhakaran D, Singh K, Kruk ME. Reasons for low utilisation of public facilities among households with hypertension: analysis of a population-based survey in India. BMJ Glob Health 2018; 3:e001002. [PMID: 30622745 PMCID: PMC6307571 DOI: 10.1136/bmjgh-2018-001002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 11/14/2018] [Accepted: 12/03/2018] [Indexed: 11/04/2022] Open
Abstract
Introduction In India, for most patients, primary healthcare remains the intended entry point for the management of non-communicable disease risk factors. The extent and determinants of non-utilisation of public primary care among households with hypertension are not well examined. We explored health facility utilisation patterns and reasons for non-utilisation of public facilities in 21 states and union territories in India, with a focus on hypertension. Methods We used data from the 2012-2013 District Level Household and Facility Survey. We examined the self-reported usual source of care for all households, households with hypertension and─to understand multimorbidity for those with hypertension─households with hypertension and diabetes. Hypertension was defined by self-reported diagnosis or measurement of systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg. Diabetes was defined by self-reported diagnosis or fasting blood glucose level ≥ 7.0 mmol/L or non-fasting blood glucose level ≥ 11.1 mmol/L. We assessed facility utilisation choice and reasons for non-utilisation of public facilities by household with the presence of hypertension alone and hypertension with diabetes. Results In 336 305 households, 37.6% (N=126 597) had at least one household member with hypertension, while 15.9% (N=53 385) had members with hypertension and diabetes. 20.0% of households sought care at public primary clinics, 29.9% at public hospitals and 48.3% at private facilities. Choice of private facilities increased with the burden of disease. Households with hypertension only and hypertension and diabetes cited quality reasons for non-utilisation of public facilities more than households without hypertension. Conclusion Households, particularly those with hypertension, chose private over public primary facilities for usual care. Quality of care was an important determinant of facility choice in households with hypertension and diabetes. With the increase in hypertension and cardiovascular disease in India, quality of public primary healthcare must be addressed for current policy to become reality.
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Affiliation(s)
- Stephanie A Kujawski
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Hannah H Leslie
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India.,Public Health Foundation of India, Gurgaon, India.,London School of Hygiene and Tropical Medicine, London, UK
| | - Kavita Singh
- Centre for Chronic Disease Control, New Delhi, India.,Public Health Foundation of India, Gurgaon, India
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Heidinger M, Simonnet E, Karippadathu SF, Puchinger M, Pfeifer J, Grisold A. Analysis of Social Determinants of Health and Disability Scores in Leprosy-Affected Persons in Salem, Tamil Nadu, India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2769. [PMID: 30563301 PMCID: PMC6313506 DOI: 10.3390/ijerph15122769] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/21/2018] [Accepted: 12/03/2018] [Indexed: 12/05/2022]
Abstract
A consistent relationship has been found between leprosy and inequities in social determinants of health. It, however, remains unclear which aspect of these social determinants contributes most to the risk of infection, and even less clear are the risk factors for the development of leprosy-related disabilities. The objective of this study was to elicit the differential impact of social determinants of health in leprosy-affected persons, and determine whether structural inequities in accessibility to societal resources and lower socioeconomic parameters correlated with higher severity of disabilities. This analysis was based on a sampled population affected by leprosy in Salem, Tamil Nadu, India. Persons enrolled in the study were covered by a nongovernmental lifelong care program, had completed a multidrug therapy for leprosy and/or were slit-skin-smear negative, and showed Grade 1 or higher disabilities due to leprosy. Multiple stepwise linear regression analysis was performed. The Eyes-Hands-Feet (EHF) score was the outcome variable, and gender, age, time after release from treatment, monthly income, and living space were explanatory variables. There were 123 participants, comprised of 41 (33.33%) women and 82 (66.67%) men. All study participants belonged to India's Backward classes; 81.30% were illiterate and the average monthly income was 1252 Indian rupee (INR) (US$19.08 or €17.16). The average EHF score was 7.016 (95% CI, 6.595 to 7.437). Stepwise multiple linear regression analysis built a significant model, where F(2, 120) = 13.960, p ≤ 0.001, effect size (Cohen's f2) = 0.81, explaining 18.9% of the variance in EHF scores (R² = 0.189). Significant predictors of a higher EHF score in persons affected by leprosy were found to be higher age (beta = 0.340, 95% CI, 0.039 to 0.111, p < 0.001), as well as less living space (beta = -0.276, 95% CI, -0.041 to -0.011, p = 0.001). Our results suggest that inequalities in social determinants of health correspond to higher disability scores, which indicates that poor living standards are a common phenomenon in those living with leprosy-related disabilities. Further research is needed to dissect the exact development of impairments after release from treatment (RFT) in order to take targeted actions against disability deterioration.
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Affiliation(s)
- Martin Heidinger
- Global Health and Development, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria.
| | - Elisa Simonnet
- Global Health and Development, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria.
| | - Sr Francina Karippadathu
- Doctor Typhagne Memorial Charitable Trust, S.M.M.I. Convent Staff Quarters, St. Mary's Hospital Campus, Arisipalayam, Salem, Tamil Nadu 636009, India.
| | - Markus Puchinger
- Research Unit for Medical Engineering and Computing, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria.
| | - Johann Pfeifer
- Global Health and Development, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria.
- Department of General and Visceral Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria.
| | - Andrea Grisold
- Global Health and Development, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria.
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria.
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Challenges in Accessing Health Care for People with Disability in the South Asian Context: A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112366. [PMID: 30373102 PMCID: PMC6265903 DOI: 10.3390/ijerph15112366] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/04/2018] [Accepted: 10/16/2018] [Indexed: 12/11/2022]
Abstract
South Asia is a unique geopolitical region covering 3.4% of the world’s surface area and supporting 25% of the world’s population (1.75 billion). Available evidence from South Asia shows variable estimates of the magnitude of disability. The projected magnitude depends on whether an impairment focus is highlighted (approximately 1.6–2.1%) or functionality is given precedence (3.6–15.6%). People with disability (PWD) face significant challenges to accessing health care in the region. Studies show that adults with disability reported a four times higher incidence of a serious health problem in a year’s recall period. Evidence shows a significantly higher rate (17.8%) of hospitalization among PWD compared to others (5%). Chronic conditions like diabetes were also significantly higher. Women with disability had significantly more concerns on reproductive health issues. Studies from the South Asia region reveal that not only did PWD have a higher load of adverse health outcomes but they also faced significantly more barriers in accessing health services.
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Bright T, Kuper H. A Systematic Review of Access to General Healthcare Services for People with Disabilities in Low and Middle Income Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091879. [PMID: 30200250 PMCID: PMC6164773 DOI: 10.3390/ijerph15091879] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/17/2018] [Accepted: 08/29/2018] [Indexed: 12/30/2022]
Abstract
Background: A systematic review was undertaken to explore access to general healthcare services for people with disabilities in low and middle-income countries (LMICs). Methods: Six electronic databases were searched in February 2017. Studies comparing access to general healthcare services by people with disabilities to those without disabilities from LMICs were included. Eligible measures of healthcare access included: utilisation, coverage, adherence, expenditure, and quality. Studies measuring disability using self-reported or clinical assessments were eligible. Title, abstract and full-text screening and data extraction was undertaken by the two authors. Results: Searches returned 13,048 studies, of which 50 studies were eligible. Studies were predominantly conducted in sub-Saharan Africa (30%), Latin America (24%), and East Asia/Pacific (12%). 74% of studies used cross-sectional designs and the remaining used case-control designs. There was evidence that utilisation of healthcare services was higher for people with disabilities, and healthcare expenditure was higher. There were less consistent differences between people with and without disabilities in other access measures. However, the wide variation in type and measurement of disability, and access outcomes, made comparisons across studies difficult. Conclusions: Developing common metrics for measuring disability and healthcare access will improve the availability of high quality, comparable data, so that healthcare access for people with disabilities can be monitored and improved.
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Affiliation(s)
- Tess Bright
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
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Geldsetzer P, Manne-Goehler J, Theilmann M, Davies JI, Awasthi A, Vollmer S, Jaacks LM, Bärnighausen T, Atun R. Diabetes and Hypertension in India: A Nationally Representative Study of 1.3 Million Adults. JAMA Intern Med 2018; 178:363-372. [PMID: 29379964 PMCID: PMC5885928 DOI: 10.1001/jamainternmed.2017.8094] [Citation(s) in RCA: 207] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE Understanding how diabetes and hypertension prevalence varies within a country as large as India is essential for targeting of prevention, screening, and treatment services. However, to our knowledge there has been no prior nationally representative study of these conditions to guide the design of effective policies. OBJECTIVE To determine the prevalence of diabetes and hypertension in India, and its variation by state, rural vs urban location, and individual-level sociodemographic characteristics. DESIGN, SETTING, AND PARTICIPANTS This was a cross-sectional, nationally representative, population-based study carried out between 2012 and 2014. A total of 1 320 555 adults 18 years or older with plasma glucose (PG) and blood pressure (BP) measurements were included in the analysis. EXPOSURES State, rural vs urban location, age, sex, household wealth quintile, education, and marital status. MAIN OUTCOMES AND MEASURES Diabetes (PG level ≥126 mg/dL if the participant had fasted or ≥200 mg/dL if the participant had not fasted) and hypertension (systolic BP≥140 mm Hg or diastolic BP≥90 mm Hg). RESULTS Of the 1 320 555 adults, 701 408 (53.1%) were women. The crude prevalence of diabetes and hypertension was 7.5% (95% CI, 7.3%-7.7%) and 25.3% (95% CI, 25.0%-25.6%), respectively. Notably, hypertension was common even among younger age groups (eg, 18-25 years: 12.1%; 95% CI, 11.8%-12.5%). Being in the richest household wealth quintile compared with being in the poorest quintile was associated with only a modestly higher probability of diabetes (rural: 2.81 percentage points; 95% CI, 2.53-3.08 and urban: 3.47 percentage points; 95% CI, 3.03-3.91) and hypertension (rural: 4.15 percentage points; 95% CI, 3.68-4.61 and urban: 3.01 percentage points; 95% CI, 2.38-3.65). The differences in the probability of both conditions by educational category were generally small (≤2 percentage points). Among states, the crude prevalence of diabetes and hypertension varied from 3.2% (95% CI, 2.7%-3.7%) to 19.9% (95% CI, 17.6%-22.3%), and 18.0% (95% CI, 16.6%-19.5%) to 41.6% (95% CI, 37.8%-45.5%), respectively. CONCLUSIONS AND RELEVANCE Diabetes and hypertension prevalence is high in middle and old age across all geographical areas and sociodemographic groups in India, and hypertension prevalence among young adults is higher than previously thought. Evidence on the variations in prevalence by state, age group, and rural vs urban location is critical to effectively target diabetes and hypertension prevention, screening, and treatment programs to those most in need.
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Affiliation(s)
- Pascal Geldsetzer
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Jennifer Manne-Goehler
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Michaela Theilmann
- Department of Economics & Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - Justine I Davies
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Education Campus, University of Witwatersrand, Johannesburg, South Africa.,Centre for Global Health, King's College London, London, England
| | | | - Sebastian Vollmer
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Department of Economics & Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - Lindsay M Jaacks
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Public Health Foundation of India, Delhi NCR, India
| | - Till Bärnighausen
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Institute of Public Health, Heidelberg University, Heidelberg, Germany.,Africa Health Research Institute, Mtubatuba, South Africa
| | - Rifat Atun
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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Lee TJ, Saran I, Rao KD. Ageing in
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ndia: Financial hardship from health expenditures. Int J Health Plann Manage 2017; 33:414-425. [DOI: 10.1002/hpm.2478] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/01/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- Ting‐Hsuan J. Lee
- Department of International HealthThe Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Indrani Saran
- Duke Global Health InstituteDuke University Durham North Carolina USA
| | - Krishna D. Rao
- Department of International HealthThe Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
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Pandey A, Ploubidis GB, Clarke L, Dandona L. Trends in catastrophic health expenditure in India: 1993 to 2014. Bull World Health Organ 2017; 96:18-28. [PMID: 29403097 PMCID: PMC5791868 DOI: 10.2471/blt.17.191759] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 11/06/2017] [Accepted: 11/07/2017] [Indexed: 11/27/2022] Open
Abstract
Objective To investigate trends in out-of-pocket health-care payments and catastrophic health expenditure in India by household age composition. Methods We obtained data from four national consumer expenditure surveys and three health-care utilization surveys conducted between 1993 and 2014. Households were divided into five groups by age composition. We defined catastrophic health expenditure as out-of-pocket payments equalling or exceeding 10% of household expenditure. Factors associated with catastrophic expenditure were identified by multivariable analysis. Findings Overall, the proportion of catastrophic health expenditure increased 1.47-fold between the 1993–1994 expenditure survey (12.4%) and the 2011–2012 expenditure survey (18.2%) and 2.24-fold between the 1995–1996 utilization survey (11.1%) and the 2014 utilization survey (24.9%). The proportion increased more in the poorest than the richest quintile: 3.00-fold versus 1.74-fold, respectively, across the utilization surveys. Catastrophic expenditure was commonest among households comprising only people aged 60 years or older: the adjusted odds ratio (aOR) was 3.26 (95% confidence interval, CI: 2.76–3.84) compared with households with no older people or children younger than 5 years. The risk was also increased among households with both older people and children (aOR: 2.58; 95% CI: 2.31–2.89), with a female head (aOR: 1.32; 95% CI: 1.19–1.47) and with a rural location (aOR: 1.27; 95% CI: 1.20–1.35). Conclusion The proportion of households experiencing catastrophic health expenditure in India increased over the past two decades. Such expenditure was highest among households with older people. Financial protection mechanisms are needed for population groups at risk for catastrophic health expenditure.
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Affiliation(s)
- Anamika Pandey
- Public Health Foundation of India, Plot 47, Sector 44, Institutional Area, Gurugram 122 002, National Capital Region, India
| | - George B Ploubidis
- Centre for Longitudinal Studies, UCL Institute of Education, London, England
| | - Lynda Clarke
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, England
| | - Lalit Dandona
- Public Health Foundation of India, Plot 47, Sector 44, Institutional Area, Gurugram 122 002, National Capital Region, India
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Jeyashree K, Suliankatchi Abdulkader R, Kathirvel S, Chinnakali P, Kumar Mv A. Profile of and expenditure on morbidity and hospitalizations among elderly-Analysis of a nationally representative sample survey in India. Arch Gerontol Geriatr 2017; 74:55-61. [PMID: 28992514 DOI: 10.1016/j.archger.2017.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/21/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Understanding morbidity pattern and associated expenditure is essential for implementation of appropriate healthcare and social security measures for the elderly. This study aims to assess the proportion of ailing persons (PAP) in the last 15days, the utilization of hospitalization services in the last 365days and the expenditure incurred for hospitalizations among the elderly in India. METHODS This study analysed data from a nationally representative survey by the National Sample Survey Office (NSSO) in 2014-15 on 36,480 rural and 29,452 urban households. Distribution of morbidity and in-patient health care utilisation were analysed by subgroups of sex, residence, wealth quintile and type of health care provider. All estimates were weighted to account for the complex sampling design. RESULTS & DISCUSSION Among 27,245 elderly persons, 30.3% reported having suffered an ailment in the past 15days and 8% reported at least one hospitalisation episode in the last 365days. All quintiles, except the lowest, utilized private sector more than the public sector for hospitalisations. The distribution of PAP (Concentration Index (CI)=+0.11; +0.07,+0.15) and the utilization of hospitalisation services (CI=+0.18; +0.11,+0.25) were found to be significantly pro-rich. The median (IQR) expenditure on hospitalization was INR 7370 (2600, 18,060). The wealthiest quintile spent 3.1 times more than the poorest quintile on hospitalisation. CONCLUSION Efforts to reduce inequity among elderly persons in health status and healthcare utilization should be integral to any strategy targeting achievement of third sustainable development goal- "ensuring healthy lives and promoting well-being for all at all ages".
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Affiliation(s)
- Kathiresan Jeyashree
- Department of Community Medicine, Velammal Medical College Hospital and Research Institute, Madurai 625009, India.
| | | | - Soundappan Kathirvel
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Palanivel Chinnakali
- Department of Preventive and Social Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Ajay Kumar Mv
- Centre for Operational Research, International Union Against Tuberculosis and Lung Diseases (The Union), Paris, France
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Chih HJ, Liang W. Effect of unaffordable medical need on distress level of family member: analyses of 1997-2013 United States National Health Interview Surveys. BMC Psychiatry 2017; 17:323. [PMID: 28865419 PMCID: PMC5581444 DOI: 10.1186/s12888-017-1483-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 08/23/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Reduced funding to public health care systems during economic downturns is a common phenomenon around the world. The effect of health care cost on family members of the patients has not been established. This paper aims to explore the relationship between affordability of health care and vulnerability of family members to distress levels. METHODS Data of a total of 262,843 participants were obtained from 17 waves (1997-2013) of the United States National Health Interview Survey. Multinomial logistic regression was used to investigate psychological distress level as a result of having family members who experienced unmet medical needs due to cost. RESULTS Among participants without family members who experienced unmet needs for medical care due to cost, risks of having 'moderate' (score of 5-12) or 'serious' (score of 13 or above) level of psychological distress were 1.0% and 11.5%, respectively. Risks of having 'moderate' or 'serious' level of psychological distress were 3.1% and 23.4%, respectively among participants with family members who experienced unmet needs. The adjusted relative risk ratio of 'moderate' and 'serious', as compared to 'normal' level of psychological distress, were 1.58 (95% confidence interval: 1.47-1.69) and 2.09 (95% confidence interval: 1.78-2.45) if one's family members experienced unmet medical needs. CONCLUSIONS Unmet medical needs due to cost increases risk of distress levels experienced by family members. Careful planning and adequate funding to public health care system could be implemented to prevent any unnecessary detrimental effect on mental health among family members of the unwell and any further increment of the prevalence of mental illnesses. This recommendation aligns with the World Health Organization Mental Health Action Plan 2013-2020.
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Affiliation(s)
- Hui Jun Chih
- School of Public Health, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Wenbin Liang
- 0000 0004 0375 4078grid.1032.0National Drug Research Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA 6845 Australia
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Pandey A, Ploubidis GB, Clarke L, Dandona L. Horizontal inequity in outpatient care use and untreated morbidity: evidence from nationwide surveys in India between 1995 and 2014. Health Policy Plan 2017; 32:969-979. [PMID: 28419286 PMCID: PMC5886081 DOI: 10.1093/heapol/czx016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2017] [Indexed: 11/23/2022] Open
Abstract
Equity in healthcare has been a long-term guiding principle of health policy in India. We estimate the change in horizontal inequities in healthcare use over two decades comparing the older population (60 years or more) with the younger population (under 60 years). We used data from the nationwide healthcare surveys conducted in India by the National Sample Survey Organization in 1995-96 and 2014 with sample sizes 633 405 and 335 499, respectively. Bivariate and multivariate logit regression analyses were used to study the socioeconomic differentials in self-reported morbidity (SRM), outpatient care and untreated morbidity. Deviations in the degree to which healthcare was distributed according to need were measured by horizontal inequity index (HI). In each consumption quintile the older population had four times higher SRM and outpatient care rate than the younger population in 2014. In 1995-96, the pro-rich inequity in outpatient care was higher for the older (HI: 0.085; 95% CI: 0.066, 0.103) than the younger population (0.039; 0.034, 0.043), but by 2014 this inequity became similar. Untreated morbidity was concentrated among the poor; more so for the older (-0.320; -0.391, -0.249) than the younger (-0.176; -0.211, -0.141) population in 2014. The use of public facilities increased most in the poorest and poor quintiles; the increase was higher for the older than the younger population in the poorest (1.19 times) and poor (1.71 times) quintiles. The use of public facilities was disproportionately higher for the poor in 2014 than in 1995-96 for the older (-0.189; -0.234, -0.145 vs - 0.065; -0.129, -0.001) and the younger (-0.145; -0.175, -0.115 vs - 0.056; -0.086, -0.026) population. The older population has much higher morbidity and is often more disadvantaged in obtaining treatment. Health policy in India should pay special attention to equity in access to healthcare for the older population.
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Affiliation(s)
- Anamika Pandey
- Public Health Foundation of India, New Delhi, India
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - George B Ploubidis
- Centre for Longitudinal Studies, Department of Social Science, UCL-Institute of Education, University College London, UK
| | - Lynda Clarke
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Lalit Dandona
- Public Health Foundation of India, New Delhi, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Sekhri Feachem N, Afshar A, Pruett C, Avanceña AL. Mapping healthcare systems: a policy relevant analytic tool. Int Health 2017; 9:252-262. [PMID: 28541518 PMCID: PMC5881270 DOI: 10.1093/inthealth/ihx005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 12/02/2016] [Accepted: 02/27/2017] [Indexed: 11/16/2022] Open
Abstract
Background In the past decade, an international consensus on the value of well-functioning systems has driven considerable health systems research. This research falls into two broad categories. The first provides conceptual frameworks that take complex healthcare systems and create simplified constructs of interactions and functions. The second focuses on granular inputs and outputs. This paper presents a novel translational mapping tool - the University of California, San Francisco mapping tool (the Tool) - which bridges the gap between these two areas of research, creating a platform for multi-country comparative analysis. Methods Using the Murray-Frenk framework, we create a macro-level representation of a country's structure, focusing on how it finances and delivers healthcare. The map visually depicts the fundamental policy questions in healthcare system design: funding sources and amount spent through each source, purchasers, populations covered, provider categories; and the relationship between these entities. Results We use the Tool to provide a macro-level comparative analysis of the structure of India's and Thailand's healthcare systems. Conclusions As part of the systems strengthening arsenal, the Tool can stimulate debate about the merits and consequences of different healthcare systems structural designs, using a common framework that fosters multi-country comparative analyses.
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Affiliation(s)
- Neelam Sekhri Feachem
- Global Health Sciences and Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Ariana Afshar
- University of California, San Francisco, San Francisco, California, USA
| | - Cristina Pruett
- Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Anton L.V. Avanceña
- The Global Health Group, University of California, San Francisco, San Francisco, California, USA
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Sultana M, Mahumud RA, Sarker AR. Burden of chronic illness and associated disabilities in Bangladesh: Evidence from the Household Income and Expenditure Survey. Chronic Dis Transl Med 2017; 3:112-122. [PMID: 29063064 PMCID: PMC5627690 DOI: 10.1016/j.cdtm.2017.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the distribution of chronic illness and associated disability, out-of-pocket payment (OOPP), and other related factors using survey data from Bangladesh. METHODS This study analyzed Bangladesh Household Income and Expenditure Survey data that include socio-economic and demographic data, such as consumption, expenditures, and assets, along with information regarding chronic illness and disability. Multiple linear regression models were used to identify factors significantly associated with OOPP. Furthermore, a binary Logistic regression model was employed to assess the association of the explanatory variables with disability status. RESULTS A higher prevalence of chronic illness was found for those with chronic gastritis (18.70%), and 41.92% of the population had at least one side disability. The average OOPP healthcare expenditure for chronic illness was estimated to be US$7.59. Higher OOPP was found among the upper 2 wealth quintiles. Overall OOPP health expenditure was significantly higher among individuals with an associated disability (P < 0.001). The likelihood of having an associated disability was higher among those individuals with a lower education level (OR = 2.36, 95% CI: 1.95-4.06), those who not earning an income (OR = 2.85, 95% CI: 2.53-3.21), those who did not seek care (OR = 1.73, 95% CI: 1.57-1.90), those who sought care from a pharmacy (OR = 8.91, 95% CI: 7.38-10.74), and those in the lowest wealth quintile (OR = 7.21, 95% CI: 6.41-8.12). CONCLUSIONS The high OOPP illustrates the necessity of financial risk protection for the population at low socio-economic status. Therefore, we recommend that the government strengthen the healthcare system with appropriate support directed to the rural and elderly populations.
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Affiliation(s)
- Marufa Sultana
- Health Economics and Financing Research, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr'b), Dhaka, Bangladesh
| | - Rashidul Alam Mahumud
- Health Economics and Financing Research, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr'b), Dhaka, Bangladesh
| | - Abdur Razzaque Sarker
- Health Economics and Financing Research, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr'b), Dhaka, Bangladesh
- University of Strathclyde, Glasgow, United Kingdom
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Abstract
ABSTRACTUganda's population is ageing, which comes with increased and varied burdens of disease and health-care needs. At the same time, gerontological care in Uganda remains neglected. This paper examines the factors that cause older Ugandans to delay health-care access. We conduct a thematic analysis of data drawn from nine focus groups held with rural Ugandans aged 60-plus. Our analysis highlights the factors that delay older persons’ access to health care and how these align with the Three-Delay Model, which was originally developed to assess and improve obstetric care in low-resource settings. Our participants report delays in deciding to seek care related to mobility and financial limitations, disease aetiology, severity and stigma (Delay I); reaching care because of poor roads and limited transportation options (Delay II); and receiving appropriate care because of ageism among health-care workers, and poorly staffed and under-supplied facilities (Delay III). We find these delays to care are interrelated and impacted by factors at the individual, community and health-system levels. We conclude by arguing for multi-pronged interventions that will address these delays, improve access to care and ultimately enhance older Ugandans’ health and wellbeing.
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Gwatidzo SD, Stewart Williams J. Diabetes mellitus medication use and catastrophic healthcare expenditure among adults aged 50+ years in China and India: results from the WHO study on global AGEing and adult health (SAGE). BMC Geriatr 2017; 17:14. [PMID: 28077072 PMCID: PMC5225610 DOI: 10.1186/s12877-016-0408-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 12/27/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Expenditure on medications for highly prevalent chronic conditions such as diabetes mellitus (DM) can result in financial impoverishment. People in developing countries and in low socioeconomic status groups are particularly vulnerable. China and India currently hold the world's two largest DM populations. Both countries are ageing and undergoing rapid economic development, urbanisation and social change. This paper assesses the determinants of DM medication use and catastrophic expenditure on medications in older adults with DM in China and India. METHODS Using national standardised data collected from adults aged 50 years and above with DM (self-reported) in China (N = 773) and India (N = 463), multivariable logistic regression describes: 1) association between respondents' socio-demographic and health behavioural characteristics and the dependent variable, DM medication use, and 2) association between DM medication use (independent variable) and household catastrophic expenditure on medications (dependent variable) (China: N = 630; India: N = 439). The data source is the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 (2007-2010). RESULTS Prevalence of DM medication use was 87% in China and 71% in India. Multivariable analysis indicates that people reporting lifestyle modification were more likely to use DM medications in China (OR = 6.22) and India (OR = 8.45). Women were more likely to use DM medications in China (OR = 1.56). Respondents in poorer wealth quintiles in China were more likely to use DM medications whereas the reverse was true in India. Almost 17% of people with DM in China experienced catastrophic healthcare expenditure on medications compared with 7% in India. Diabetes medication use was not a statistically significant predictor of catastrophic healthcare expenditure on medications in either country, although the odds were 33% higher among DM medications users in China (OR = 1.33). CONCLUSIONS The country comparison reflects major public policy differences underpinned by divergent political and ideological frameworks. The DM epidemic poses huge public health challenges for China and India. Ensuring equitable and affordable access to medications for DM is fundamental for healthy ageing cohorts, and is consistent with the global agenda for universal healthcare coverage.
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Affiliation(s)
- Shingai Douglas Gwatidzo
- Umeå International School of Public Health, Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, SE-90185 Umeå, Sweden
| | - Jennifer Stewart Williams
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, SE-90185 Umeå, Sweden
- Research Centre for Gender, Health and Ageing, Faculty of Health, University of Newcastle, New Lambton Heights, Newcastle, NSW 2305 New South Wales Australia
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Brinda EM, Rajkumar AP, Attermann J, Gerdtham UG, Enemark U, Jacob KS. Health, Social, and Economic Variables Associated with Depression Among Older People in Low and Middle Income Countries: World Health Organization Study on Global AGEing and Adult Health. Am J Geriatr Psychiatry 2016; 24:1196-1208. [PMID: 27743841 DOI: 10.1016/j.jagp.2016.07.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/18/2016] [Accepted: 07/21/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Although depression among older people is an important public health problem worldwide, systematic studies evaluating its prevalence and determinants in low and middle income countries (LMICs) are sparse. The biopsychosocial model of depression and prevailing socioeconomic hardships for older people in LMICs have provided the impetus to determine the prevalence of geriatric depression; to study its associations with health, social, and economic variables; and to investigate socioeconomic inequalities in depression prevalence in LMICs. METHODS The authors accessed the World Health Organization Study on Global AGEing and Adult Health Wave 1 data that studied nationally representative samples from six large LMICs (N = 14,877). A computerized algorithm derived depression diagnoses. The authors assessed hypothesized associations using survey multivariate logistic regression models for each LMIC and pooled their risk estimates by meta-analyses and investigated related socioeconomic inequalities using concentration indices. RESULTS Cross-national prevalence of geriatric depression was 4.7% (95% CI: 1.9%-11.9%). Female gender, illiteracy, poverty, indebtedness, past informal-sector occupation, bereavement, angina, and stroke had significant positive associations, whereas pension support and health insurance showed significant negative associations with geriatric depression. Pro-poor inequality of geriatric depression were documented in five LMICs. CONCLUSIONS Socioeconomic factors and related inequalities may predispose, precipitate, or perpetuate depression amongolder people in LMICs. Relative absence of health safety net places socioeconomically disadvantaged older people in LMICs at risk. The need for population-based public health interventions and policies to prevent and to manage geriatric depression effectively in LMICs cannot be overemphasized.
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Affiliation(s)
- Ethel M Brinda
- Section for Health Promotion and Health Services Research, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anto P Rajkumar
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, UK; Mental Health of Older Adults and Dementia Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK.
| | - Jǿrn Attermann
- Section of Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Ulf G Gerdtham
- Health Economics Unit, Department of Clinical Sciences, Lund University, Lund, Sweden; Institute of Economic Research, Health Economics & Management, Lund University, Lund, Sweden
| | - Ulrika Enemark
- Section for Health Promotion and Health Services Research, Department of Public Health, Aarhus University, Aarhus, Denmark
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Federici S, Bracalenti M, Meloni F, Luciano JV. World Health Organization disability assessment schedule 2.0: An international systematic review. Disabil Rehabil 2016; 39:2347-2380. [PMID: 27820966 DOI: 10.1080/09638288.2016.1223177] [Citation(s) in RCA: 221] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criteria for evaluating relevant international scientific literature. The aims were to establish the extent of international dissemination and use of WHODAS 2.0 and analyze psychometric research on its various translations and adaptations. In particular, we wanted to highlight which psychometric features have been investigated, focusing on the factor structure, reliability, and validity of this instrument. METHOD Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on "whodas" using the ProQuest, PubMed, and Google Scholar electronic databases. RESULTS We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry). CONCLUSIONS The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them. Implications for Rehabilitation WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability. The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry. WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations. A critical issue for rehabilitation is that a single "minimal clinically important .difference" score for the WHODAS 2.0 has not yet been established.
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Affiliation(s)
- Stefano Federici
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Marco Bracalenti
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Fabio Meloni
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Juan V Luciano
- b Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan De Déu , St. Boi De Llobregat , Spain.,c Primary Care Prevention and Health Promotion Research Network (RedIAPP) , Madrid , Spain
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Hidden burden of non-medical spending associated with inpatient care among the poor in Afghanistan. Int J Public Health 2016; 61:661-671. [DOI: 10.1007/s00038-016-0833-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 04/28/2016] [Accepted: 05/04/2016] [Indexed: 10/21/2022] Open
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Jacobs B, de Groot R, Fernandes Antunes A. Financial access to health care for older people in Cambodia: 10-year trends (2004-14) and determinants of catastrophic health expenses. Int J Equity Health 2016; 15:94. [PMID: 27316716 PMCID: PMC4912821 DOI: 10.1186/s12939-016-0383-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/13/2016] [Indexed: 01/10/2023] Open
Abstract
Background Older people make up an increasing proportion of the population in low- and middle-income countries. This brings a number of challenges, as their health needs are greater than, and different from, those of younger people. In general, these health systems are not geared to address their needs, and traditional support systems tend to erode, potentially causing financial hardship when accessing health care. This paper provides an overview of older Cambodians’ financial access to health care over time, using nationally representative data to enable the formulation of appropriate responses. Methods Using data from three nationally representative household surveys from 2004, 2009 and 2014, we assess key indicators of financial access to health care for households with older people (aged 60 years or older), and compare these with households without older members. For 2014 data, the determinants of catastrophic health expenses at the 10 and 40 % threshold were determined for older people. Data was stratified by age and place of residence (urban/rural), and analysed using Stata statistical software. Sample weights were calibrated to reflect accurate population composition at the time of the survey. Monetary values for 2004 and 2009 were transformed into 2014 values using annual inflation rate figures. Results Care-seeking when sick among older people increased considerably from 2004 to 2014, irrespective of gender or place of residence. There were positive trends in the incidence of catastrophic and impoverishing healthcare expenses over the studied time periods. This was also the case for indebtedness. Rural households with older people were considerable more likely to suffer financial hardship due to health-related expenses than their urban equivalents. In 2014, older people spent 50 % more per month on health care than younger people. Determinants of catastrophic health expenditures among households with older people were residing in a rural area, and having a household member with an illness, especially a non-communicable disease. Conclusion In order to make health care more equitable for older people, efforts should be directed to rural areas. Interventions should include improving management of non-communicable diseases at the primary care level, together with a reconfiguration of social health protection schemes to increase the inclusion of older people.
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Affiliation(s)
- Bart Jacobs
- Social Health Protection Programme, Deutsche Gesellschaft für Internationale Zusammenarbeit (GiZ), c/o NIPH, No.2, Street 289, Khan Toul Kork, P.O. Box 1238, Phnom Penh, Cambodia.
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Beard JR, Officer A, de Carvalho IA, Sadana R, Pot AM, Michel JP, Lloyd-Sherlock P, Epping-Jordan JE, Peeters GMEEG, Mahanani WR, Thiyagarajan JA, Chatterji S. The World report on ageing and health: a policy framework for healthy ageing. Lancet 2016; 387:2145-2154. [PMID: 26520231 PMCID: PMC4848186 DOI: 10.1016/s0140-6736(15)00516-4] [Citation(s) in RCA: 1345] [Impact Index Per Article: 168.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Although populations around the world are rapidly ageing, evidence that increasing longevity is being accompanied by an extended period of good health is scarce. A coherent and focused public health response that spans multiple sectors and stakeholders is urgently needed. To guide this global response, WHO has released the first World report on ageing and health, reviewing current knowledge and gaps and providing a public health framework for action. The report is built around a redefinition of healthy ageing that centres on the notion of functional ability: the combination of the intrinsic capacity of the individual, relevant environmental characteristics, and the interactions between the individual and these characteristics. This Health Policy highlights key findings and recommendations from the report.
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Affiliation(s)
- John R Beard
- Ageing and Life Course, World Health Organization, Geneva, Switzerland.
| | - Alana Officer
- Ageing and Life Course, World Health Organization, Geneva, Switzerland
| | | | - Ritu Sadana
- Ageing and Life Course, World Health Organization, Geneva, Switzerland
| | - Anne Margriet Pot
- Ageing and Life Course, World Health Organization, Geneva, Switzerland
| | | | | | | | | | - Wahyu Retno Mahanani
- Health statistics and information systems, World Health Organization, Geneva, Switzerland
| | | | - Somnath Chatterji
- Health statistics and information systems, World Health Organization, Geneva, Switzerland
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Pandey KR, Meltzer DO. Financial Burden and Impoverishment Due to Cardiovascular Medications in Low and Middle Income Countries: An Illustration from India. PLoS One 2016; 11:e0155293. [PMID: 27159055 PMCID: PMC4861328 DOI: 10.1371/journal.pone.0155293] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 04/27/2016] [Indexed: 11/18/2022] Open
Abstract
Background Health expenditures are a major financial burden for many persons in low and middle-income countries, where individuals often lack health insurance. We estimate the effect of purchasing cardiovascular medicines on poverty in low and middle-income populations using rural and urban India as an example. Methods We created step-up treatment regimens for prevention of ischemic heart disease for the most common cardiovascular medications in India based on their cost and relative risk reduction. Cost was measured by Government of India mandated ceiling prices in rupees (Rs. 1 = $0·016) for essential medicines plus taxes. We calculated step-wise projected incidence and intensity of impoverishment due to medicine purchase. To do this we measured the resources available to individuals as daily per-capita expenditures from the latest National Sample Survey, subtracted daily medication costs, and compared this to 2014 poverty thresholds recommended by an expert group. Findings Analysis of cost-effectiveness resulted in five primary prevention drug regimens, created by progressive addition of Aspirin 75 mg, Hydrochlorothiazide 12.5mg, Losartan 25 mg, and Atorvastatin 10 mg or 40mg. Daily cost from steps 1 to 5 increased from Rs. 0·13, Rs. 1.16, Rs. 3.81, Rs. 10.07, to Rs. 28.85. At baseline, 31% of rural and 27% percent of urban Indian population are poor at the designated poverty thresholds. The Rs. 28.85 regimen would be unaffordable to 81% and 58% of rural and urban people. A secondary prevention regimen with aspirin, hydrochlorothiazide, atenolol and atorvastatin could be unaffordable to 81% and 57% rural and urban people respectively. According to our estimates, 17% of the rural 32% of the urban adult population could benefit with these medications, and their out of pocket purchase could impoverish 17 million rural and 10 million urban people in India and increase respective poverty gaps by 2.9%. Conclusion Medication costs for cardiovascular disease have the potential to cause financial burden to a significant proportion of people in India. These costs increase the likelihood that patients will forego needed treatment and emphasize the need for programs to reduce the costs of medications for cardiovascular patients in India, including by expansion of prescription drug coverage.
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Affiliation(s)
- Kiran Raj Pandey
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
- * E-mail:
| | - David O. Meltzer
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
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81
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Pattern, growth and determinant of household health spending in India, 1993–2012. J Public Health (Oxf) 2016. [DOI: 10.1007/s10389-016-0712-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Skirbekk V, Loichinger E, Weber D. Variation in cognitive functioning as a refined approach to comparing aging across countries. Proc Natl Acad Sci U S A 2012; 109:770-4. [PMID: 22184241 PMCID: PMC3271876 DOI: 10.1073/pnas.1112173109] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Comparing the burden of aging across countries hinges on the availability of valid and comparable indicators. The Old Age Dependency Ratio allows only a limited assessment of the challenges of aging, because it does not include information on any individual characteristics except age itself. Existing alternative indicators based on health or economic activity suffer from measurement and comparability problems. We propose an indicator based on age variation in cognitive functioning. We use newly released data from standardized tests of seniors' cognitive abilities for countries from different world regions. In the wake of long-term advances in countries' industrial composition, and technological advances, the ability to handle new job procedures is now of high and growing importance, which increases the importance of cognition for work performance over time. In several countries with older populations, we find better cognitive performance on the part of populations aged 50+ than in countries with chronologically younger populations. This variation in cognitive functioning levels may be explained by the fact that seniors in some regions of the world experienced better conditions during childhood and adult life, including nutrition, duration and quality of schooling, lower exposure to disease, and physical and social activity patterns. Because of the slow process of cohort replacement, those countries whose seniors already have higher cognitive levels today are likely to continue to be at an advantage for several decades to come.
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Affiliation(s)
- Vegard Skirbekk
- World Population Program, International Institute for Applied Systems Analysis, 2361 Laxenburg, Austria.
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