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Mohsin KF, Ahsan MN, Haider MZ. Understanding variation in catastrophic health expenditure from socio-ecological aspect: a systematic review. BMC Public Health 2024; 24:1504. [PMID: 38840231 PMCID: PMC11151512 DOI: 10.1186/s12889-024-18579-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 04/12/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Out-of-pocket (OOP) payment is one of many countries' main financing options for health care. High OOP payments push them into financial catastrophe and the resultant impoverishment. The infrastructure, society, culture, economic condition, political structure, and every element of the physical and social environment influence the intensity of financial catastrophes in health expenditure. Hence, the incidence of Catastrophic Health Expenditure (CHE) must be studied more intensively, specifically from regional aspects. This systematic review aims to make a socio-ecological synthesis of the predictors of CHE. METHOD We retrieved data from Scopus and Web of Science. This review followed PRISMA guidelines. The interest outcomes of the included literature were the incidence and the determinants of CHE. This review analyzed the predictors in light of the socio-ecological model. RESULTS Out of 1436 screened documents, fifty-one met the inclusion criteria. The selected studies were quantitative. The studies analyzed the socioeconomic determinants from the demand side, primarily focused on general health care, while few were disease-specific and focused on utilized care. The included studies analyzed the interpersonal, relational, and institutional predictors more intensively. In contrast, the community and policy-level predictors are scarce. Moreover, neither of the studies analyzed the supply-side predictors. Each CHE incidence has different reasons and different outcomes. We must go with those case-specific studies. Without the supply-side response, it is difficult to find any effective solution to combat CHE. CONCLUSION Financial protection against CHE is one of the targets of sustainable development goal 3 and a tool to achieve universal health coverage. Each country has to formulate its policy and enact laws that consider its requirements to preserve health rights. That is why the community and policy-level predictors must be studied more intensively. Proper screening of the cause of CHE, especially from the perspective of the health care provider's perspective is required to identify the individual, organizational, community, and policy-level barriers in healthcare delivery.
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Affiliation(s)
| | - Md Nasif Ahsan
- Economics Discipline, Khulna University, Khulna, Bangladesh.
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Sarker AR, Zabeen I, Hossain Z, Ali N, Khan JAM. Increasing rates of cesarean birth in Bangladesh: A household-level pooled analysis. Birth 2024; 51:326-342. [PMID: 37994253 DOI: 10.1111/birt.12789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 12/24/2022] [Accepted: 10/07/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Cesarean birth (CB) rates have been increasing rapidly globally, including in Bangladesh. This study aimed to assess national trends in CB rates and to investigate associated factors in Bangladesh. METHODS We analyzed data from the five most recent Bangladesh Demographic and Health Surveys (BDHS) between 2003 and 2018. A total of 27,328 ever-married women aged 15-49 who had a live birth in the 2 years preceding the survey were included in this study. We estimated the prevalence of CB from 2003 to 2018, as well as changes in the prevalence. Logistic regression analysis was used to measure the association between dependent and independent variables. RESULTS The overall prevalence of CB among Bangladeshi mothers was 3.99% in 2003-04; this rate increased to 33.22% in 2017-18. The annual percentage change in CB rate was 16.34% from 2004 to 2017-18, which is alarming relative to the World Health Organization's cesarean birth recommended threshold. Several factors, such as maternal age, maternal and paternal education, working status of the mother, maternal BMI, age at first pregnancy, antenatal care (ANC) use, administrative division, and wealth status, had a significant influence on the rising rate of CB in Bangladesh. CONCLUSIONS This study documents the alarming rate of CB increase in Bangladesh since 2003. It is critical that authorities implement more effective national monitoring measures to identify the causes of this dramatic increase and work to mitigate the rate of unnecessary CB in Bangladesh.
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Affiliation(s)
- Abdur Razzaque Sarker
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Irfat Zabeen
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
| | - Zakir Hossain
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
| | - Nausad Ali
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
| | - Jahangir A M Khan
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
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Shaltynov A, Jamedinova U, Semenova Y, Abenova M, Myssayev A. Inequalities in Out-of-Pocket Health Expenditure Measured Using Financing Incidence Analysis (FIA): A Systematic Review. Healthcare (Basel) 2024; 12:1051. [PMID: 38786461 PMCID: PMC11121301 DOI: 10.3390/healthcare12101051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/11/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
Government efforts and reforms in health financing systems in various countries are aimed at achieving universal health coverage. Household spending on healthcare plays a very important role in achieving this goal. The aim of this systematic review was to assess out-of-pocket health expenditure inequalities measured by the FIA across different territories, in the context of achieving UHC by 2030. A comprehensive systematic search was conducted in the PubMed, Scopus, and Web of Science databases to identify original quantitative and mixed-method studies published in the English language between 2016 and 2022. A total of 336 articles were initially identified, and after the screening process, 15 articles were included in the systematic review, following the removal of duplicates and articles not meeting the inclusion criteria. Despite the overall regressivity, insurance systems have generally improved population coverage and reduced inequality in out-of-pocket health expenditures among the employed population, but regional studies highlight the importance of examining the situation at a micro level. The results of the study provide further evidence supporting the notion that healthcare financing systems relying less on public funding and direct tax financing and more on private payments are associated with a higher prevalence of catastrophic health expenditures and demonstrate a more regressive pattern in terms of healthcare financing, highlighting the need for policy interventions to address these inequities. Governments face significant challenges in achieving universal health coverage due to inequalities experienced by financially vulnerable populations, including high out-of-pocket payments for pharmaceutical goods, informal charges, and regional disparities in healthcare financing administration.
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Affiliation(s)
- Askhat Shaltynov
- Epidemiology and Biostatistics Department, Semey Medical University, Semey 071400, Kazakhstan; (U.J.); (M.A.)
| | - Ulzhan Jamedinova
- Epidemiology and Biostatistics Department, Semey Medical University, Semey 071400, Kazakhstan; (U.J.); (M.A.)
| | - Yulia Semenova
- School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan;
| | - Madina Abenova
- Epidemiology and Biostatistics Department, Semey Medical University, Semey 071400, Kazakhstan; (U.J.); (M.A.)
| | - Ayan Myssayev
- Department of the Science and Human Resources, Ministry of Healthcare of the Republic of Kazakhstan, Astana 010000, Kazakhstan;
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Houeninvo HG, Quenum VCC, Senou MM. Out- Of- Pocket health expenditure and household consumption patterns in Benin: Is there a crowding out effect? HEALTH ECONOMICS REVIEW 2023; 13:19. [PMID: 36971878 PMCID: PMC10041797 DOI: 10.1186/s13561-023-00429-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
Health shocks are common and have serious consequences for households in developing countries where health insurance is lacking. In this study, we examine whether out-of-pocket health expenditures crowd out household consumption of non-healthcare necessities, such as education items in Benin using a sample of 14,952 households from the global vulnerability and food security analysis survey. We estimated a system of conditional Engel curves with three stage least squared (3SLS) and seemingly unrelated regression (SURE) for seven categories of goods using the Quadratic Almost Ideal Demand System (QUAIDS) in the form of budget shares corresponding to proportions of total non-health expenditure. Findings show that out of pocket health expenditure leads households to spend more on health care that in fine crowd out expenditure in other necessity goods such as education item. These findings highlight the need for social protection programs to mitigate the impact of health shocks on vulnerable households in Benin.
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Affiliation(s)
| | | | - Melain Modeste Senou
- University of Abomey Calavi, Calavi, Benin.
- African Economic Research Consortium, Nairobi, Kenya.
- Economics, African Centre of Excellence for Inequality Research, Cape Town, South Africa.
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Sarker AR, Zabeen I, Ali N, Ashraf A, Hossain Z. Inequality of handwashing practice using antimicrobial agents in Bangladesh: a household level analyses. Public Health 2023; 214:106-115. [PMID: 36549019 DOI: 10.1016/j.puhe.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/01/2022] [Accepted: 11/11/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES About 2.3 billion individuals worldwide are still deprived of the amenity of handwashing with antimicrobial agents. The progress of handwashing with antimicrobial agents in Bangladesh is relatively slower than in many developing countries. The objective of this study was to capture the inequality of the prevalence of handwashing with antimicrobial agents and to identify the factors that are potentially contributing to socio-economic inequalities of handwashing practice in Bangladesh. STUDY DESIGN Cross-sectional study. METHODS The present study used the nationally representative cross-sectional data from the latest Bangladesh Demographic and Health Survey (BDHS) 2017-18. A total of 19,457 households were included in the analysis of this study. A regression-based decomposition method was applied to assess the socio-economic contributors of inequality. RESULTS This study showed that only 38% of Bangladeshi households wash their hands with antimicrobial agents while a pro-rich socio-economic inequality was observed. Household's wealth index was responsible for about 46% of the overall inequality of handwashing with antimicrobial agents while the type of place for handwashing variable contributed 38% of total inequalities. Hygienic toilet facilities (12%) and exposure to mass media (7.4%) are other determinants of total inequalities of handwashing with antimicrobial agents. CONCLUSIONS Despite recent declines in attributable mortality, handwashing with antimicrobial agents remains an important determinant of public health problems in many developing countries like Bangladesh. The regular programs aimed at promoting best hand hygiene practices and ensuring the availability of the necessary infrastructure at the community level will be important measures to eliminate this inequality at the population level.
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Affiliation(s)
- A R Sarker
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh.
| | - I Zabeen
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh.
| | - N Ali
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh.
| | - A Ashraf
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh.
| | - Z Hossain
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh.
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Sheikh N, Sarker AR, Sultana M, Mahumud RA, Ahmed S, Islam MT, Howick S, Morton A. Disease-specific distress healthcare financing and catastrophic out-of-pocket expenditure for hospitalization in Bangladesh. Int J Equity Health 2022; 21:114. [PMID: 35987656 PMCID: PMC9392951 DOI: 10.1186/s12939-022-01712-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 08/03/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Financial risk protection and equity are two fundamental components of the global commitment to achieve Universal Health Coverage (UHC), which mandates health system reform based on population needs, disease incidence, and economic burden to ensure that everyone has access to health services without any financial hardship. We estimated disease-specific incidences of catastrophic out-of-pocket health expenditure and distress financing to investigate progress toward UHC financial risk indicators and investigated inequalities in financial risk protection indicators by wealth quintiles. In addition, we explored the determinants of financial hardship indicators as a result of hospitalization costs.
Methods
In order to conduct this research, data were extracted from the latest Bangladesh Household Income and Expenditure Survey (HIES), conducted by the Bangladesh Bureau of Statistics in 2016–2017. Financial hardship indicators in UHC were measured by catastrophic health expenditure and distress financing (sale/mortgage, borrowing, and family support). Concentration curves (CC) and indices (CI) were estimated to measure the pattern and severity of inequalities across socio-economic classes. Binary logistic regression models were used to assess the determinants of catastrophic health expenditure and distress financing.
Results
We found that about 26% of households incurred catastrophic health expenditure (CHE) and 58% faced distress financing on hospitalization in Bangladesh. The highest incidence of CHE was for cancer (50%), followed by liver diseases (49.2%), and paralysis (43.6%). The financial hardship indicators in terms of CHE (CI = -0.109) and distress financing (CI = -0.087) were more concentrated among low-income households. Hospital admission to private health facilities, non-communicable diseases, and the presence of chronic patients in households significantly increases the likelihood of higher UHC financial hardship indicators.
Conclusions
The study findings strongly suggest the need for national-level social health security schemes with a particular focus on low-income households, since we identified greater inequalities between low- and high-income households in UHC financial hardship indicators. Regulating the private sector and implementing subsidized healthcare programmes for diseases with high treatment costs, such as cancer, heart disease, liver disease, and kidney disease are also expected to be effective to protect households from financial hardship. Finally, in order to reduce reliance on OOPE, the government should consider increasing its allocations to the health sector.
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Kumar K. A public-private partnership based model for regulating out-of-pocket expenditures to strengthen primary care system. Int J Health Plann Manage 2022; 37:2964-2991. [PMID: 35819356 DOI: 10.1002/hpm.3535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 05/20/2022] [Accepted: 06/10/2022] [Indexed: 11/07/2022] Open
Abstract
In developing countries like India, the cost of health care is largely borne by patient out-of-pocket payments. Recent studies have reported that patients skip public-funded clinics providing free consultation for distant private care providers. Some of the reasons identified for such behaviour include longer waiting times, perception regarding quality of care, etc. Therefore, optimal allocation of existing and new capacity is critical for a greater public interest. This article presents a decision-making framework towards this intent for strengthening the existing government primary healthcare network. In this article, a mixed-integer linear programing (MILP) model is developed for optimal reconfiguration of the existing government primary healthcare network to minimise patient out-of-pocket expenditures (OOPE). The model involves three types of facilities: Primary Health Centre (PHC), Community Health Centre (CHC), and Private OPD (outpatient department). Implementation of the proposed model can help in reducing out-of-pocket expenditures. The optimization model proposed in the article is unique as it incorporates for the first time, patient out-of-pocket expenditure, capacity reconfiguration, and public-private partnership decisions in the primary healthcare system. A solution algorithm is also proposed for the optimization model. The model would be useful for theory development and also in policy-making.
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Affiliation(s)
- Kaushal Kumar
- Department of Operational Research, University of Delhi, New Delhi, India
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Li Z, Hu M. Spatio-Temporal Disparity and Driving Forces of the Supply Level of Healthcare Service in the Yangtze River Delta. Front Public Health 2022; 10:863571. [PMID: 35530733 PMCID: PMC9068963 DOI: 10.3389/fpubh.2022.863571] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/10/2022] [Indexed: 11/13/2022] Open
Abstract
The equalization of healthcare supply is not only related to the people's need for a better life, but can also provide a strong guarantee for the high-quality and sustainable development of the Yangtze River Delta integration. By using exploratory spatial analysis techniques, this study analyzed the spatio-temporal evolution characteristics and heterogeneous influence effects of the supply level of healthcare service in the Yangtze River Delta from 2007 to 2019. It was found that the supply level of healthcare service in the Yangtze River Delta had improved significantly. The differences in the supply level of healthcare service between cities had tended to narrow without polarization, and the supply level of healthcare service generally showed a high spatial pattern in the south delta and low spatial pattern in the north delta. The higher the supply level of healthcare service was, the weaker the interannual variability was. The supply level of healthcare service in the Yangtze River Delta region presented obvious spatial association and differentiated tendency of local high and low spatial clusters. The relative length and curvature of the supply level of healthcare service in the Yangtze River Delta generally presented a spatial pattern with low values in the northeast and high values in the southwest. Population density and urban-rural income gap generally exhibited negative spatio-temporal impact on the supply level of healthcare service across most cities. On the other hand, urbanization level and per capita disposable income generally had positive spatio-temporal impact on the supply level of healthcare service across most cities. Per capita gross domestic product (GDP) showed an increasingly positive spatio-temporal impact on the supply level of healthcare service across most cities. While per capita fiscal expenditure exhibited significantly negative impact on the supply level of healthcare service across most cities in space.
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Affiliation(s)
- Zaijun Li
- Research Institute of Central Jiangsu Development, Yangzhou University, Yangzhou, China
| | - Meijuan Hu
- College of Tourism and Culinary Science, Yangzhou University, Yangzhou, China
- *Correspondence: Meijuan Hu
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Baharin MFA, Juni MH, Abdul Manaf R. Equity in Out-of-Pocket Payments for Healthcare Services: Evidence from Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084500. [PMID: 35457364 PMCID: PMC9029138 DOI: 10.3390/ijerph19084500] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Out-of-pocket (OOP) payments are an inequitable mechanism for health financing as their high share of total health expenditures poses a risk of catastrophic healthcare expenditures. This study aimed to assess the distribution and progressivity of OOP payments made by Malaysian households for various group of healthcare services. METHODS This study utilized data from the Malaysian Household Expenditure Survey (HES) between 2014 and 2015, which involved 14,473 households. Distribution and progressivity of OOP payments were measured through their proportion of household consumption, a concentration curves plot and the Kakwani Progressivity Index (KPI). RESULTS The mean proportion of Malaysian OOP payments for healthcare of household consumption was 1.65%. The proportion increased across households' consumption quintiles, from 1.03% made by the poorest 20% to 1.86% by the richest 20%. The OOP payments in Malaysia were progressive with a positive KPI of 0.0910. The OOP payments made for hospital-based services were the most progressive (KPI 0.1756), followed by medical products, appliances and equipment (KPI 0.1192), pharmaceuticals (0.0925) and outpatient-based services (KPI 0.0394) as the least progressive. CONCLUSIONS Overall, the OOP payments for healthcare services in Malaysia were progressive and equitable as they were more concentrated among the richer households.
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Affiliation(s)
- Mohamed Fakhri Abu Baharin
- Public Health Unit, Department of Primary Health Care, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai 71800, Malaysia
- Correspondence: ; Tel.: +60-6798-5024
| | - Muhamad Hanafiah Juni
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia; (M.H.J.); (R.A.M.)
| | - Rosliza Abdul Manaf
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia; (M.H.J.); (R.A.M.)
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