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Ma H, Jia E, Ma H, Pan Y, Jiang S, Xiong J. Preferences for public long-term care insurance among middle-aged and elderly residents: A discrete choice experiment in Hubei Province, China. Front Public Health 2023; 11:1050407. [PMID: 36778541 PMCID: PMC9909219 DOI: 10.3389/fpubh.2023.1050407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/09/2023] [Indexed: 01/27/2023] Open
Abstract
Objective It is critical to incorporate residents' preferences into the design of long-term care insurance (LTCI). However, little is known about middle-aged and elderly residents' preferences for personalized need-related attributes of LTCI in China. Through a discrete choice experiment (DCE), we aimed to focus on the direct beneficiaries of LTCI and then elicit their preferences for LTCI under a hypothetical scenario of dysfunction. Methods Attributes and levels were defined through a literature review and two rounds of expert consultations (n = 8). A D-optimal fractional factorial design was used to generate the DCE questionnaire. Face-to-face interviews with middle-aged and elderly residents were conducted in two cities in Hubei Province, China, between November and December 2020. A mixed logit model was utilized for estimation. Results Five attributes were identified and incorporated into the DCE questionnaire. A total of 390 participants completed DCE questionnaires. Care facilities, care content, reimbursement rate, caregivers, and annual premium per person all had a significant impact on residents' preferences. Residents had significantly higher preferences for the LTCI scheme with home and community-based care centers (β = 1.40, p < 0.01), multi-level services (β = 0.44, p < 0.01), 90% reimbursement rate (β = 0.37, p < 0.01), and sufficiently trained caregivers (β = 0.26, p < 0.01). Individual characteristics, such as gender, employment, and education level were the factors that drove heterogeneity in preferences for LTCI. Conclusion This study provides new evidence on the preferences of middle-aged and elderly residents for personalized need-related public LTCI features. The design of the LTCI scheme in China needs to take these findings into account to maximize the utility for direct beneficiaries of LTCI and enhance their enrollment.
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Affiliation(s)
- He Ma
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Erping Jia
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Huimin Ma
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yanzhi Pan
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shan Jiang
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Juyang Xiong
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China,*Correspondence: Juyang Xiong ✉
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Zuhair M, Roy RB. Eliciting relative preferences for the attributes of health insurance schemes among rural consumers in India. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2022; 22:443-458. [PMID: 35394574 DOI: 10.1007/s10754-022-09327-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 03/12/2022] [Indexed: 06/14/2023]
Abstract
There is a limited understanding of the preferences of rural consumers in India for health insurance schemes. In this article, we investigate the preferences of the rural population for the attributes of a health insurance scheme by implementing a discrete choice experiment (DCE). We identified six attributes through qualitative and quantitative study: enrollment, management, benefit package, coverage, transportation facility, and monthly premium. A D-efficient design of 18 choices has been constructed, each comprising two health insurance choices. We collected the representative sample from 675 household heads of the rural population through personal interviews. The preferences for the attributes and attribute levels were estimated using the multinomial logit (MNL) and random-parameter logit (RPL) models. The analysis shows that all attribute levels significantly affect the choice behavior (P < 0.05). The relative order of preferences for attributes are; enrollment, benefit package, monthly premium, management, coverage, and transportation.
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Affiliation(s)
- Mohd Zuhair
- Department of Computer Science and Engineering, Institute of Technology, Nirma University, Ahmedabad, Gujarat, India.
| | - Ram Babu Roy
- Indian Institute of Technology Kharagpur, Kharagpur, West Bengal, India
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Chen N, Bai J, Nicholas S, Maitland E, Tan J, Wang J. Preferences for private health insurance in China: A discrete choice experiment. Front Public Health 2022; 10:985582. [PMID: 36148354 PMCID: PMC9486459 DOI: 10.3389/fpubh.2022.985582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/08/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction There is limited evidence on the sustainability and optimal design of China's private health insurance market, especially from the demand-side. With the increasing medical cost burden on both patients and the social security system, policy makers need data on potential clients' demand for private health insurance. Methods A discrete choice experiment was conducted to explore potential clients' preferences for a type of government-involved private supplementary health insurance, Huimin Insurance, in China. A mixed logit model was used to evaluated participants' preferences for six attributes. Willingness to pay, subgroup analysis and interaction effects were estimated based on the initial model. Results Among the 947 participants, 883 (93.2%) were aged 18 to 59 years and 578 (61.0%) were female. Participants had a strong preference for government involvement, extensive benefit packages, high reimbursement ratio and compensation for pre-existing conditions. With respect to the attribute of deductible, participants were indifferent between the level of CNY15,000 and CNY18,000 but had strong and significant preference for the level of CNY15,000 than CNY20,000. The premium was significantly correlated with a decline in the utility of PHI. Conclusions All attributes had a significant impact on participants' preference for Huimin Insurance. Providing a reference point for the development of private health insurance in China, our results inform the optimal design of PHI, especially Huimin Insurance's products.
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Affiliation(s)
- Nuo Chen
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Beijing, China
| | - Jing Bai
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Beijing, China
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, Sydney, NSW, Australia,Newcastle Business School, University of Newcastle, Newcastle, NSW, Australia
| | - Elizabeth Maitland
- School of Management, University of Liverpool, Liverpool, United Kingdom
| | - Jialong Tan
- School of Public Health, Wuhan University, Wuhan, China,*Correspondence: Jialong Tan
| | - Jian Wang
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Beijing, China,Center for Health Economics and Management at the School of Economics and Management, Wuhan University, Wuhan, China,Jian Wang
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Patient and Public Preferences for Coordinated Care in Switzerland: Development of a Discrete Choice Experiment. THE PATIENT - PATIENT-CENTERED OUTCOMES RESEARCH 2022; 15:485-496. [PMID: 35067858 PMCID: PMC9197802 DOI: 10.1007/s40271-021-00568-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/12/2021] [Indexed: 11/10/2022]
Abstract
Objective Our objective was to develop and test a discrete choice experiment (DCE) eliciting public and patient preferences for better-coordinated care in Switzerland. Methods We applied a multistage mixed-methods procedure using qualitative and quantitative approaches. First, to identify attributes, we performed a review of the DCE literature in healthcare with a focus on chronic care. Next, attribute selection involved stakeholders (N = 7) from various healthcare sectors to select the most relevant and actionable attributes, followed by three organized focus groups involving the general public and patients (N = 21) to verify the selection and the clarity of the DCE tasks and explanations. Finally, we conducted an online pilot in the target population to test the survey and obtain priors for a final six tested attributes to refine the final design of the experiment. Results After identifying an initial 33 attributes, a final list of six attributes was selected following stakeholder involvement and the three focus groups involving the target population. At the online pilot-testing stage with 301 participants, the majority of respondents found the DCE choice tasks socially relevant for Switzerland but challenging. The quality of the answers was relatively high. Most attributes had signs matching those in the literature and focus group discussions. Conclusion This article will be useful to researchers designing DCEs from a broad health policy perspective. The multistage approach involving a range of stakeholders was essential for the development of a DCE that is relevant for policy makers and well-accepted by the general public and patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40271-021-00568-2.
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Tweedie Model for Predicting Factors Associated with Distance Traveled to Access Inpatient Services in Kenya. JOURNAL OF PROBABILITY AND STATISTICS 2022. [DOI: 10.1155/2022/2706504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim. This study aims to examine which factors influence the distance traveled by patients for inpatient care in Kenya. Methods. We used data from the fourth round of the Kenya Household Health Expenditure and Utilization survey. Our dependent variable was the self-reported distance traveled by patients to access inpatient care at public health facilities. As the clustered data were correlated, we used the generalized estimating equations approach with an exchangeable correlation under a Tweedie distribution. To select the best-fit covariates for predicting distance, we adopted a variable selection technique using the
and
criteria, wherein the lowest (highest) value for the former (latter) is preferred. Results. Using data for 451 participants from 47 counties, we found that three-fifths were admitted between 1 and 5 days, two-thirds resided in rural areas, and 90% were satisfied with the facilities’ service. Wealth quintiles were evenly distributed across respondents. Most admissions (81%) comprised
15,
65, and 25–54 years. Many households were of medium size (4–6 members) and had low education level (48%), and nine-tenths had no access to insurance. While two-thirds reported employment-based income, the same number reported not having cash to pay for inpatient services; 6 out of 10 paid over 3000 KES. Thus, differences in employment, ability to pay, and household size influence the distance traveled to access government healthcare facilities in Kenya. Interpretation. Low-income individuals more likely have large households and live in rural areas and, thus, are forced to travel farther to access inpatient care. Unlike the unemployed, the employed may have better socioeconomic status and possibly live near inpatient healthcare facilities, thereby explaining their short distances to access these services. Policymakers must support equal access to inpatient services, prioritize rural areas, open job opportunities, and encourage smaller families.
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Mahwati Y, Nurrika D, Latief K. The Determinants of Undiagnosed Hypertension Among Indonesian Adults: A Cross-sectional Study Based on the 2014-2015 Indonesia Family Life Survey. J Prev Med Public Health 2022; 55:60-67. [PMID: 35135049 PMCID: PMC8841202 DOI: 10.3961/jpmph.21.500] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/05/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives This study investigated the determinants of undiagnosed hypertension among Indonesian adults. Methods This study involved an analysis of secondary data from the 2014 Indonesia Family Life Survey (IFLS) on 5914 Indonesian adults (≥40 years). The determinant variables examined in this cross-sectional study were education level, monthly per capita expenditures (PCE), whether the participant experienced headaches in the morning, and other general health variables. The outcome variable was undiagnosed hypertension, which was defined as participants with hypertension who had not received a hypertension diagnosis from a health professional and had never been prescribed medication for treating hypertension. The data were analyzed using logistic regression. Results A total of 3322 participants (56.2%) were found to have undiagnosed hypertension. The odds ratios (ORs) and 95% confidence intervals (CIs) of undiagnosed hypertension were significantly higher among those who completed primary school or lower (OR, 1.60; 95% CI, 1.29 to 1.98), had low monthly PCE (OR, 1.28; 95% CI, 1.13 to 1.43), did not report experiencing headaches in the morning (OR, 1.97; 95% CI, 1.76 to 2.21), and reported a general health status of healthy (OR, 2.05; 95% CI, 1.82 to 2.30) than those who had a higher education level, had high monthly PCE, experienced headaches in the morning, and were unhealthy. Conclusions Education level, monthly PCE, the experience of headaches in the morning, and general health status were associated with undiagnosed hypertension. The monitoring system for detecting undiagnosed hypertension cases must be strengthened. Health promotion is also necessary to reduce the prevalence of undiagnosed hypertension.
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Affiliation(s)
- Yeni Mahwati
- Sekolah Tinggi Ilmu Kesehatan Dharma Husada, Bandung, Indonesia
- Ministry of Research, Technology and Higher Education, Higher Education Service Institutions (LL-DIKTI) Region IV, Bandung, Indonesia
- Corresponding author: Yeni Mahwati Sekolah Tinggi Ilmu Kesehatan Dharma Husada, 77 Jalan Terusan Jakarta, Bandung 40291, Indonesia E-mail:
| | - Dieta Nurrika
- Ministry of Research, Technology and Higher Education, Higher Education Service Institutions (LL-DIKTI) Region IV, Bandung, Indonesia
- Banten School of Health Science, South Tangerang, Indonesia
| | - Kamaluddin Latief
- Center for Family Welfare, Faculty of Public Health, University of Indonesia, Depok, Indonesia
- Global Health & Health Security Department, College of Public Health, Taipei Medical University, Taipei, Taiwan
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Quantifying the Burden of Hyperphagia in Prader-Willi Syndrome Using Quality-Adjusted Life-years. Clin Ther 2021; 43:1164-1178.e4. [PMID: 34193348 DOI: 10.1016/j.clinthera.2021.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 05/14/2021] [Accepted: 05/21/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Prader-Willi syndrome (PWS) is a rare disease associated with cognitive impairment, hypotonia, hyperphagia (an insatiable hunger), and obesity. Therapies that target hyperphagia are in development, but understanding the value of these therapies to inform patient-focused drug development (PFDD) requires valid data on disease burden. We estimated disease burden by measuring and comparing quality-adjusted life-years (QALYs) for 3 PWS health states relevant to current PFDD initiatives. METHODS Time trade-off (TTO) and a visual analog scale (VAS) were used to elicit PWS caregivers' values for 3 fixed health states for a standardized patient described with (1) untreated PWS, (2) PWS with controlled obesity, and (3) PWS with controlled obesity and hyperphagia. We excluded participants who left at least 1 TTO or VAS question blank or incomplete (noncompleters) and respondents who reported the same answer for all TTO scenarios (nontraders). The remaining group of respondents (traders) were used for all primary analyses. We assessed validity and bias of QALY estimates by comparing differences in health state valuations, treatment priorities, and characteristics among respondents who did and did not complete the TTO. RESULTS A total of 458 respondents completed the survey, including 226 traders, 93 nontraders, and 139 noncompleters. Traders valued untreated PWS at 0.69 QALYs, PWS with controlled obesity at 0.79 QALYs, and controlled hyperphagia/obesity at 0.91 QALY (P < 0.01 for differences among health state values). Reported VAS ratings were similar for traders versus nontraders for untreated PWS (38.64 vs 38.95, P = 0.89) and PWS with controlled obesity (57.36 vs 55.14, P = 0.35) but varied for PWS with controlled obesity and hyperphagia (70.70 vs 64.46, P = 0.02). Exclusion of noncompleters did not introduce obvious bias because traders and noncompleters were similar in treatment priorities and characteristics. The exclusion of nontraders did not meaningfully alter mean or distribution of valuations. CONCLUSIONS This study found that avoiding hyperphagia decreases the burden of PWS and that these results are robust, even once imposing strict inclusion criteria. Use of fixed health states to estimate QALYs addresses many of the complexities of measuring disease burden in rare and pediatric conditions, indicating the potential value of this approach to inform premarket decision makers in identifying outcome importance. (Clin Ther. 2021;XX:XXX-XXX) © 2021 Elsevier HS Journals, Inc.
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Kebede SA, Liyew AM, Tesema GA, Agegnehu CD, Teshale AB, Alem AZ, Yeshaw Y. Spatial distribution and associated factors of health insurance coverage in Ethiopia: further analysis of Ethiopia demographic and health survey, 2016. ACTA ACUST UNITED AC 2020; 78:25. [PMID: 32190301 PMCID: PMC7076975 DOI: 10.1186/s13690-020-00407-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/09/2020] [Indexed: 11/10/2022]
Abstract
Background Health insurance is one of the instruments to achieve universal health coverage. However, in Ethiopia, the coverage of health insurance is very low and varies from place to place as well. Therefore, exploring the spatial distribution of health insurance is important to prioritize and design targeted intervention programs in the country. Methods A total of 16,583 reproductive age group women (15–49 years) were included in this study. The Bernoulli model was used by applying Kulldorff methods using the SaTScan software to analyse the purely spatial clusters of health insurance coverage. ArcGIS version 10.3 was used to visualize the distribution of health insurance coverage across the country. Mixed-effect logistic regression analysis was also used to identify predictors of health insurance coverage. Results Health insurance coverage among women aged 15–49 years had spatial variations across the country (Moran’s I: 0.115, p < 0.001). Health insurance coverage in Amhara (p < 0.001) and Tigray (p < 0.001) National Regional States clustered spatially. Reading newspapers at least once a week (Adjusted Odds Ratio (AOR) = 1.78, 95% CI: (1.18–2.68))), 40–44 years of age (AOR = 2.14, 95% CI: (1.37–3.35)), clerical working mothers (AOR = 4.33, 95% CI: (2.50–7.49)), mothers’ with secondary school education (AOR = 1.77; 95% CI: (1.21–2.58)), mothers’ with higher school education (AOR = 2.62; 95% CI: (1.63–4.23)), having more than 5 family members (AOR = 1.25; 95% CI: (1.01–1.55)) and richest wealth quantile (AOR = 3.43, 95% CI: (1.96–6.01)) were predictors of health insurance coverage among reproductive age group women in Ethiopia. Conclusion Health insurance coverage was very low in Ethiopia and had spatial variations across the country. The hot spot areas with low health insurance coverage need more coherent and harmonized action such as strengthening financial protection through national health packages, sharing experience from regions which have better health insurance coverage and using mass media to increase awareness and confidence of potentials in the systems, which may encourage them to enrol.
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Affiliation(s)
- Sewnet Adem Kebede
- 1Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemneh Mekuriaw Liyew
- 1Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getayeneh Antehunegn Tesema
- 1Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Chilot Desta Agegnehu
- 2School of Nursing, College of Medicine and Health Sciences and Comprehensive specialized hospital, University of Gondar, Gondar, Ethiopia
| | - Achamyeleh Birhanu Teshale
- 1Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adugnaw Zeleke Alem
- 1Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yigizie Yeshaw
- 3Department of Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Soekhai V, de Bekker-Grob EW, Ellis AR, Vass CM. Discrete Choice Experiments in Health Economics: Past, Present and Future. PHARMACOECONOMICS 2019; 37:201-226. [PMID: 30392040 PMCID: PMC6386055 DOI: 10.1007/s40273-018-0734-2] [Citation(s) in RCA: 375] [Impact Index Per Article: 75.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Discrete choice experiments (DCEs) are increasingly advocated as a way to quantify preferences for health. However, increasing support does not necessarily result in increasing quality. Although specific reviews have been conducted in certain contexts, there exists no recent description of the general state of the science of health-related DCEs. The aim of this paper was to update prior reviews (1990-2012), to identify all health-related DCEs and to provide a description of trends, current practice and future challenges. METHODS A systematic literature review was conducted to identify health-related empirical DCEs published between 2013 and 2017. The search strategy and data extraction replicated prior reviews to allow the reporting of trends, although additional extraction fields were incorporated. RESULTS Of the 7877 abstracts generated, 301 studies met the inclusion criteria and underwent data extraction. In general, the total number of DCEs per year continued to increase, with broader areas of application and increased geographic scope. Studies reported using more sophisticated designs (e.g. D-efficient) with associated software (e.g. Ngene). The trend towards using more sophisticated econometric models also continued. However, many studies presented sophisticated methods with insufficient detail. Qualitative research methods continued to be a popular approach for identifying attributes and levels. CONCLUSIONS The use of empirical DCEs in health economics continues to grow. However, inadequate reporting of methodological details inhibits quality assessment. This may reduce decision-makers' confidence in results and their ability to act on the findings. How and when to integrate health-related DCE outcomes into decision-making remains an important area for future research.
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Affiliation(s)
- Vikas Soekhai
- Section of Health Technology Assessment (HTA) and Erasmus Choice Modelling Centre (ECMC), Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam (EUR), P.O. Box 1738, Rotterdam, 3000 DR The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center, P.O. Box 2040, Rotterdam, 3000 CA The Netherlands
| | - Esther W. de Bekker-Grob
- Section of Health Technology Assessment (HTA) and Erasmus Choice Modelling Centre (ECMC), Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam (EUR), P.O. Box 1738, Rotterdam, 3000 DR The Netherlands
| | - Alan R. Ellis
- Department of Social Work, North Carolina State University, Raleigh, NC USA
| | - Caroline M. Vass
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
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Sydavong T, Goto D, Kawata K, Kaneko S, Ichihashi M. Potential demand for voluntary community-based health insurance improvement in rural Lao People's Democratic Republic: A randomized conjoint experiment. PLoS One 2019; 14:e0210355. [PMID: 30620771 PMCID: PMC6324784 DOI: 10.1371/journal.pone.0210355] [Citation(s) in RCA: 5] [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: 09/08/2018] [Accepted: 12/20/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION In Lao People's Democratic Republic (PDR), community-based health insurance (CBHI) is the only voluntary insurance scheme; it typically targets self-employed people, most of whom reside in rural areas and are dependent on agricultural activities for subsistence. However, until very recently, the enrollment rate has fallen short and failed to reach a large percentage of the target group. To promote the CBHI scheme and increase demand, some supporting components should be considered for inclusion together with the health infrastructure component. OBJECTIVES This paper provides empirical evidence that the benefit package components of hypothetical CBHI schemes have causal effects on enrollment probabilities. Furthermore, we examine the distribution of willingness to pay (WTP) in response to policy changes based on a sample of 5,800 observations. METHODS A randomized conjoint experiment is conducted in rural villages in Savannakhet Province, Lao PDR, to elicit stated preference data. Each respondent ranks three options-two hypothetical alternatives and the CBHI status quo scheme. The levels of seven attributes-insurance coverage for medical consultations, hospitalizations, traffic accidents, pharmaceuticals and transportation; premiums; and prepaid discounts-are randomly and simultaneously assigned to the two alternatives. RESULTS The findings suggest that the average WTP is at least as large as 10.9% of the per capita income of those who live in rural areas, which is higher than the WTP for health insurance averaged across low- and middle-income countries (LMICs) in the literature. The component of round-trip transportation insurance coverage has a significant effect on WTP distribution, particularly increasing the share of the highest bin. CONCLUSION Therefore, the low CBHI scheme enrollment rate in Lao PDR does not necessarily imply low demand among the targeted population, as the finding from the WTP analysis illustrates potential demand for the CBHI scheme. Specifically, if transportation is addressed, enrollment is likely to significantly increase.
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Affiliation(s)
- Thiptaiya Sydavong
- Graduate School for International Development and Cooperation, Hiroshima University, Higashi-hiroshima, Hiroshima, Japan
- Department of Planning and Investment, Savannakhet Provincial Government, Savannakhet, Lao People’s Democratic Republic
| | - Daisaku Goto
- Graduate School for International Development and Cooperation, Hiroshima University, Higashi-hiroshima, Hiroshima, Japan
| | - Keisuke Kawata
- Institute of Social Science, University of Tokyo, Tokyo, Japan
| | - Shinji Kaneko
- Graduate School for International Development and Cooperation, Hiroshima University, Higashi-hiroshima, Hiroshima, Japan
| | - Masaru Ichihashi
- Graduate School for International Development and Cooperation, Hiroshima University, Higashi-hiroshima, Hiroshima, Japan
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Ozawa S, Yemeke TT, Tawah AF, Kulkarni V, Villar Uribe M. Out-of-Pocket Household Expenditures on Medical Injections in Cambodia. PHARMACOECONOMICS - OPEN 2018; 2:415-421. [PMID: 29427148 PMCID: PMC6249188 DOI: 10.1007/s41669-018-0067-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Cambodia has one of the highest rates of overall medical injection usage worldwide. Therapeutic injections, which are often unnecessary, contribute to the spread of blood-borne diseases. OBJECTIVE This study describes injection practices and associated household expenditures in rural northwest Cambodia. METHODS We assessed care-seeking patterns of surveyed adult family members who sought healthcare in the previous 30 days, including location of care, medical injection use, and out-of-pocket household expenditures for treatment. A regression model was used to explore the impact of injection use on out-of-pocket household expenditures. RESULTS Among 480 households sampled, 298 included members who had been sick within the previous 30 days; a total of 342 episodes of care had been sought. Private providers accounted for over 66% (n = 226) of all episodes of care, with public and informal providers accounting for 20% (n = 69) and 14% (n = 47), respectively. Injections were administered in over 120 (35%) episodes of care, with 81% of injections administered by private providers. Patients who received injections incurred total out-of-pocket household expenditures that were, on average, 126,590 Cambodian Riel (KHR) (US$31.65) higher than those who did not receive injections (p < 0.01), equivalent to nearly half of the country's total annual health expenditure per capita. Receiving injections and perceived severity of illness were significantly associated with higher out-of-pocket household expenditures. CONCLUSION This study found high levels of medical injection use, particularly among private healthcare providers, which was significantly associated with high healthcare expenditures. Reducing the number of medical injections would not only reduce disease transmission risk but also contribute to reduced healthcare costs and greater financial protection.
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Affiliation(s)
- Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB#7574, Beard Hall 115H, Chapel Hill, NC, 27599, USA.
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Tatenda T Yemeke
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB#7574, Beard Hall 115H, Chapel Hill, NC, 27599, USA
| | - Alie F Tawah
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Carey Business School, Baltimore, MD, USA
| | - Vivek Kulkarni
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Manuela Villar Uribe
- Health Nutrition and Population Global Practice, World Bank Group, Washington, DC, USA
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Ozawa S, Villar-Uribe M, Evans DR, Kulkarni V, Ir P. Building informed trust: developing an educational tool for injection practices and health insurance in Cambodia. Health Policy Plan 2018; 33:1009-1017. [DOI: 10.1093/heapol/czy080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2018] [Indexed: 12/11/2022] Open
Affiliation(s)
- Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Manuela Villar-Uribe
- Health Nutrition and Population Global Practice, World Bank Group, Washington, DC, USA
| | | | - Vivek Kulkarni
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Por Ir
- National Institute of Public Health, Phnom Penh, Cambodia
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