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Faraji M, Sharifi T, Mohammad-Pour S, Javan-Noughabi J, Aboutorabi A, Yousefi S, Jakovljevic M. Out-of-pocket pharmaceutical expenditure and its determinants among Iranian households with elderly members: a double-hurdle model. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:15. [PMID: 38373969 PMCID: PMC10877920 DOI: 10.1186/s12962-024-00521-8] [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: 05/27/2023] [Accepted: 01/30/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES The population of older adults continues to grow in Iran, with pharmaceutical costs as a leading driver of household health-related costs. The present study was conducted to estimate the out-of-pocket pharmaceutical expenditure and its socioeconomic predictors among households with the elderly in Iran. METHOD This study is a secondary analysis using 2019 national household expenditure and income survey data in Iran. The sample size was 9381 households with at least one member older than 65. The double-hurdle model in STATA 16 was used to examine the association between independent variables and households' out-of-pocket pharmaceutical expenditures. RESULTS The mean out-of-pocket pharmaceutical expenditures for each household with elderly member was $8065 per year. There was a positive association between the (female) gender of the household head, urban residence, employment status, insurance expenditure and a higher level of education of the head of the household with the out-of-pocket pharmaceutical expenditures (P < 0.05). The income of elderly households did not affect these expenditures (P > 0.05). CONCLUSIONS This study showed that the socioeconomic characteristics of elderly families not only influenced their decision to enter the medicine market, but also the rate of medicine purchase. It is helpful to manage and control the pharmaceutical costs among the elderly.
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Affiliation(s)
- Mehran Faraji
- Department of Health Economics, School of Management and Medical Information, Iran University of Medical Sciences, Tehran, Iran
| | - Tahereh Sharifi
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Saeed Mohammad-Pour
- Department of Health Economics, School of Management and Medical Information, Iran University of Medical Sciences, Tehran, Iran
| | - Javad Javan-Noughabi
- Department of Health Economics and Management Sciences, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Ali Aboutorabi
- Department of Health Economics, School of Management and Medical Information, Iran University of Medical Sciences, Tehran, Iran
| | - Shaghayegh Yousefi
- Kenneth Levene Graduate School of Business, Faculty of Graduate Studies and Research, University of Regina, Regina, SK, Canada
| | - Mihajlo Jakovljevic
- UNESCO-TWAS, Trieste, 34100, Italy
- Shaanxi University of Technology, Hanzhong, 723099, China
- Department of Global Health Economics and Policy, University of Kragujevac, 34000, Kragujevac, Serbia
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Liu Y, Zheng Z, Wang X, Xia J, Zhu X, Cheng F, Liu Z. Factors associated with the incidence and the expenditure of self-medication among middle-aged and older adults in China: A cross-sectional study. Front Public Health 2023; 11:1120101. [PMID: 37124784 PMCID: PMC10134663 DOI: 10.3389/fpubh.2023.1120101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/15/2023] [Indexed: 05/02/2023] Open
Abstract
Background With the accelerated ageing of population and the growing prevalence of various chronic diseases in China, self-medication plays an increasingly important role in complementing the health care system due to its convenience and economy. Objective This study aimed to investigate the incidence of self-medication and the amount of self-medication expenditure among middle-aged and older adults in China, and to explore factors associated with them. Methods A total of 10,841 respondents aged 45 years and older from the China Health and Retirement Longitudinal Study (CHARLS) wave 4 which conducted in 2018 were included as the sample of this study. The two-part model was adopted to identify the association between the incidence of self-medication and the amount of self-medication expenditure and specific factors, respectively. Results The incidence of self-medication among Chinese middle-aged and older adults was 62.30%, and the average total and out-of-pocket (OOP) pharmaceutical expenditure of self-medication of the self-medicated individuals were 290.50 and 264.38 Chinese yuan (CNY) respectively. Participants who took traditional Chinese medicine (TCM), self-reported fair, and poor health status, suffered from one and multiple chronic diseases had strongly higher incidence of self-medication. Older age and multiple chronic diseases were strongly associated with higher expenditure of self-medication. Those who took TCM had more self-medication expenditure, while those who drank alcohol had less. Conclusion Our study demonstrated the great prevalence of self-medication among middle-aged and older adults in China and the large pharmaceutical expenditure that come with it, especially in the high-risk groups of self-medication identified in this paper. These findings enhanced our understanding of self-medication behaviors among Chinese middle-aged and older adults and may contribute to the formulation of targeted public health policy.
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Affiliation(s)
- Yuxin Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zehao Zheng
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiubo Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiabei Xia
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xingce Zhu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fanjun Cheng
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiyong Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Zhiyong Liu,
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La DTV, Zhao Y, Arokiasamy P, Atun R, Mercer S, Marthias T, McPake B, Pati S, Palladino R, Lee JT. Multimorbidity and out-of-pocket expenditure for medicines in China and India. BMJ Glob Health 2022; 7:bmjgh-2021-007724. [DOI: 10.1136/bmjgh-2021-007724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 09/01/2022] [Indexed: 11/06/2022] Open
Abstract
IntroductionUsing nationally representative survey data from China and India, this study examined (1) the distribution and patterns of multimorbidity in relation to socioeconomic status and (2) association between multimorbidity and out-of-pocket expenditure (OOPE) for medicines by socioeconomic groups.MethodsSecondary data analysis of adult population aged 45 years and older from WHO Study on Global Ageing and Adult Health (SAGE) India 2015 (n=7397) and China Health and Retirement Longitudinal Study (CHARLS) 2015 (n=11 570). Log-linear, two-parts, zero-inflated and quantile regression models were performed to assess the association between multimorbidity and OOPE for medicines in both countries. Quantile regression was adopted to assess the observed relationship across OOPE distributions.ResultsBased on 14 (11 self-reported) and 9 (8 self-reported) long-term conditions in the CHARLS and SAGE datasets, respectively, the prevalence of multimorbidity in the adult population aged 45 and older was found to be 63.4% in China and 42.2% in India. Of those with any long-term health condition, 38.6% in China and 20.9% in India had complex multimorbidity. Multimorbidity was significantly associated with higher OOPE for medicines in both countries (p<0.05); an additional physical long-term condition was associated with a 18.8% increase in OOPE for medicine in China (p<0.05) and a 20.9% increase in India (p<0.05). Liver disease was associated with highest increase in OOPE for medicines in China (61.6%) and stroke in India (131.6%). Diabetes had the second largest increase (China: 58.4%, India: 91.6%) in OOPE for medicines in both countries.ConclusionMultimorbidity was associated with substantially higher OOPE for medicines in China and India compared with those without multimorbidity. Our findings provide supporting evidence of the need to improve financial protection for populations with an increased burden of chronic diseases in low-income and middle-income countries.
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Zhang Z, Ge P, Yan M, Niu Y, Liu D, Xiong P, Li Q, Zhang J, Yu W, Sun X, Liu Z, Wu Y. Self-Medication Behaviors of Chinese Residents and Consideration Related to Drug Prices and Medical Insurance Reimbursement When Self-Medicating: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13754. [PMID: 36360638 PMCID: PMC9656509 DOI: 10.3390/ijerph192113754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/16/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Self-medication has become a common phenomenon. Economic factors are important factors that affect the self-medication of residents. This study aimed to investigate the current status of self-medication behaviors in China and explored the related factors affecting considerations associated with medical insurance reimbursement or drug price in self-medication. METHODS A national cross-sectional investigation was conducted among Chinese people over 18 years old under a multi-stage sampling method through a questionnaire, which includes demographic sociological characteristics, self-medication behaviors and scales. The Chi-square test was used to analyze whether the respondents consider medical insurance reimbursement or drug price as an important factor when purchasing over-the-counter (OTC) drugs. Logistic regression was used to examine the associated factors of considering medical insurance reimbursement or drug price. RESULTS In total, 9256 respondents were included in this study; 37.52% of the respondents regarded drug prices as an important consideration, and 28.53% of the respondents attached great importance to medical insurance reimbursement. Elderly respondents who lived in the central region, had medical insurance, and had lower levels of health literacy were more likely to consider the medical insurance reimbursement, while respondents with high monthly family income as well as students were less likely to consider the same issue (p < 0.05). Respondents settled in the central and western regions, students, those without fixed occupations, those who suffered from chronic diseases, or those with lower health literacy were more likely to consider drug prices, while the respondents with bachelor degrees, urban population and high per capita monthly income were less likely to consider the drug prices (p < 0.05). CONCLUSION Self-medication behaviors with OTC drugs were prevalent in China, and consideration factors of medical insurance reimbursement or drug prices were related to socio-demographic characteristics and health literacy. There is a need to take measures to reduce the economic burden of self-medication, improve the health literacy of residents and strengthen public health education.
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Affiliation(s)
- Ziwei Zhang
- School of Public Health, Peking University, Beijing 100191, China
| | - Pu Ge
- Institute of Chinese Medical Sciences, University of Macau, Macao 999078, China
| | - Mengyao Yan
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100006, China
| | - Yuyao Niu
- Faculty of Arts and Humanities, University of Macau, Macao 999078, China
| | - Diyue Liu
- International School of Public Health and One Health, Hainan Medical University, Haikou 571199, China
| | - Ping Xiong
- Institute of Chinese Medical Sciences, University of Macau, Macao 999078, China
| | - Qiyu Li
- School of Humanities and Management, Jinzhou Medical University, Jinzhou 121001, China
| | - Jinzi Zhang
- School of Humanities and Social Sciences, Harbin Medical University, Harbin 150076, China
| | - Wenli Yu
- School of Foreign Languages, Weifang University of Science and Technology, Weifang 262700, China
| | - Xinying Sun
- School of Public Health, Peking University, Beijing 100191, China
| | - Zhizhong Liu
- School of Finance and Trade, Liaoning University, Shenyang 110036, China
| | - Yibo Wu
- School of Public Health, Peking University, Beijing 100191, China
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Gender Differentials in Out of Pocket Health Expenditure Among Older Adults in India: Evidence from National Sample Survey 2014 and 2018. AGEING INTERNATIONAL 2021. [DOI: 10.1007/s12126-021-09451-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kočiš Krůtilová V. The out-of-pocket medication burden: Which health problems impact the Czech population aged 50+? Int J Health Plann Manage 2021; 36:2129-2144. [PMID: 34240456 DOI: 10.1002/hpm.3281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 10/30/2020] [Accepted: 07/01/2021] [Indexed: 11/06/2022] Open
Abstract
Adults 50-years-old and greater form the group most vulnerable to a high burden from payments for medication. These Czech older adults devote around 60% of out-of-pocket payments for medication, which might influence their consumption patterns and access to health care. This paper extends the empirical evidence of the out-of-pocket burden and catastrophic payments by addressing the consumption of medication among the Czech population aged 50 and higher. Data from the Survey of Health, Ageing and Retirement in Europe, wave 6, is used. A generalised linear model is applied for estimating the out-of-pocket medication burden; a binary logistic regression is used for the investigation of catastrophic medication expenditure. The results showed that medications for pain, joint pain/joint inflammation, anxiety and depression, heart diseases and high blood pressure are robust predictors for the medication burden and risk factors for catastrophic payments. Special attention should also be paid to medications for suppressing inflammation and sleep problems. Despite universal coverage in the Czech Republic, taking medications for specific health problems, especially those related to the nervous system, influences the well-being of older individuals. Policy makers should revise the prescription practice and related reimbursement policies and reconsider current protection from the high medication burden.
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The Contribution of Material, Behavioral, Psychological, and Social-Relational Factors to Income-Related Disparities in Cardiovascular Risk Among Older Adults. J Cardiovasc Nurs 2021; 36:E38-E50. [PMID: 36036986 PMCID: PMC8201797 DOI: 10.1097/jcn.0000000000000808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental digital content is available in the text. Understanding the factors underlying health disparities is vital to developing strategies to improve health equity in old age. Such efforts should be encouraged in Korea.
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Change in Denture Procedures after Implementation of National Health Insurance Coverage for the Elderly in Korea: A Nationwide Database. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052283. [PMID: 33669019 PMCID: PMC7967673 DOI: 10.3390/ijerph18052283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/19/2021] [Accepted: 02/19/2021] [Indexed: 12/03/2022]
Abstract
Background: Dental health is an important factor in daily life routines and is closely associated with maintaining a health-related quality of life. This study examined denture procedure changes after implementation of the National Health Insurance (NHI) Coverage of Dentures for the elderly. Methods: We used the “Korean Community Health Survey (KCHS)” developed by the Korea Centers for Diseases Control and Prevention. We analyzed the association between policy implementation and dental health-related outcomes using difference-in-differences (DID) analysis to compare patients aged ≥75 with those 65–74 years before and after coverage. Results: A comparison of age groups and coverage periods showed that patients aged ≥75 years had higher (OR: 1.038, 95% CI: 1.021–1.055) procedure rates after coverage. In particular, elderly patients on medical aid had significantly higher denture procedure rates, while those without oral health screening were more likely to have denture procedures. Conclusions: This study determined the impact of the NHI Coverage of Denture procedure policy for the elderly and found increased denture treatments in the elderly. This policy appeared to positively affect older patients by increasing denture procedures for low-income and medical aid beneficiaries. Hence, the government needs to increase oral health examination and dental health policies for the elderly.
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Plácido AI, Herdeiro MT, Simões JL, Amaral O, Figueiras A, Roque F. Health professionals perception and beliefs about drug- related problems on polymedicated older adults- a focus group study. BMC Geriatr 2021; 21:27. [PMID: 33413137 PMCID: PMC7792196 DOI: 10.1186/s12877-020-01972-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Polymedicated older patients are at greater risk of suffering from adverse events. For this reason, the detection of both inappropriate polypharmacy and polypharmacy-associated Drug-Related Problems (DRPs) are essential to improve the health and wellbeing of older adults and to reduce healthcare costs. This work aims to explore health professionals' perceptions and opinions about polypharmacy and the handling of medicines by polymedicated older adults. METHODS Thirteen focus groups with 94 health professionals (20 community pharmacists, 40 general practitioners and, 34 nurses) were conducted in primary healthcare centers of the center region of Portugal. Participants were asked to discuss their perceptions and beliefs concerning DRPs in polymedicated older adults. The sessions were audiotaped. After the transcription and coding of focus group sessions, a thematic analysis was done. RESULTS The following four main themes emerged from the 13 focus group sessions: poor compliance and polypharmacy- A perpetuated vicious cycle, organization of the healthcare system, interaction and communication between the health professionals, and strategies to prevent inappropriate polypharmacy. CONCLUSIONS The lack of both an efficient network of information and Interaction and communication between Health professionals makes the detection and/ or prevention of polypharmacy in older adults difficult. The implementation of new models to manage and/or prevent polypharmacy based on health professional perception and beliefs is essential to prevent DRPs and improve compliance among older adults.
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Affiliation(s)
- Ana Isabel Plácido
- Research Unit for Inland Development, Polytechnic of Guarda (UDI-IPG), Avenida Dr. Francisco Sá Carneiro, n. ° 50, 6300-559, Guarda, Portugal
| | - Maria Teresa Herdeiro
- Institute of Biomedicine (iBiMED) and Department of Medical Sciences, University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal
| | - João Lindo Simões
- Institute of Biomedicine (iBiMED) and School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal
| | - Odete Amaral
- Health Sciences School, Polytechnic of Viseu, R. D. João Crisostomo Gomes de Almeida, n.° 102, 3500-843, Viseu, Portugal
| | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Santiago de Compostela, Spain.,Institute of Health Research of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Fátima Roque
- Research Unit for Inland Development, Polytechnic of Guarda (UDI-IPG), Avenida Dr. Francisco Sá Carneiro, n. ° 50, 6300-559, Guarda, Portugal. .,Health Sciences Research Centre, University of Beira Interior (CICS-UBI), Av. Infante D. Henrique, 6200-506, Covilhã, Portugal. .,Escola Superior de Saúde, Instituto Politécnico da Guarda Rua da Cadeia, 6300-035, Guarda, Portugal.
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Park E, Choi S. Who Benefits from the Fixed Copayment of Medical and Pharmaceutical Expenditure among the Korean Elderly? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218118. [PMID: 33153173 PMCID: PMC7663709 DOI: 10.3390/ijerph17218118] [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: 09/14/2020] [Revised: 10/26/2020] [Accepted: 11/01/2020] [Indexed: 06/11/2023]
Abstract
The Korean National Health Insurance system imposes a 30% coinsurance for outpatient medical care and prescription drugs; however, at the age of 65, the coinsurance model changes to a copayment model that offers lower fees for the elderly. Thus, this study aimed to investigate the influence of the copayment model for outpatient visits and prescription drugs on healthcare utilization among the Korean elderly. We compared total outpatient visits, total prescriptions, and out-of-pocket expenses between a case group with copayment reduction (65 years or older) and a control group without any reduction (64 years or younger). We obtained secondary data collected from seven waves of the Korea Health Panel Survey (2010-2016). Outpatient visits increased exclusively in the case group among those with lower income. After adjusting for covariates, the results of the difference-in-differences analysis showed that, compared to the control group, there was a significant increase in outpatient visits among individuals with lower income in the case group. Our study shows that cost sharing changes affect Korean patients with different income levels in different ways.
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Affiliation(s)
- Eunja Park
- Korea Institute for Health and Social Affairs, Sejong 30147, Korea;
| | - Sookja Choi
- Red Cross College of Nursing, Chung-Ang University, Seoul 06974, Korea
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National trends in metformin-based combination therapy of oral hypoglycaemic agents for type 2 diabetes mellitus. Eur J Clin Pharmacol 2019; 75:1723-1730. [DOI: 10.1007/s00228-019-02751-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 08/23/2019] [Indexed: 12/20/2022]
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12
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Du J, Yang X, Chen M, Wang Z. Socioeconomic determinants of out-of-pocket pharmaceutical expenditure among middle-aged and elderly adults based on the China Health and Retirement Longitudinal Survey. BMJ Open 2019; 9:e024936. [PMID: 31371285 PMCID: PMC6678031 DOI: 10.1136/bmjopen-2018-024936] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Out-of-pocket pharmaceutical expenditure (OOPPE) is a considerable burden for middle-aged and elderly adults due to their high prevalence of diseases, insufficient income and absence of medical insurance in China. The objective of this study was to assess the determinants of OOPPE among Chinese middle-aged and elderly adults. METHODS This is a cross-sectional study based on the China Health and Retirement Longitudinal Survey conducted in 2015. The Andersen behavioural health model was used to select the factors. Binary multivariable logistic and generalised linear regressions were both applied to examine the determinants of OOPPE. RESULTS Of the respondents, 15.28%, 5.20% and 51.35% reported an OOPPE for outpatient services, inpatient services and self-medication, respectively. The OOPPE for outpatient services, inpatient services and self-medication was US$6.66, US$17.93 and US$15.32, respectively. Increased age significantly influenced the likelihood of OOPPE, and older people (aged >65 years) had lower OOPPE for outpatient services. Having health insurance significantly reduced the likelihood of OOPPE for outpatient and inpatient services but increased OOPPE for self-medication. In general, compared with the low-income group, higher income groups had a significantly lower likelihood of having an OOPPE, and when they did the amounts were less. Generally, middle-aged and elderly people with poor self-reported health status, limitation of daily activities, and critical or chronic diseases had a significantly higher likelihood of having an OOPPE and at a significantly higher amount. CONCLUSION Policy-making efforts should focus on reducing self-medication OOPPE and alleviating its associated socioeconomic determinants to ease the economic burden of diseases among middle-aged and elderly adults in China.
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Affiliation(s)
- Jinglin Du
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Xue Yang
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Mingsheng Chen
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
- Creative Health Policy Research Group, Nanjing Medical University, Nanjing, China
| | - Zhonghua Wang
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
- Creative Health Policy Research Group, Nanjing Medical University, Nanjing, China
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13
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Sum G, Hone T, Atun R, Millett C, Suhrcke M, Mahal A, Koh GCH, Lee JT. Multimorbidity and out-of-pocket expenditure on medicines: a systematic review. BMJ Glob Health 2018; 3:e000505. [PMID: 29564155 PMCID: PMC5859814 DOI: 10.1136/bmjgh-2017-000505] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/21/2017] [Accepted: 11/29/2017] [Indexed: 01/11/2023] Open
Abstract
Background Multimorbidity, the presence of two or more non-communicable diseases (NCD), is a costly and complex challenge for health systems globally. Patients with NCDs incur high levels of out-of-pocket expenditure (OOPE), often on medicines, but the literature on the association between OOPE on medicines and multimorbidity has not been examined systematically. Methods A systematic review was conducted via searching medical and economics databases including Ovid Medline, EMBASE, EconLit, Cochrane Library and the WHO Global Health Library from year 2000 to 2016. Study quality was assessed using Newcastle-Ottawa Scale. PROSPERO: CRD42016053538. Findings 14 articles met inclusion criteria. Findings indicated that multimorbidity was associated with higher OOPE on medicines. When number of NCDs increased from 0 to 1, 2 and ≥3, annual OOPE on medicines increased by an average of 2.7 times, 5.2 times and 10.1 times, respectively. When number of NCDs increased from 0 to 1, 2, ≥2 and ≥3, individuals spent a median of 0.36% (IQR 0.15%–0.51%), 1.15% (IQR 0.62%–1.64%), 1.41% (IQR 0.86%–2.15%), 2.42% (IQR 2.05%–2.64%) and 2.63% (IQR 1.56%–4.13%) of mean annual household net adjusted disposable income per capita, respectively, on annual OOPE on medicines. More multimorbidities were associated with higher OOPE on medicines as a proportion of total healthcare expenditures by patients. Some evidence suggested that the elderly and low-income groups were most vulnerable to higher OOPE on medicines. With the same number of NCDs, certain combinations of NCDs yielded higher medicine OOPE. Non-adherence to medicines was a coping strategy for OOPE on medicines. Conclusion Multimorbidity of NCDs is increasingly costly to healthcare systems and OOPE on medicines can severely compromise financial protection and universal health coverage. It is crucial to recognise the need for better equity and financial protection, and policymakers should consider health system financial options, cost sharing policies and service patterns for those with NCD multimorbidities.
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Affiliation(s)
- Grace Sum
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Thomas Hone
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Rifat Atun
- Harvard T.H Chan, School of Public Health, and Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Marc Suhrcke
- Centre for Health Economics, University of York, England, UK.,Luxembourg Institute for Socio-economic Research, Luxembourg, Europe
| | - Ajay Mahal
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | - John Tayu Lee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK.,Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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