1
|
Zhang W, Su M, Li D, Zhang T, Li W. Catastrophic health expenditure and its inequality in rural China: based on longitudinal data from 2013 to 2018. BMC Public Health 2023; 23:1861. [PMID: 37752487 PMCID: PMC10521565 DOI: 10.1186/s12889-023-16692-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 09/04/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Catastrophic health expenditure (CHE) is an important indicator of measuring health inequality. Previous studies mainly focused on specific vulnerable populations rather than a wider range of vulnerable areas through panel data. Rural China is often associated with an underdeveloped economy and insufficient health resources. This study aims to update the information on the extent of and trends in the incidence and inequality of CHE among the households of rural China through longitudinal survey data. METHODS Data were obtained from three waves of the China Health and Retirement Longitudinal Study (CHARLS): 2013, 2015, and 2018. In total, 2,575 households were included in the analysis. CHE was defined as household health expenditures exceeding 40% of non-food expenditures. Inequality in CHE was measured using the concentration curve and concentration index. The contribution to CHE inequality was decomposed using the concentration index decomposition method. RESULTS The incidence of CHE was 0.2341 (95% CI: 0.22, 0.25) in 2013, 0.2136 (95% CI: 0.20, 0.23) in 2015, and 0.2897 (95% CI: 0.27, 0.31) in 2018 in rural China. The concentration curve lay above the equality line, and the concentration index was negative: -0.1528 (95% CI: -0.1941, -0.1115) in 2013, -0.1010 (95% CI: -0.1442, -0. 0577) in 2015, and -0.0819 (95% CI: -0.1170, -0.0467) in 2018. Economic status, age, and chronic diseases were the main contributors to inequality in CHE. CONCLUSIONS The incidence of CHE in rural China displayed an upward trend from 2013 to 2018, although it was not continuous. Furthermore, a strong pro-low-economic inequality in CHE existed in rural China. Mainly economic status, age, and chronic diseases contributed to this pro-low-economic inequality. Health policies to allocate resources and services are needed to satisfy the needs of rural households and provide more accessible and affordable health services. More concern needs to be directed toward households with chronic diseases and older persons to reduce the incidence of CHE and promote health equality.
Collapse
Affiliation(s)
- Weile Zhang
- School of Public Administration, Inner Mongolia University, Zhaojun Road, Yuquan District, Hohhot, Inner Mongolia, 010070, China
| | - Min Su
- School of Public Administration, Inner Mongolia University, Zhaojun Road, Yuquan District, Hohhot, Inner Mongolia, 010070, China.
| | - Dongxu Li
- School of Public Administration, Inner Mongolia University, Zhaojun Road, Yuquan District, Hohhot, Inner Mongolia, 010070, China.
| | - Tianjiao Zhang
- School of Public Administration, Inner Mongolia University, Zhaojun Road, Yuquan District, Hohhot, Inner Mongolia, 010070, China
| | - Wenhui Li
- School of Public Administration, Inner Mongolia University, Zhaojun Road, Yuquan District, Hohhot, Inner Mongolia, 010070, China
| |
Collapse
|
2
|
Chen L, Xu X. Relationships between the Physical Activity Intensity and the Medical Expenditure of Middle-Aged and Elderly People: Parsing from the CHARLS Database. Behav Sci (Basel) 2023; 13:566. [PMID: 37504013 PMCID: PMC10376150 DOI: 10.3390/bs13070566] [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: 06/01/2023] [Revised: 06/24/2023] [Accepted: 07/03/2023] [Indexed: 07/29/2023] Open
Abstract
There are many studies on the impact of physical activity on health but few studies on the relationship between physical activity and medical expenditure among the elderly. Based on the China Health and Retirement Longitudinal Survey (CHARLS) database and selected 4456 valid samples, this paper used a two-part model to analyze the effects of high, moderate, and low physical activity intensity on medical expenditure. It is found that the intensity of physical activity was negatively correlated with medical expenditure, and the medical expenditure of the high physical activity intensity group was significantly lower than that of the low physical activity intensity group. For example, compared to people with no physical activity, the total medical expenditure decreased by 22.4%, 40.4%, and 62.5% per week in those with low, moderate, and high physical activity intensity. Thus, the government should provide more places for the elderly to exercise, planning special exercise areas for the elderly in community playgrounds, such as a dancing square, which will also help the elderly to increase their amount of exercise per week and develop a daily exercise habit.
Collapse
Affiliation(s)
- Linhong Chen
- School of Marxism, Chongqing Technology and Business University, Chongqing 400067, China
| | - Xiaocang Xu
- School of Economics and Management, Huzhou University, Huzhou 313000, China
| |
Collapse
|
3
|
Vu PH, Sepehri A, Tran LTT. Trends in out-of-pocket expenditure on facility-based delivery and financial protection of health insurance: findings from Vietnam's Household Living Standard Survey 2006-2018. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2023; 23:237-254. [PMID: 35419672 DOI: 10.1007/s10754-022-09330-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/22/2022] [Indexed: 05/05/2023]
Abstract
Much of the existing empirical literature on the association between health insurance and out-of-pocket (OOP) expenditures on facility-based delivery in low- and middle-income countries is cross sectional in nature. Comparatively little is known about the dynamic shifts in OOP expenditures and the health insurance nexus. Using seven biennial waves of Vietnam's Household Living Standard Survey covering the period 2006-2018 and a generalized linear model this study examines trends in OOP expenditures on facility-based delivery and financial protection afforded by Vietnam's social health insurance system. Over the period under consideration, the pattern of health facility utilization among the insured shifted steadily from commune health centers towards higher-level government hospitals. Real OOP for delivery was 52.7% higher in 2018 than in 2006-2008 and insurance reduced OOP expenditures by 28.5%. Compared to district hospitals, giving birth at higher-level government hospitals increased OOP expenditures by 72.3% while giving birth at commune health centers reduced OOP expenditures by 55.7%. Additional analysis involving interactions between insurance status, types of public health facility and year dummies suggested a drop in financial protection of insurance, from 48% to 26.9% among women delivering at district hospitals and from 31.2 to 18.7% among those delivering at higher-level government hospitals. The modest financial protection of health insurance and its declining trend calls for policy measures that would strengthen the quality of maternal care at primary care institutions, strengthen financial protection and curb the provision of two-tiered clinical services and charges.
Collapse
Affiliation(s)
- Phuong Hung Vu
- School of Banking & Finance, National Economics University, Hanoi, Vietnam
| | - Ardeshir Sepehri
- Department of Economics, University of Manitoba, Winnipeg, MB, R3T 5V5, Canada.
| | | |
Collapse
|
4
|
Gheinali Z, Moshiri E, Ebrahimi Tavani M, Haghi M, Gharibi F. Catastrophic health expenditures in hospitalized patients with delta variant of COVID-19: A cross-sectional study. Health Promot Perspect 2023; 13:68-76. [PMID: 37309437 PMCID: PMC10257567 DOI: 10.34172/hpp.2023.09] [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: 08/21/2022] [Accepted: 02/05/2023] [Indexed: 06/14/2023] Open
Abstract
Background: Financial protection of populations against healthcare costs is one of the fundamental responsibilities of governments. This study aimed to investigate the incidence of catastrophic health expenditures (CHE) and it's affecting factors in hospitalized patients with delta variant of COVID-19. Methods: In this cross-sectional study, we included 400 hospitalized COVID-19 patients at Kosar Hospital of Semnan in 2022, using a researcher-made checklist. Based on qualitative nature of the variables, chi-square test was used to investigate the statistical associations between the demographic/background characteristics and the incidence of CHE. Results: On average, COVID-19 imposed 1833.43 USD direct medical costs per one hospitalized patient. The ratio of direct-medical costs to household's non-food expenses was 2.35, and 61% (CI:±4.78%) of the patients were subject to CHE. Besides, residence place, basic insurance type, benefitting from supplementary insurance, suffering from underlying diseases, hospitalization in ICU, falling into a coma, facing pulmonary failure, and performing hemoperfusion had significant associations with CHE (P<0.05). Conclusion: The incidence of CHE in hospitalized COVID-19 patients was undesirable, which may be due to geographical, economical, and occupational inequalities apart from the factors related to the severity of the disease. So, health policymakers should pay attention to the provision of proper financial risk protection policies to make the health insurance system more efficient and appropriate.
Collapse
Affiliation(s)
- Zahra Gheinali
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Esmaeil Moshiri
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Masoumeh Ebrahimi Tavani
- Quality Improvement, Monitoring and Evaluation Department, Center of Health Network Management, Deputy of Public Health, Ministry of Health & Medical Education, Tehran, Iran
| | - Mehdi Haghi
- Social Determinants of Health Research Center, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Farid Gharibi
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| |
Collapse
|
5
|
de Siqueira Filha NT, Li J, Phillips-Howard PA, Quayyum Z, Kibuchi E, Mithu MIH, Vidyasagaran A, Sai V, Manzoor F, Karuga R, Awal A, Chumo I, Rao V, Mberu B, Smith J, Saidu S, Tolhurst R, Mazumdar S, Rosu L, Garimella S, Elsey H. The economics of healthcare access: a scoping review on the economic impact of healthcare access for vulnerable urban populations in low- and middle-income countries. Int J Equity Health 2022; 21:191. [PMID: 36585704 PMCID: PMC9805259 DOI: 10.1186/s12939-022-01804-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 12/08/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The growing urban population imposes additional challenges for health systems in low- and middle-income countries (LMICs). We explored the economic burden and inequities in healthcare utilisation across slum, non-slum and levels of wealth among urban residents in LMICs. METHODS This scoping review presents a narrative synthesis and descriptive analysis of studies conducted in urban areas of LMICs. We categorised studies as conducted only in slums, city-wide studies with measures of wealth and conducted in both slums and non-slums settlements. We estimated the mean costs of accessing healthcare, the incidence of catastrophic health expenditures (CHE) and the progressiveness and equity of health expenditures. The definitions of slums used in the studies were mapped against the 2018 UN-Habitat definition. We developed an evidence map to identify research gaps on the economics of healthcare access in LMICs. RESULTS We identified 64 studies for inclusion, the majority of which were from South-East Asia (59%) and classified as city-wide (58%). We found severe economic burden across health conditions, wealth quintiles and study types. Compared with city-wide studies, slum studies reported higher direct costs of accessing health care for acute conditions and lower costs for chronic and unspecified health conditions. Healthcare expenditures for chronic conditions were highest amongst the richest wealth quintiles for slum studies and more equally distributed across all wealth quintiles for city-wide studies. The incidence of CHE was similar across all wealth quintiles in slum studies and concentrated among the poorest residents in city-wide studies. None of the definitions of slums used covered all characteristics proposed by UN-Habitat. The evidence map showed that city-wide studies, studies conducted in India and studies on unspecified health conditions dominated the current evidence on the economics of healthcare access. Most of the evidence was classified as poor quality. CONCLUSIONS Our findings indicated that city-wide and slums residents have different expenditure patterns when accessing healthcare. Financial protection schemes must consider the complexity of healthcare provision in the urban context. Further research is needed to understand the causes of inequities in healthcare expenditure in rapidly expanding and evolving cities in LMICs.
Collapse
Affiliation(s)
| | - Jinshuo Li
- Department of Health Sciences, University of York, York, UK
| | | | - Zahidul Quayyum
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Eliud Kibuchi
- MRC/CSO Social &, University of Glasgow, Public Health Sciences Unit, Glasgow, UK
| | | | | | - Varun Sai
- The George Institute for Global Health, New Delhi, India
| | - Farzana Manzoor
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | - Abdul Awal
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Ivy Chumo
- African Population and Health Research Center, Nairobi, Kenya
| | - Vinodkumar Rao
- The Society for Promotion of Area Resource Centres, Mumbai, India
| | - Blessing Mberu
- African Population and Health Research Center, Nairobi, Kenya
| | - John Smith
- COMAHS: University of Sierra Leone, Freetown, Sierra Leone
| | - Samuel Saidu
- COMAHS: University of Sierra Leone, Freetown, Sierra Leone
| | - Rachel Tolhurst
- Liverpool School of Tropical Medicine, Department of International Public Health, Liverpool, UK
| | - Sumit Mazumdar
- University of York, Centre for Health Economics, York, UK
| | - Laura Rosu
- Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, UK
| | | | - Helen Elsey
- Department of Health Sciences, University of York, York, UK
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Rahman T, Gasbarro D, Alam K. Financial risk protection from out-of-pocket health spending in low- and middle-income countries: a scoping review of the literature. Health Res Policy Syst 2022; 20:83. [PMID: 35906591 PMCID: PMC9336110 DOI: 10.1186/s12961-022-00886-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/05/2022] [Indexed: 11/26/2022] Open
Abstract
Background Financial risk protection (FRP), defined as households’ access to needed healthcare services without experiencing undue financial hardship, is a critical health systems target, particularly in low- and middle-income countries (LMICs). Given the remarkable growth in FRP literature in recent times, we conducted a scoping review of the literature on FRP from out-of-pocket (OOP) health spending in LMICs. The objective was to review current knowledge, identify evidence gaps and propose future research directions. Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines to conduct this scoping review. We systematically searched PubMed, Scopus, ProQuest and Web of Science in July 2021 for literature published since 1 January 2015. We included empirical studies that used nationally representative data from household surveys to measure the incidence of at least one of the following indicators: catastrophic health expenditure (CHE), impoverishment, adoption of strategies to cope with OOP expenses, and forgone care for financial reasons. Our review covered 155 studies and analysed the geographical focus, data sources, methods and analytical rigour of the studies. We also examined the level of FRP by disease categories (all diseases, chronic illnesses, communicable diseases) and the effect of health insurance on FRP. Results The extant literature primarily focused on India and China as research settings. Notably, no FRP study was available on chronic illness in any low-income country (LIC) or on communicable diseases in an upper-middle-income country (UMIC). Only one study comprehensively measured FRP by examining all four indicators. Most studies assessed (lack of) FRP as CHE incidence alone (37.4%) or as CHE and impoverishment incidence (39.4%). However, the LMIC literature did not incorporate the recent methodological advances to measure CHE and impoverishment that address the limitations of conventional methods. There were also gaps in utilizing available panel data to determine the length of the lack of FRP (e.g. duration of poverty caused by OOP expenses). The current estimates of FRP varied substantially among the LMICs, with some of the poorest countries in the world experiencing similar or even lower rates of CHE and impoverishment compared with the UMICs. Also, health insurance in LMICs did not consistently offer a higher degree of FRP. Conclusion The literature to date is unable to provide a reliable representation of the actual level of protection enjoyed by the LMIC population because of the lack of comprehensive measurement of FRP indicators coupled with the use of dated methodologies. Future research in LMICs should address the shortcomings identified in this review. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-022-00886-3.
Collapse
Affiliation(s)
- Taslima Rahman
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia. .,Institute of Health Economics, University of Dhaka, Dhaka, 1000, Bangladesh.
| | - Dominic Gasbarro
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia
| | - Khurshid Alam
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia
| |
Collapse
|
8
|
Xu X, Wang Q, Li C. The Impact of Dependency Burden on Urban Household Health Expenditure and Its Regional Heterogeneity in China: Based on Quantile Regression Method. Front Public Health 2022; 10:876088. [PMID: 35602138 PMCID: PMC9116474 DOI: 10.3389/fpubh.2022.876088] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/05/2022] [Indexed: 11/28/2022] Open
Abstract
Background The aging population has led to a growing health expenditure burden. According to the National Bureau of Statistics of China, the old-age dependency ratio rose from 10.7% in 2003 to 17.8% in 2019, and health expenditure increased from 658.410 billion yuan in 2003 to 5812.191 billion yuan in 2019 in China. Methods This paper utilizes the quantile regression method to discuss the influencing factors of health expenditure in urban China based on the China Household Finance Survey (CHFS), especially dependency burden. Moreover, its regional heterogeneity is also compared. Results The old-age dependency ratio, age, family size, self-rated health status, and income significantly impact the health expenditure of urban families in the quantile regression of the national sample. Dependency burden and other variables on urban household health expenditure have great regional heterogeneity. The relationship between urban health expenditure and residential areas in western China is more stable than that in eastern and central China. Discussion Government should improve the healthcare system suitable for the older adult population as soon as possible. The government of western China should pay more attention to the introduction of professional medical talents and the configuration of precision medical equipment to improve the health system in western China.
Collapse
Affiliation(s)
- Xiaocang Xu
- School of Economics and Management, Huzhou University, Huzhou, China.,Research Center for Economy of Upper Reaches of the Yangtse River/School of Economics, Chongqing Technology and Business University, Chongqing, China
| | - Qingqing Wang
- Business School, Zhengzhou University, Zhengzhou, China
| | - Chang Li
- School of Economics and Management, Hebei University of Science and Technology, Shijiazhuang, China
| |
Collapse
|
9
|
Gheysvandi E, Mohammadi SZ, Amirkiyasar MN, Rad EH, Kouchakinejad-Eramsadati L, Mohtasham-Amiri Z. Measuring Catastrophic Costs in Families Facing Traumatic Brain Injury in Iran. Korean J Neurotrauma 2022; 19:53-62. [PMID: 37051037 PMCID: PMC10083442 DOI: 10.13004/kjnt.2022.18.e46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/04/2022] [Accepted: 08/15/2022] [Indexed: 11/11/2022] Open
Abstract
Objectives Traumatic brain injury (TBI) is preventable and expensive. The medical costs of TBI can be too high for some households and might lead to poverty, malnutrition, and loss of assets, which are called catastrophic expenditures. In this study, we investigated the incidence of catastrophic costs associated with TBI caused by road accidents in a province in northern Iran. Methods This prospective study involved a 1-year follow-up after the accident. Data of 220 patients were collected from the medical records of the Poursina Hospital, Rasht, Iran from March 2018 to February 2020. Direct and indirect costs faced by the households of patients with TBI and catastrophic costs related to TBI were calculated. Regression models were obtained and sensitivity analyses were performed at the end of the study. Results In total, the prevalence of households TBI-related catastrophic costs (TBICC) was 45.5% . Households of female patients (odds ratio [OR]: 0.289, p=0.042), households of retired patients (OR: 0.053, p=0.005), and households falling in the fifth quintile of wealth (OR: 0.370, p=0.050) faced lower TBICC compared to other groups. The Activities of Daily Living scores had a significant negative relationship with TBICC. Conclusions Political interventions such as implementation of insurance schemes, exemptions from payment for certain groups, identification of poor households, and coverage of assistance services can protect households from catastrophic health expenditures.
Collapse
Affiliation(s)
- Elham Gheysvandi
- School of Medical Sciences, Khomein University of Medical Sciences, Khomein, Iran
- Molecular and Medicine Research Center, Khomein University of Medical Sciences, Khomein, Iran
| | - Seyedeh Zahra Mohammadi
- Student Research Committee, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Enayatollah Homaie Rad
- Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Zahra Mohtasham-Amiri
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
10
|
Mowafi H, Rice B, Nambaziira R, Nirere G, Wongoda R, James M, Group GW, Bisanzo M, Post L. Household economic impact of road traffic injury versus routine emergencies in a low-income country. Injury 2021; 52:2657-2664. [PMID: 34210454 DOI: 10.1016/j.injury.2021.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/18/2021] [Accepted: 06/09/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Road traffic injuries (RTIs) are increasing and have disproportionate impact on residents of low- and middle-income countries (LMICs) where 90% of deaths occur. RTIs are a leading cause of death for those aged 15 - 29 years with costs estimated to be up to 3% of GDP. Despite this fact, little primary research has been done on the household economic impact of these events. METHODS From July to October 2016, 860 consecutive emergency department patients were enrolled and followed up at 6-8 weeks to assess the household financial impacts of these emergency presentations. At follow-up, patients were queried regarding health status, lost wages or schooling, household costs incurred due to their injury or illness, and assets sold. RESULTS 860 patients were enrolled and 675 patients (78%) completed follow-up surveys. Of those, 660 had a confirmed reason for visit - 303 (45%) road traffic injuries, 357 (53%) other emergency presentations (non-RTI) - encompassing medical presentations and other types of injury, and reason for visit was missing for 15 patients (2%). More than 90% of RTI patients were working or in school prior to their injury. In the economically productive ages (15-44 years) RTI predominated (70%) vs non-RTI (39%). RTI patients were more likely to report residual disability (78.2% RTI vs 68.1% non-RTI, p=0.004). All emergency patients reported difficulty paying for basic needs (food, housing and medical expenses). More than ⅓ of emergency patients reported having to sell assets in order to meet basic needs after their illness or injury. Despite similar hospital costs and fewer lost days of work for both patients and caregivers, the mean financial impact on households of RTI patients was 37% more than for non-RTI patients. These costs equalled between 6-16 weeks of income for patients based on their occupation type and median reported pre-hospitalization income. DISCUSSION Ugandan emergency care patients suffered significant personal and household economic hardship. In addition to the need for policy and infrastructural changes to improve road safety, these findings highlight the need for basic emergency care systems to secure economic gains in vulnerable households and prevent medical impoverishment of marginal communities.
Collapse
Affiliation(s)
- Hani Mowafi
- Yale University, 464 Congress Ave, Suite 260, New Haven, CT, 06519, USA.
| | - Brian Rice
- Stanford University, 900 Welch Rd, Suite 350, Palo Alto, CA, 94304, USA; Global Emergency Care Collaborative, PO Box 4404, Shrewsbury, MA 01545, USA
| | - Rashida Nambaziira
- Global Emergency Care Collaborative, PO Box 4404, Shrewsbury, MA 01545, USA
| | - Gloria Nirere
- Global Emergency Care Collaborative, PO Box 4404, Shrewsbury, MA 01545, USA
| | | | - Matthew James
- Yale University, 464 Congress Ave, Suite 260, New Haven, CT, 06519, USA
| | - Gecc Writing Group
- Global Emergency Care Collaborative, PO Box 4404, Shrewsbury, MA 01545, USA
| | - Mark Bisanzo
- Global Emergency Care Collaborative, PO Box 4404, Shrewsbury, MA 01545, USA; University of Vermont, 111 Colchester Avenue, Burlington, VT 05401, USA
| | - Lori Post
- Northwestern University, 211 E. Ontario St, Suite 200, Chicago, IL, 60611, USA
| |
Collapse
|