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Jadidfard MP, Zafarmand AH, Shafiei S. Association Between Dental Expenditure and Socioeconomic Status in Iran. Int Dent J 2024:S0020-6539(24)00132-1. [PMID: 38851932 DOI: 10.1016/j.identj.2024.04.027] [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: 12/19/2023] [Revised: 04/21/2024] [Accepted: 04/27/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Health care spending by households can be a great indicator of a society's commitment to good health stewardship and the efficiency of institutions responsible for managing health costs. Equitable and appropriate distribution of dental services is a challenging issue for realising universal health coverage. This study aimed to evaluate Iranian households' per capita dental expenditure (DE) according to their socioeconomic status (SES). METHODS In this cross-sectional study, the income and expenditure of 18,701 urban and 19,261 rural households in Iran were scrutinised according to the data provided by the Statistics Center of Iran (2017-2018). After model creation, the SES index was determined using principal component analysis and weighting based on the analytical hierarchy process. The dependent variable was the share of per capita household's expenditure spent on dental health. The zero-inflated gamma regression model was applied to confirm the presumed association between per capita DE and SES. Analyses were performed using PROC NLMIXED in SAS software (version 4.9). RESULTS The results revealed that approximately 9% of urban and 4% of rural households paid for dental treatments in the past month. The DE to total health expenditure (HE) ratios were 8.5% and 14.8% for rural and urban households, respectively. Also, with each level increase in SES, the average per capita DE increased by 23% and 16% in rural and urban households, respectively. CONCLUSIONS The study confirms association between per capita DE and SES in Iran. This implies targeted strategies to facilitate the utilisation of dental care especially for lower SES groups according to their needs.
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Affiliation(s)
- Mohammad-Pooyan Jadidfard
- Department of Community Oral Health, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A Hamid Zafarmand
- Department of Community Oral Health, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sediqe Shafiei
- Department of Community Oral Health, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Hone T, Gonçalves J, Seferidi P, Moreno-Serra R, Rocha R, Gupta I, Bhardwaj V, Hidayat T, Cai C, Suhrcke M, Millett C. Progress towards universal health coverage and inequalities in infant mortality: an analysis of 4·1 million births from 60 low-income and middle-income countries between 2000 and 2019. Lancet Glob Health 2024; 12:e744-e755. [PMID: 38614628 DOI: 10.1016/s2214-109x(24)00040-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/14/2024] [Accepted: 01/19/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Expanding universal health coverage (UHC) might not be inherently beneficial to poorer populations without the explicit targeting and prioritising of low-income populations. This study examines whether the expansion of UHC between 2000 and 2019 is associated with reduced socioeconomic inequalities in infant mortality in low-income and middle-income countries (LMICs). METHODS We did a retrospective analysis of birth data compiled from Demographic and Health Surveys (DHSs). We analysed all births between 2000 and 2019 from all DHSs available for this period. The primary outcome was infant mortality, defined as death within 1 year of birth. Logistic regression models with country and year fixed effects assessed associations between country-level progress to UHC (using WHO's UHC service coverage index) and infant mortality (overall and by wealth quintile), adjusting for infant-level, mother-level, and country-level variables. FINDINGS A total of 4 065 868 births to 1 833 011 mothers were analysed from 177 DHSs covering 60 LMICs between 2000 and 2019. A one unit increase in the UHC index was associated with a 1·2% reduction in the risk of infant death (AOR 0·988, 95% CI 0·981-0·995; absolute measure of association, 0·57 deaths per 1000 livebirths). An estimated 15·5 million infant deaths were averted between 2000 and 2019 because of increases in UHC. However, richer wealth quintiles had larger associated reductions in infant mortality from UHC (quintile 5 AOR 0·983, 95% CI 0·973-0·993) than poorer quintiles (quintile 1 0·991, 0·985-0·998). In the early stages of UHC, UHC expansion was generally beneficial to poorer populations (ie, larger reductions in infant mortality for poorer households [infant deaths per 1000 per one unit increase in UHC coverage: quintile 1 0·84 vs quintile 5 0·59]), but became less so as overall coverage increased (quintile 1 0·64 vs quintile 5 0·57). INTERPRETATION Since UHC expansion in LMICs appears to become less beneficial to poorer populations as coverage increases, UHC policies should be explicitly designed to ensure lower income groups continue to benefit as coverage expands. FUNDING UK National Institute for Health and Care Research.
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Affiliation(s)
- Thomas Hone
- Public Health Policy Evaluation Unit, Imperial College London, London, UK; Instituto de Estudos para Políticas de Saúde, São Paulo, Brazil.
| | - Judite Gonçalves
- Public Health Policy Evaluation Unit, Imperial College London, London, UK; NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal
| | - Paraskevi Seferidi
- Public Health Policy Evaluation Unit, Imperial College London, London, UK
| | | | - Rudi Rocha
- Instituto de Estudos para Políticas de Saúde, São Paulo, Brazil; São Paulo School of Business Administration, Fundação Getulio Vargas, São Paulo, Brazil
| | - Indrani Gupta
- Institute of Economic Growth, University of Delhi, Delhi, India
| | - Vinayak Bhardwaj
- South African Medical Research Council and Wits Centre for Health Economics and Decision Science, PRICELESS South Africa, Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Taufik Hidayat
- Center for Health Economics and Policy Studies, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia; Department of Economics, University of Sussex, Brighton, UK
| | - Chang Cai
- Public Health Policy Evaluation Unit, Imperial College London, London, UK
| | - Marc Suhrcke
- Centre for Health Economics, University of York, Heslington, York, UK; Luxembourg Institute of Socio-economic Research, Esch-sur-Alzette, Luxembourg
| | - Christopher Millett
- Public Health Policy Evaluation Unit, Imperial College London, London, UK; NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal
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Hasan MZ, Rabbani MG, Akter O, Mehdi GG, Ahmed MW, Ahmed S, Chowdhury ME. Patient Satisfaction With the Health Care Services of a Government-Financed Health Protection Scheme in Bangladesh: Cross-Sectional Study. JMIR Form Res 2024; 8:e49815. [PMID: 38656783 PMCID: PMC11079759 DOI: 10.2196/49815] [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: 06/10/2023] [Revised: 10/07/2023] [Accepted: 11/22/2023] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Since 2016, the government of Bangladesh has been piloting a health protection scheme known as Shasthyo Surokhsha Karmasuchi (SSK), which specifically targets households living below the poverty line. This noncontributory scheme provides enrolled households access to inpatient health care services for 78 disease groups. Understanding patients' experiences with health care utilization from the pilot SSK scheme is important for enhancing the quality of health care service delivery during the national-level scale-up of the scheme. OBJECTIVE We aimed to evaluate patient satisfaction with the health care services provided under the pilot health protection scheme in Bangladesh. METHODS A cross-sectional survey was conducted with the users of the SSK scheme from August to November 2019. Patients who had spent a minimum of 2 nights at health care facilities were selected for face-to-face exit interviews. During these interviews, we collected information on patients' socioeconomic characteristics, care-seeking experiences, and level of satisfaction with various aspects of health care service delivery. To measure satisfaction, we employed a 5-point Likert scale (very satisfied, 5; satisfied, 4; neither satisfied nor dissatisfied, 3; dissatisfied, 2; very dissatisfied, 1). Descriptive statistics, statistical inferential tests (t-test and 1-way ANOVA), and linear regression analyses were performed. RESULTS We found that 55.1% (241/438) of users were either very satisfied or satisfied with the health care services of the SSK scheme. The most satisfactory indicators were related to privacy maintained during diagnostic tests (mean 3.91, SD 0.64), physicians' behaviors (mean 3.86, SD 0.77), services provided at the registration booth (mean 3.86, SD 0.62), confidentiality maintained regarding diseases (mean 3.78, SD 0.72), and nurses' behaviors (mean 3.60, SD 0.83). Poor satisfaction was identified in the interaction of patients with providers about illness-related information (mean 2.14, SD 1.40), availability of drinking water (mean 1.46, SD 0.76), cleanliness of toilets (mean 2.85, SD 1.04), and cleanliness of the waiting room (mean 2.92, SD 1.09). Patient satisfaction significantly decreased by 0.20 points for registration times of 16-30 minutes and by 0.32 points for registration times of >30 minutes compared with registration times of ≤15 minutes. Similarly, patient satisfaction significantly decreased with an increase in the waiting time to obtain services. However, the satisfaction of users significantly increased if they received a complete course of medicines and all prescribed diagnostic services. CONCLUSIONS More than half of the users were satisfied with the services provided under the SSK scheme. However, there is scope for improving user satisfaction. To improve the satisfaction level, the SSK scheme implementation authorities should pay attention to reducing the registration time and waiting time to obtain services and improving the availability of drugs and prescribed diagnostic services. The authorities should also ensure the supply of drinking water and enhance the cleanliness of the facility.
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Affiliation(s)
- Md Zahid Hasan
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Md Golam Rabbani
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Orin Akter
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Gazi Golam Mehdi
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | | | - Sayem Ahmed
- Health Economics and Health Technology Assessment, School of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Thomas AR, Muhammad T, Sahu SK, Dash U. Examining the factors contributing to a reduction in hardship financing among inpatient households in India. Sci Rep 2024; 14:7164. [PMID: 38532118 DOI: 10.1038/s41598-024-57984-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 03/24/2024] [Indexed: 03/28/2024] Open
Abstract
In India, the rising double burden of diseases and the low fiscal capacity of the government forces people to resort to hardship financing. This study aimed to examine the factors contributing to the reduction in hardship financing among inpatient households in India. The study relies on two rounds of National Sample Surveys with a sample of 34,478 households from the 71st round (2014) and 56,681 households from the 75th round (2018). We employed multivariable logistic regression and multivariate decomposition analyses to explore the factors associated with hardship financing in Indian households with hospitalized member(s) and assess the contributing factors to the reduction in hardship financing between 2014 and 2018. Notably, though hardship financing for inpatient households has decreased between 2014 and 2018, households with catastrophic health expenditure (CHE) had higher odds of hardship financing than those without CHE. While factors such as CHE, prolonged hospitalization, and private hospitals had impoverishing effects on hardship financing in 2014 and 2018, the decomposition model showed the potential of CHE (32%), length of hospitalization (32%), and private hospitals (24%) to slow down this negative impact over time. The findings showed the potential for further improvements in financial health protection for inpatient care over time, and underscore the need for continuing efforts to strengthen the implementation of public programs and schemes in India such as Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY).
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Affiliation(s)
- Arya Rachel Thomas
- Department of Humanities and Social Sciences, Indian Institute of Technology (IIT), Madras, Chennai, Tamil Nadu, 600036, India.
| | - T Muhammad
- Department of Family and Generations, International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
| | - Santosh Kumar Sahu
- Department of Humanities and Social Sciences, Indian Institute of Technology (IIT), Madras, Chennai, Tamil Nadu, 600036, India
| | - Umakant Dash
- Institute of Rural Management Anand (IRMA), Near NDDB, PO Box-60, Anand, Gujarat, 388001, India
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Naz L, Sriram S. Out-of-pocket expenditures associated with double disease burden in Pakistan: a quantile regression analysis. BMC Public Health 2024; 24:801. [PMID: 38486277 PMCID: PMC10938732 DOI: 10.1186/s12889-024-18320-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 03/10/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Pakistan is currently experiencing a double burden of disease. Families with members having both communicable and noncommunicable diseases are at a greater risk of impoverishment due to enormous out-of-pocket payments. This study examines the percentile distribution of the determinants of the out-of-pocket expenditure on the double disease burden. METHOD The study extracted a sample of 6,775 households with at least one member experiencing both communicable and noncommunicable diseases from the Household Integrated Economic Survey 2018-19. The dataset is cross-sectional and nationally representative. Quantile regression was used to analyze the association of various socioeconomic factors with the OOP expenditure associated with double disease burden. RESULTS Overall, 28.5% of households had double disease in 2018-19. The households with uneducated heads, male heads, outpatient healthcare, patients availing public sector healthcare services, and rural and older members showed a significant association with the prevalence of double disease. The out-of-pocket expenditure was higher for depression, liver and kidney disease, hepatitis, and pneumonia in the upper percentiles. The quantile regression results showed that an increased number of communicable and noncommunicable diseases was associated with higher monthly OOP expenditure in the lower percentiles (10th percentile, coefficient 312, 95% CI: 92-532), and OOP expenditure was less pronounced among the higher percentiles (75th percentile, coefficient 155, 95% CI: 30-270). The households with older members were associated with higher OOP expenditure at higher tails (50th and 75th percentiles) compared to lower (10th and 25th percentiles). Family size was associated with higher OOPE at lower percentiles than higher ones. CONCLUSION The coexistence of communicable and noncommunicable diseases is associated with excessive private healthcare costs in Pakistan. The results call for addressing the variations in financial costs associated with double diseases.
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Affiliation(s)
- Lubna Naz
- Department of Economics, School of Economics and Social Sciences, Institute of Business Administration, 75270, Karachi, Pakistan
| | - Shyamkumar Sriram
- Department of Social and Public Health, Ohio University, 45701, Athens, OH, USA.
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Bunkley EN, Asante C, Burack S, Kaufman L, Miti S, Hunleth J. A Heart for the Care: Affect, Kin, and Care Work in a Zambian Hospital. Med Anthropol Q 2024; 38:54-66. [PMID: 38112051 PMCID: PMC10922508 DOI: 10.1111/maq.12837] [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: 01/19/2023] [Accepted: 10/21/2023] [Indexed: 12/20/2023]
Abstract
At the only standalone pediatric hospital in Zambia, patient wellbeing often rests in the hands of bedsiders. Bedsiders are caregivers, often family, who sit at the patient's bedside, feeding, cleaning them, and running medical errands. Bedsiders are critical human infrastructure for the hospital and its staff. In our research, we heard repeatedly that bedsiders must have a "heart" for caregiving, taking on unremunerated and exhausting informal labor. We draw on Wendland's "heart for the work," a phrase commonly used among healthcare workers in Malawi and Zambia describing the medical profession, to explore what this metaphor reveals about care.
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Affiliation(s)
- Emma Nelson Bunkley
- Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, Colorado, USA
| | - Comfort Asante
- Ndola Teaching Hospital, Ndola, Zambia
- Tropical Diseases Research Centre, Ndola, Zambia
| | - Sarah Burack
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Lindsey Kaufman
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Sam Miti
- Department of Pediatrics and Child Health, Arthur Davison Children's Hospital, Ndola, Zambia
- Tropical Diseases Research Centre, Ndola, Zambia
| | - Jean Hunleth
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, USA
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Savova A, Manova M, Tachkov K, Petrova G. The role of insurance policies in the drug pricing landscape. Expert Rev Pharmacoecon Outcomes Res 2024; 24:189-202. [PMID: 38064353 DOI: 10.1080/14737167.2023.2292693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/05/2023] [Indexed: 01/27/2024]
Abstract
INTRODUCTION This overview paper aims at summarizing and analyzing the available literature on healthcare system organization and pricing policies of 11 European countries, comparing them to the Bulgarian pharmaceutical system. The countries were selected based on the reference basket for the pricing of pharmaceuticals in Bulgaria - Belgium, Greece, Spain, Italy, Latvia, Lithuania, Romania, Slovakia, Slovenia, and France. AREAS COVERED In the first part, we explore the health system models in the above-mentioned countries. In the second part we explore the pricing and reimbursement policies, and in the third part we analyze healthcare and pharmaceutical economic indicators, as well as life expectancy. The major focus of the review is the outpatient care. EXPERT OPINION In this work, we attempted to outline differences and similarities between the countries of interest. Despite the differences in their healthcare system organization, health and pharmaceutical expenditures constantly increased during the observed 2 decades. This increase in expenditures, however, has not had a significant impact on life-expectancy. Minor increases were observed - from 2 to 4 years total. No country had an expectancy above 85 years of age. It might be said that other factors are influencing the life expectancy to a greater extent.
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Affiliation(s)
- Alexandra Savova
- Faculty of Pharmacy, Medical University of Sofias, Sofia, Bulgaria
- National council of prices and reimbursement of medicines, Sofia, Bulgaria
| | - Manoela Manova
- Faculty of Pharmacy, Medical University of Sofias, Sofia, Bulgaria
- National council of prices and reimbursement of medicines, Sofia, Bulgaria
| | | | - Guenka Petrova
- Faculty of Pharmacy, Medical University of Sofias, Sofia, Bulgaria
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Xu L, You X, Cui Y, You J. Health poverty alleviation in China from the perspective of historical institutionalism: policy changes and driving factors. Front Public Health 2024; 11:1265588. [PMID: 38298260 PMCID: PMC10829491 DOI: 10.3389/fpubh.2023.1265588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 12/21/2023] [Indexed: 02/02/2024] Open
Abstract
Health poverty alleviation is an effective tool for improving the living quality and developmental conditions of impoverished populations. Since 1978, China has been actively implementing health poverty alleviation projects, resulting in a more robust rural healthcare service network and increased convenience for the local population to access medical treatment. However, it is crucial to acknowledge that China still faces a complex situation with the simultaneous existence of multiple disease threats and the interweaving of various health influencing factors. Ongoing risks of emerging infectious diseases persist, and some previously controlled or eliminated infectious diseases are at risk of resurgence. The incidence of chronic diseases is on the rise and exhibits a trend toward affecting younger populations. Therefore, examining the successful experiences of China's health poverty alleviation over the past 40 years becomes a critically important issue. The study focuses on China's health poverty alleviation policies, employing historical institutionalism as a theoretical perspective to analyze the historical changes and evolutionary logic of health poverty alleviation policies. A historical institutionalist analytical framework for health poverty alleviation policies is constructed. The research findings reveal that China's health poverty alleviation policy has undergone three distinct periods since 1978: the initial phase (1978-2000), the exploratory phase (2000-2012), and the stable development phase (2013-present). At the macro level, the political, economic, and social contexts of different periods have influenced the evolution of health poverty alleviation policies. On the meso level, coordination effects and adaptive expectations have had an impact on China's health poverty alleviation policy. At the micro level, various actors, including the central government, local governments at different levels, social forces, and impoverished communities, interact during the evolution of health poverty alleviation policies. This paper summarizes the theoretical aspects of China's health poverty alleviation policy experience. The research conclusions, viewed through the lens of historical institutionalism, offer practical insights into the evolution of government policies. This provides directional guidance for enhancing health poverty alleviation projects.
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Affiliation(s)
| | - Xiaojian You
- School of Marxist, Southwest University of Science and Technology, Mianyang, China
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Alam MM, Rayhan MI, Mansur M. From the local disparities to national realities: Mapping and multilevel modeling of catastrophic health expenditure in Bangladesh using HIES 2016. PLoS One 2024; 19:e0290746. [PMID: 38166087 PMCID: PMC10760898 DOI: 10.1371/journal.pone.0290746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/14/2023] [Indexed: 01/04/2024] Open
Abstract
In developing nations, catastrophic health expenditures have become an all-too-common occurrence, threatening to push households into impoverishment and poverty. By analyzing the Household Income and Expenditure Survey 2016, which features a sample of 46,080 households, this study provides a comprehensive district-by-district analysis of the variation in household catastrophic health expenditures and related factors. The study utilizes a multilevel logistic regression model, which considers both fixed and random effects to identify factors associated with catastrophic health expenditure. The findings of the study indicate that districts located in the eastern and southern regions are at a significantly higher risk of experiencing catastrophic health expenditures. A potential explanation for this trend may be attributed to the high prevalence of chronic diseases in these districts, as well as their economic conditions. The presence of chronic diseases (AOR 5.45 with 95% CI: 5.14, 5.77), presence of old age person (AOR 1.50 with 95% CI: 1.39, 1.61), place of residence (AOR 1.40 with 95% CI: 1.14, 1.73) are found to be highly associated factors. Additionally, the study reveals that the thresholds used to define catastrophic health expenditures exhibit substantial variation across different regions, and differ remarkably from the threshold established by the WHO. On average, the thresholds are 23.12% of nonfood expenditure and 12.14% of total expenditure. In light of these findings, this study offers important insights for policymakers and stakeholders working towards achieving universal health coverage and sustainable development goals in Bangladesh.
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Affiliation(s)
- Md. Muhitul Alam
- Institute of Statistical Research and Training (ISRT), University of Dhaka, Dhaka, Bangladesh
| | - Md. Israt Rayhan
- Institute of Statistical Research and Training (ISRT), University of Dhaka, Dhaka, Bangladesh
| | - Mohaimen Mansur
- Institute of Statistical Research and Training (ISRT), University of Dhaka, Dhaka, Bangladesh
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Walani SR, Penny N, Nakku D. The global challenges of surgical congenital anomalies: Evidence, models, and lessons. Semin Pediatr Surg 2023; 32:151348. [PMID: 38006693 DOI: 10.1016/j.sempedsurg.2023.151348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
The treatment of congenital anomalies (structural birth defects) is common to all the surgical sub-specialties dealing with children. Globally more than 90 % of all babies born with a congenital anomaly are born in middle-and-low-income countries where there is often limited access to needed surgical care. Challenges include lacks of early identification, registry and surveillance systems, missing referral pathways, shortage of trained surgical expertise and insufficient surgical infrastructure. Poverty, transportation logistics, financial constraints and social stigma are also serious barriers for families. There is, however, growing recognition of the priority to expand services, encouraged by the World Health Organization and other global players, and examples of successful models of care. Registry programs are growing, especially in Latin America. The Ponseti method of clubfoot care has been revolutionary on a global scale. The role of not-for-profit non-governmental-organizations has been instrumental in fundraising, training and logistical support as exemplified in the care of oro-facial clefts. Specialized "niche" hospitals are providing needed sub-specialist expertise. The way forward includes the need for effective partnerships, innovative methods to distribute care out from referral hospitals into the districts and the development of national plans embedded in national health policy.
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Affiliation(s)
| | - Norgrove Penny
- Branch for Global Surgical Care, University of British Columbia, Vancouver, Canada
| | - Doreen Nakku
- Department of Surgery, Mbarara University of Science and Technology (MUST) Mbarara, Uganda
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Sultana R, Slavkovsky R, Ullah MR, Tasnim Z, Sultana S, Khan S, Shirin T, Haque S, Hossen MT, Islam MM, Khanom JA, Haque A, Nazneen A, Rimi NA, Hossain K, Islam MT, Hasan S, Yazdany MS, Ahsan MS, Mehedi K, Marfin AA, Letson GW, Pecenka C, Nguyen ALT. Cost of Acute and Sequelae Care for Japanese Encephalitis Patients, Bangladesh, 2011-2021. Emerg Infect Dis 2023; 29:2488-2497. [PMID: 37987586 PMCID: PMC10683813 DOI: 10.3201/eid2912.230594] [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] [Indexed: 11/22/2023] Open
Abstract
Japanese encephalitis (JE) is associated with an immense social and economic burden. Published cost-of-illness data come primarily from decades-old studies. To determine the cost of care for patients with acute JE and initial and long-term sequelae from the societal perspective, we recruited patients with laboratory-confirmed JE from the past 10 years of JE surveillance in Bangladesh and categorized them as acute care, initial sequalae, and long-term sequelae patients. Among 157 patients, we categorized 55 as acute, 65 as initial sequelae (53 as both categories), and 90 as long-term sequelae. The average (median) societal cost of an acute JE episode was US $929 ($909), of initial sequelae US $75 ($33), and of long-term sequelae US $47 ($14). Most families perceived the effect of JE on their well-being to be extreme and had sustained debt for JE expenses. Our data about the high cost of JE can be used by decision makers in Bangladesh.
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Fetene SM, Mengistu MY, Aschalew AY. Effectiveness and impact of community-based health insurance on health service utilization in northwest Ethiopia: a quasi-experimental evaluation. Front Public Health 2023; 11:1078462. [PMID: 38026288 PMCID: PMC10679351 DOI: 10.3389/fpubh.2023.1078462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Background Addressing the health challenges of lower socioeconomic groups in Ethiopia is still a huge problem. In that regard, the government piloted the community-based health insurance (CBHI) in 2011 in a few districts and subsequently scaled up. However, the effectiveness of the program on the utilization of health services and its impact was not well explored. Thus, we aimed to evaluate the effectiveness of CBHI toward health services' utilization and its impact in northwest Ethiopia. Methods A quasi-experimental matched comparison group evaluation design with sequential explanatory mixed methods was employed. To evaluate the CBHI program, the effectiveness and impact dimensions from the Organization for Economic Cooperation and Development framework were used. A multistage sampling technique was used to select a total of 332 households enrolled in the CBHI program; 341 comparison households who did not enroll in the program were also randomly selected. A structured interviewer-administrated questionnaire was used to evaluate the effectiveness and impact of CBHI on health service utilization. The Propensity score matching model was employed for the estimation of the effect of the CBHI program on health service utilization. Challenges for program achievement toward health service utilization were explained through qualitative data and these were then analyzed thematically. Results The evaluation showed 1.3 visits per capita per year of health service utilization among CBHI members. Households enrolled in CBHI increased health service utilization by 6.9 percentage points (ATT = 0.069; 95% CI: 0.034, 0.114). There was an improvement in health service utilization after the introduction of CBHI, however, there are challenges: (i) shortage of human resources, (ii) out-of-stock of drugs and medical supplies, and (iii) long waiting times for service and reimbursement claims. These issues limit the success of the program toward health service utilization. Conclusion The CBHI program contributed to health service utilization improvement among CBHI members. However, the utilization rate of health services among CBHI members is still less than the target stated for the program and also the WHO recommendation. Therefore, the findings of this evaluation can be used by program implementers, policy makers, and other stakeholders to overcome the identified challenges and to increase the success of the program.
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Affiliation(s)
- Samrawit Mihret Fetene
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Binyaruka P, Foss A, Alibrahim A, Mziray N, Cassidy R, Borghi J. Supply-side factors influencing demand for facility-based delivery in Tanzania: a multilevel analysis. HEALTH ECONOMICS REVIEW 2023; 13:52. [PMID: 37930445 PMCID: PMC10629065 DOI: 10.1186/s13561-023-00468-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Improving access to facility-based delivery care has the potential to reduce maternal and newborn deaths across settings. Yet, the access to a health facility for childbirth remains low especially in low-income settings. To inform evidence-based interventions, more evidence is needed especially accounting for demand- and supply-side factors influencing access to facility-based delivery care. We aimed to fill this knowledge gap using data from Tanzania. METHODS We used data from a cross-sectional survey (conducted in January 2012) of 150 health facilities, 1494 patients and 2846 households with women who had given births in the last 12 months before the survey across 11 districts in three regions in Tanzania. The main outcome was the place of delivery (giving birth in a health facility or otherwise), while explanatory variables were measured at the individual woman and facility level. Given the hierarchical structure of the data and variance in demand across facilities, we used a multilevel mixed-effect logistic regression to explore the determinants of facility-based delivery care. RESULTS Eighty-six percent of 2846 women gave birth in a health facility. Demand for facility-based delivery care was influenced more by demand-side factors (76%) than supply-side factors (24%). On demand-side factors, facility births were more common among women who were educated, Muslim, wealthier, with their first childbirth, and those who had at least four antenatal care visits. On supply-side factors, facility births were more common in facilities offering outreach services, longer consultation times and higher interpersonal quality. In contrast, facilities with longer average waiting times, longer travel times and higher chances of charging delivery fees had few facility births. CONCLUSIONS Policy responses should aim for strategies to improve demand like health education to raise awareness towards care seeking among less educated groups and those with higher parity, reduce financial barriers to access (including time costs to reach and access care), and policy interventions to enhance interpersonal quality in service provision.
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Affiliation(s)
- Peter Binyaruka
- Department of Health System, Impact Evaluation and Policy, Ifakara Health Institute, PO Box 78373, Dar es Salaam, Tanzania.
| | - Anna Foss
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Abdullah Alibrahim
- College of Engineering and Petroleum, Kuwait University, Kuwait City, Kuwait
| | - Nicholaus Mziray
- Department of Health System, Impact Evaluation and Policy, Ifakara Health Institute, PO Box 78373, Dar es Salaam, Tanzania
| | - Rachel Cassidy
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
- KPM Center for Public Management, University of Bern, Schanzeneckstrasse 1, Bern, 3012, Switzerland
| | - Josephine Borghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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Kolesar RJ, Erreygers G, Van Damme W, Chea V, Choeurng T, Leng S. Hardship financing, productivity loss, and the economic cost of illness and injury in Cambodia. Int J Equity Health 2023; 22:208. [PMID: 37805483 PMCID: PMC10559627 DOI: 10.1186/s12939-023-02016-z] [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: 01/19/2022] [Accepted: 09/18/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Financial risk protection is a core dimension of universal health coverage. Hardship financing, defined as borrowing and selling land or assets to pay for healthcare, is a measure of last recourse. Increasing indebtedness and high interest rates, particularly among unregulated money lenders, can lead to a vicious cycle of poverty and exacerbate inequity. METHODS To inform efforts to improve Cambodia's social health protection system we analyze 2019-2020 Cambodia Socio-economic Survey data to assess hardship financing, illness and injury related productivity loss, and estimate related economic impacts. We apply two-stage Instrumental Variable multiple regression to address endogeneity relating to net income. In addition, we calculate a direct economic measure to facilitate the regular monitoring and reporting on the devastating burden of excessive out-of-pocket expenditure for policy makers. RESULTS More than 98,500 households or 2.7% of the total population resorted to hardship financing over the past year. Factors significantly increasing risk are higher out-of-pocket healthcare expenditures, illness or injury related productivity loss, and spending of savings. The economic burden from annual lost productivity from illness or injury amounts to US$ 459.9 million or 1.7% of GDP. The estimated household economic cost related to hardship financing is US$ 250.8 million or 0.9% of GDP. CONCLUSIONS Such losses can be mitigated with policy measures such as linking a catastrophic health coverage mechanism to the Health Equity Funds, capping interest rates on health-related loans, and using loan guarantees to incentivize microfinance institutions and banks to refinance health-related, high-interest loans from money lenders. These measures could strengthen social health protection by enhancing financial risk protection, mitigating vulnerability to the devastating economic effects of health shocks, and reducing inequities.
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Affiliation(s)
- Robert John Kolesar
- Abt Associates, Phnom Penh, Cambodia
- Faculty of Business and Economics, University of Antwerp, Antwerp, Belgium
- General Secretariat for the National Social Protection Council, Cambodian Ministry of Economy and Finance, Phnom Penh, Cambodia
- Centre d’Etudes et de Recherches sur le Développement International (CERDI), Université Clermont Auvergne, Clermont-Ferrand, France
| | - Guido Erreygers
- Faculty of Business and Economics, University of Antwerp, Antwerp, Belgium
- Centre for Health Policy, University of Melbourne, Melbourne, Australia
| | | | - Vanara Chea
- General Secretariat for the National Social Protection Council, Cambodian Ministry of Economy and Finance, Phnom Penh, Cambodia
| | - Theany Choeurng
- General Secretariat for the National Social Protection Council, Cambodian Ministry of Economy and Finance, Phnom Penh, Cambodia
| | - Soklong Leng
- General Secretariat for the National Social Protection Council, Cambodian Ministry of Economy and Finance, Phnom Penh, Cambodia
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15
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Bagepally BS, Kumar SS, Sasidharan A, Haridoss M, Venkataraman K. Household catastrophic health expenditures for rheumatoid arthritis: a single centre study from South India. Sci Rep 2023; 13:15385. [PMID: 37717053 PMCID: PMC10505146 DOI: 10.1038/s41598-023-42623-y] [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: 02/17/2023] [Accepted: 09/12/2023] [Indexed: 09/18/2023] Open
Abstract
Rheumatoid arthritis (RA) not only has a physical and emotional toll but also has a substantial economic impact. This study aims to estimate the burden of catastrophic health expenditure (CHE) on households due to RA in Tamil Nadu, India. We conducted cross-sectional descriptive hospital-based single-centre study at a tertiary care private multispecialty hospital in Tamil Nadu, India. The study comprised 320 RA patients who visited the outpatient clinic from April to October 2022. Demographic and baseline descriptive characteristics were reported. Multivariable logistic regression analyses were performed to identify major determinants associated with CHE. We also examined the inequality in household annual income and CHE. Most study participants were females (88.1%) with a mean age (SD) of 55.57 ± 12.29 years. About 93% of RA patients were from urban areas, and 89.4% were literate. Only 8.1% of respondents reported having health insurance. Households experiencing CHE owing to RA were 51.4% (n = 162). The mean (95% CI) annual health expenditure for treating RA is ₹44,700 (₹41,710 to 47,690) with a median (IQR) of ₹39,210 (₹25,500) [$476 ($310)]. The corresponding mean (95% CI) and median (IQR) Out of pocket expenditure among RA patients per household were ₹40,698 (₹38,249 to 43,148) [$494 ($464 to $524)] and ₹36,450 (23,070) [$442 ($280)] respectively. Nearly half of the households with RA patients had a financial catastrophe due to healthcare costs being paid out-of-pocket and limited health insurance coverage. The results underscore the need for comprehensive approaches to strengthening public health policies along with financial risk protection and quality care in India.
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Affiliation(s)
- Bhavani Shankara Bagepally
- National Institute of Epidemiology (ICMR), Health Technology Assessment Resource Centre ICMR-NIE, R-127, Tamil Nadu Housing Board, Phase I and II, Ayapakkam, Chennai, 600077, India.
| | - S Sajith Kumar
- National Institute of Epidemiology (ICMR), Health Technology Assessment Resource Centre ICMR-NIE, R-127, Tamil Nadu Housing Board, Phase I and II, Ayapakkam, Chennai, 600077, India
| | - Akhil Sasidharan
- National Institute of Epidemiology (ICMR), Health Technology Assessment Resource Centre ICMR-NIE, R-127, Tamil Nadu Housing Board, Phase I and II, Ayapakkam, Chennai, 600077, India
| | - Madhumitha Haridoss
- National Institute of Epidemiology (ICMR), Health Technology Assessment Resource Centre ICMR-NIE, R-127, Tamil Nadu Housing Board, Phase I and II, Ayapakkam, Chennai, 600077, India
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Li ECK, Tagoola A, Komugisha C, Nabweteme AM, Pillay Y, Ansermino JM, Khowaja AR. Cost-effectiveness analysis of Smart Triage, a data-driven pediatric sepsis triage platform in Eastern Uganda. BMC Health Serv Res 2023; 23:932. [PMID: 37653477 PMCID: PMC10468891 DOI: 10.1186/s12913-023-09977-5] [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: 03/31/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Sepsis, characterized by organ dysfunction due to presumed or proven infection, has a case-fatality over 20% in severe cases in low-and-middle income countries. Early diagnosis and treatment have proven benefits, prompting our implementation of Smart Triage at Jinja Regional Referral Hospital in Uganda, a program that expedites treatment through a data-driven triage platform. We conducted a cost-effectiveness analysis of Smart Triage to explore its impact on patients and inform multicenter scale up. METHODS The parent clinical trial for Smart Triage was pre-post in design, using the proportion of children receiving sepsis treatment within one hour as the primary outcome, a measure linked to mortality benefit in existing literature. We used a decision-analytic model with Monte Carlo simulation to calculate the cost per year-of-life-lost (YLL) averted of Smart Triage from societal, government, and patient perspectives. Healthcare utilization and lost work for seven days post-discharge were translated into costs and productivity losses via secondary linkage data. RESULTS In 2021 United States dollars, Smart Triage requires an annuitized program cost of only $0.05 per child, but results in $15.32 saved per YLL averted. At a willingness-to-pay threshold of only $3 per YLL averted, well below published cost-effectiveness threshold estimates for Uganda, Smart Triage approaches 100% probability of cost-effectiveness over the baseline manual triage system. This cost-effectiveness was observed from societal, government, and patient perspectives. The cost-effectiveness observed was driven by a reduction in admission that, while explainable by an improved triage mechanism, may also be partially attributable to changes in healthcare utilization influenced by the coronavirus pandemic. However, Smart Triage remains cost-effective in sensitivity analyses introducing a penalty factor of up to 50% in the reduction in admission. CONCLUSION Smart Triage's ability to both save costs and avert YLLs indicates that patients benefit both economically and clinically, while its high probability of cost-effectiveness strongly supports multicenter scale up. Areas for further research include the incorporation of years lived with disability when sepsis disability weights in low-resource settings become available and analyzing budget impact during multicenter scale up. TRIAL REGISTRATION NCT04304235 (registered on 11/03/2020, clinicaltrials.gov).
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Affiliation(s)
- Edmond C K Li
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada.
- Department of Anesthesiology, Royal Columbian Hospital, Vancouver, BC, Canada.
| | | | - Clare Komugisha
- World Alliance for Lung and Intensive Care Medicine in Uganda, Kololo, Kampala, Uganda
| | | | - Yashodani Pillay
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
- Center for International Child Health, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - J Mark Ansermino
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
- Center for International Child Health, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Asif R Khowaja
- Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
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Loureiro RB, Guidoni LM, Fregona GC, de Oliveira SMDVL, Sacramento D, Pinheiro JDS, Gomes D, Maciel ELN. Follow-up of patients diagnosed with and treated for tuberculosis in Brazil: financial burden on the household. J Bras Pneumol 2023; 49:e20220368. [PMID: 37610956 PMCID: PMC10578937 DOI: 10.36416/1806-3756/e20220368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/21/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE To evaluate the implications of the proportion of annual family income spent in the pre- and post-diagnosis periods in tuberculosis patients followed for after at least one year after completing tuberculosis treatment in Brazil. METHODS This was a cross-sectional study of tuberculosis patients followed for at least one year after completing tuberculosis treatment in five Brazilian capitals (one in each region of the country). RESULTS A total of 62 patients were included in the analysis. The overall average cost of tuberculosis was 283.84 Brazilian reals (R$) in the pre-diagnosis period and R$4,161.86 in the post-diagnosis period. After the costs of tuberculosis disease, 71% of the patients became unemployed, with an overall increase in unemployment; in addition, the number of patients living in nonpoverty decreased by 5%, the number of patients living in poverty increased by 6%, and the number of patients living in extreme poverty increased by 5%. The largest proportion of annual household income to cover the total costs of tuberculosis was for the extremely poor (i.e., 40.37% vs. 11.43% for the less poor). CONCLUSIONS Policies to mitigate catastrophic costs should include interventions planned by the health care system and social protection measures for tuberculosis patients with lower incomes in order to eliminate the global tuberculosis epidemic by 2035-a WHO goal in line with the United Nations Sustainable Development Goals.
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Affiliation(s)
- Rafaela Borge Loureiro
- . Programa de Pós-Graduação em Saúde Coletiva - PPGSC - Universidade Federal do Espírito Santo - UFES - Vitória (ES) Brasil
- . Laboratório de Epidemiologia, Universidade Federal do Espírito Santo - UFES - Vitória (ES) Brasil
| | - Leticia Molino Guidoni
- . Laboratório de Epidemiologia, Universidade Federal do Espírito Santo - UFES - Vitória (ES) Brasil
| | - Geisa Carlesso Fregona
- . Laboratório de Epidemiologia, Universidade Federal do Espírito Santo - UFES - Vitória (ES) Brasil
- . Programa de Tuberculose, Hospital Universitário Cassiano Antônio Moraes - HUCAM - Vitória (ES) Brasil
| | - Sandra Maria do Valle Leone de Oliveira
- . Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Universidade Federal de Mato Grosso do Sul - UFMS - Campo Grande (MS) Brasil
- . Fiocruz Mato Grosso do Sul, Campo Grande (MS) Brasil
| | - Daniel Sacramento
- . Núcleo de Controle da Tuberculose, Secretaria Municipal de Saúde de Manaus, Manaus (AM) Brasil
| | - Jair dos Santos Pinheiro
- . Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (AM) Brasil
- . Programa Estadual de Controle da Tuberculose do Amazonas/Fundação de Vigilância em Saúde - Dra. Rosemary Costa Pinto, Manaus (AM) Brasil
| | - Denise Gomes
- . Centro de Referência à Tuberculose - CRTB - GCC/SCS, Porto Alegre (RS) Brasil
| | - Ethel Leonor Noia Maciel
- . Programa de Pós-Graduação em Saúde Coletiva - PPGSC - Universidade Federal do Espírito Santo - UFES - Vitória (ES) Brasil
- . Laboratório de Epidemiologia, Universidade Federal do Espírito Santo - UFES - Vitória (ES) Brasil
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Chinkhumba J, Mpinganjira S, Kumitawa A, Malopa M, Longwe D, Phiri VS, Nyirenda TS, Mwapasa V. Household costs and care seeking patterns associated with COVID-19 in Blantyre, Malawi. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002003. [PMID: 37363908 PMCID: PMC10292703 DOI: 10.1371/journal.pgph.0002003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 05/10/2023] [Indexed: 06/28/2023]
Abstract
Economic consequences of COVID-19 illness and healthcare use for households in low income countries are not well known. We estimated costs associated with COVID-19 care-seeking and treatment from a household perspective and assessed determinants of treatment costs. A cross-sectional household survey was conducted between December 2020 and November 2021 in urban and peri-urban areas of Blantyre district. Adults (age ≥18 years) with confirmed COVID-19 were asked to report the symptoms they experienced or prompted them to seek COVID-19 tests as well as healthcare seeking behaviors preceding and following COVID-19 diagnosis. For individuals who sought healthcare, information on out-of-pocket expenditures incurred while seeking and receiving care including on transport, food etc. by both the patients and their guardians was collected. Finally, data on time use seeking, receiving care and during convalesces was recorded. Multivariate Generalized Linear Models were used to evaluate association between household COVID-19 costs and their determinants. Of 171 individuals who took part in the study, the average age was 40.7 years, standard deviation (SD) 15.0, and 50.8% were females. Most participants (85.3%) were symptomatic. Of these, 67.8% sought care at health facilities and the majority (91.7%) were treated as outpatients. The average total household cost associated with COVID-19 seeking, receiving care and convalescence was $62.81 (SD $126.02). Average costs for outpatient and inpatient cases were $52.96 (SD $54.35) and $172.39 (SD $407.08), respectively. Average out-of-pocket household expenditures were $42.62 (SD $123.10), accounting for 62% of total household costs. Being a male COVID-19 patient and engagement in formal employment were significantly associated with high COVID-19 household costs. Households face high economic burden related to COVID-19 sickness and healthcare use. Social policies that support households cope with both the direct and indirect COVID-19 cost are needed to ensure access to healthcare and protect households from COVID-19 related shocks.
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Affiliation(s)
- Jobiba Chinkhumba
- Department of Health Systems and Policy, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Health Economics and Policy Unit, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Samuel Mpinganjira
- Department of Epidemiology and Biostatistics, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Andrew Kumitawa
- Department of Epidemiology and Biostatistics, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Mercy Malopa
- Department of Epidemiology and Biostatistics, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Dalitso Longwe
- Department of Epidemiology and Biostatistics, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Vincent Samuel Phiri
- Department of Epidemiology and Biostatistics, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Tonney S. Nyirenda
- Department of Pathology, School of Medicine and Oral Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Victor Mwapasa
- Department of Epidemiology and Biostatistics, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
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Yesmin M, Ali M, Saha S. The prevalence and influencing factors of coexisting prediabetes and prehypertension among Bangladeshi adults. BMC Public Health 2023; 23:1184. [PMID: 37337196 DOI: 10.1186/s12889-023-16090-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/09/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Early detection of diabetes and hypertension is helpful to prevent and/or delay the onset of these diseases through proper interventions. Therefore, it is a prerequisite to know the prevalence of prediabetes and prehypertension and the factors associated with these conditions but people from developing countries including Bangladesh often remain undiagnosed and unaware of these conditions. In this study we investigate the prevalence of prediabetes and prehypertension and their associated factors in Bangladesh using nationally representative data. METHOD We used nationally representative Bangladesh Demographic and Health Survey (BDHS) 2017-18 survey data, which included a total sample of 14,704 adults aged 18 years and more from whom blood pressure and fasting plasma glucose were collected. Chi-square test was used to examine the differences between sociodemographic and outcome variables. The univariate and multivariate logistic regression was performed to identify the factors associated with prediabetes and prehypertension. RESULTS Overall, the prevalence of prediabetes and prehypertension was 8.6% with 14% of the sampled population having from prediabetes and prehypertension separately. Among the prediabetic and prehypertensive participants, one-fourth of the participant were from the richest families and around one-third were overweight/obese, while more than fifty percent had normal Body Mass Index (BMI) and completed secondary and higher education. In the univariate analysis, the richest wealth status (UOR 3.3, 95% CI: 2.46 -4.35) and overweight/obesity (UOR 3.2, 95% CI: 2.62-3.85) are the highest predictors for prediabetes and prehypertension. After adjusting the other variables, overweight/obesity remains the largest predictor for prediabetes and prehypertension (AOR:2.5, 95% CI:2.05-3.05). Further, people aged 31 and above and from the richest family had around 2 times and 1.8 times higher risk of being prediabetic and prehypertensive compared to the younger age people (18-30 years) and the poorest family (respectively). CONCLUSION The coexistence of prediabetes and prehypertension is an early sign of a greater burden of noncommunicable diseases (NCDs) in the near future for Bangladesh. To reduce the higher burden of NCDs, our findings call for a multisectoral approach to identify the precondition of NCDs with particular attention to maintaining body weight.
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Affiliation(s)
- Maksuda Yesmin
- Health Economics Unit, Department of Clinical Science (Malmö), Lund University, Medicon Village, Scheelevagen 2, 223 63, Lund, Sweden
| | - Masum Ali
- International Food Policy Research Institute (IFPRI), Dhaka, Bangladesh
| | - Sanjib Saha
- Health Economics Unit, Department of Clinical Science (Malmö), Lund University, Medicon Village, Scheelevagen 2, 223 63, Lund, Sweden.
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20
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Moeeni M, Nosratnejad S, Rostampour M, Ponnet K. To what extent has the Iranian Health Transformation Plan addressed inequality in healthcare financing in Iran? Int J Equity Health 2023; 22:62. [PMID: 37024883 PMCID: PMC10080967 DOI: 10.1186/s12939-023-01880-z] [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: 02/19/2022] [Accepted: 03/31/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND One of the major goals of health systems is providing a financing strategy without inequality; this has a significant impact on people's access to healthcare. The present study aimed to investigate the inequality in households' financial contribution (HFC) to health expenditure both before and after the implementation of the Iranian Health Transformation Plan (HTP) in 2014. METHODS This study is a secondary analysis of two waves of a national survey conducted in Iran. The data were collected from the Households Income and Expenditure Survey in 2013 and 2015. The research sample included 76,195 Iranian households. The inequality in households' financial contributions to the health system was assessed using the Gini coefficient, and the concentration index (CI). In addition, by using econometric modeling, the relationship between the implementation of the HTP and inequality in HFC was studied. The households' financial contribution included healthcare and health insurance prepayments. RESULTS The Gini coefficient values were 0.67 and 0.65 in 2013 and 2015, respectively, indicating a medium degree of inequality in HFC in both years. The CI values were 0.54 and 0.56 in 2013 and 2015, respectively, suggesting that inequalities in HFC were in favor of higher income quintiles in the years before and after the implementation of the HTP. Regression analysis showed that households with a female head, with an unemployed head, or with a head having income without a job were contributing more to financing health expenditure. The presence of a household member over the age of 65 was associated with a higher level of HFC. The implementation of the HTP had a negative relationship with the HFC. CONCLUSION The HTP, aiming to address inequality in the financing system, did not achieve the intended goal as expected. The implementation of the HTP neglected certain factors at the household level, such as the presence of family members older than the age of 65, a female household head, and unemployment. This resulted in a failure to reduce the inequality of the HFC. We suggest that, in the future, policymakers take into account factors at the household level to reduce inequality in the HFC.
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Affiliation(s)
- Maryam Moeeni
- Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shirin Nosratnejad
- Iranian Center of Excellence in Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Manizhe Rostampour
- Iranian Center of Excellence in Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Koen Ponnet
- Faculty of Social Sciences, Imec-Mict-Ghent University, Ghent, Belgium
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Olanrewaju O, Trott M, Smith L, López Sánchez GF, Carmichael C, Oh H, Schuch F, Jacob L, Veronese N, Soysal P, Shin JI, Butler L, Barnett Y, Koyanagi A. Chronic physical conditions, physical multimorbidity, and quality of life among adults aged ≥ 50 years from six low- and middle-income countries. Qual Life Res 2023; 32:1031-1041. [PMID: 36571639 PMCID: PMC10063492 DOI: 10.1007/s11136-022-03317-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE Multimorbidity (i.e., ≥ 2 chronic conditions) poses a challenge for health systems and governments, globally. Several studies have found inverse associations between multimorbidity and quality of life (QoL). However, there is a paucity of studies from low- and middle-income countries (LMICs), especially among the older population, as well as studies examining mediating factors in this association. Thus, the present study aimed to explore the associations, and mediating factors, between multimorbidity and QoL among older adults in LMICs. METHODS Cross-sectional nationally representative data from the Study on Global Ageing and Adult Health were analyzed. A total of 11 chronic conditions were assessed. QoL was assessed with the 8-item WHO QoL instrument (range 0-100) with higher scores representing better QoL. Multivariable linear regression and mediation analyses were conducted to assess associations. RESULTS The final sample consisted of 34,129 adults aged ≥ 50 years [mean (SD) age 62.4 (16.0) years; age range 50-114 years; 52.0% females]. Compared to no chronic conditions, 2 (b-coefficient - 5.89; 95% CI - 6.83, - 4.95), 3 (- 8.35; - 9.63, - 7.06), 4 (- 10.87; - 12.37, - 9.36), and ≥ 5 (- 13.48; - 15.91, - 11.06) chronic conditions were significantly associated with lower QoL, dose-dependently. The mediation analysis showed that mobility (47.9%) explained the largest proportion of the association between multimorbidity and QoL, followed by pain/discomfort (43.5%), sleep/energy (35.0%), negative affect (31.9%), cognition (20.2%), self-care (17.0%), and interpersonal activities (12.0%). CONCLUSION A greater number of chronic conditions was associated with lower QoL dose-dependently among older adults in LMICs. Public health and medical practitioners should aim to address the identified mediators to improve QoL in patients with multimorbidity.
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Affiliation(s)
- Olawale Olanrewaju
- Cambridge Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, CB1 1PT, UK
| | - Mike Trott
- Centre for Public Health, Queens University Belfast, Belfast, UK
| | - Lee Smith
- Cambridge Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, CB1 1PT, UK.
| | - Guillermo F López Sánchez
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, School of Medicine, University of Murcia, Murcia, Spain.
| | - Christina Carmichael
- Cambridge Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, CB1 1PT, UK
| | - Hans Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, Los Angeles, CA, 90007, USA
| | - Felipe Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
- Faculty of Health Sciences, Universidad Autónoma de Chile, Providencia, Chile
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, 08830, Barcelona, Spain
| | - Nicola Veronese
- Department of Internal Medicine and Geriatrics, University of Palermo, 90133, Palermo, Italy
| | - Pinar Soysal
- Department of Geriatric Medicine, Bezmialem Vakif University, 34093, Istanbul, Turkey
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-Ro 50, Seodaemun-Gu, C.P.O Box 8044, Seoul, 03722, Republic of Korea
| | - Laurie Butler
- Cambridge Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, CB1 1PT, UK
| | - Yvonne Barnett
- Cambridge Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, CB1 1PT, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, 08830, Barcelona, Spain
- ICREA, Pg, Lluis Companys 23, 08010, Barcelona, Spain
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Ahmadnezhad E, Dastan I, Alvandi R, Abdi Z. The impact of health reform on poverty estimates in Iran: Implications for monitoring the first goal of Sustainable Development Goals. Int J Health Plann Manage 2023; 38:747-758. [PMID: 36862573 DOI: 10.1002/hpm.3622] [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: 05/13/2020] [Revised: 10/22/2022] [Accepted: 01/30/2023] [Indexed: 03/03/2023] Open
Abstract
INTRODUCTION Iran launched a series of health reforms called Health Transformation Plan (HTP) in order to improve financial protection and access to health care in 2014. This study aimed to investigate the extent of impoverishment due to out of pocket (OOP) payments during 2011-2016 and to assess the implications of health expenditures to overall national poverty rate before and after the HTP implementation, with a focus on monitoring the first Sustainable Development Goals (SDGs). METHODS The study relied on data from a nationally representative household income and expenditure survey. Two measures of poverty were estimated in this study: the prevalence (poverty headcount) and the intensity of poverty before and after OOP health payments (poverty gap). Proportion of the population fell into poverty due to OOP spending for health care from total poor population calculated for 2 years before and after the HTP implementation using three poverty lines suggested by the World Bank for global poverty comparison ($1.90, $3.2 and $5.5 per day in 2011 purchasing power parity (PPP) $). RESULTS Our results indicate that the incidence of impoverishing health expenditures has remained relatively low during 2011-2016. At the 2011 PPP $5.5 daily poverty line, the average incidence rate at the national level was 1.36% during the period. The percentage of population impoverished due to OOP health expenditures increased after HTP implementation, irrespective of the poverty line used. However, the proportion of individuals that pushed further into poverty decreased after HTP implementation. It was estimated that around 12.5% of total poor population fell below poverty line due to paying OOP payments in 2016. CONCLUSION Although health care costs are not major causes of impoverishment in Iran, the relative impact of OOP spending for health is not negligible. To attain SDG 1, pro-poor interventions that aim to reduce the burden of OOP payments should be advocated and implemented with an inter-sectoral approach.
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Affiliation(s)
- Elham Ahmadnezhad
- National Institute of Health Research (NIHR), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Ilker Dastan
- World Health Organization Country Office in Tajikistan, Dushanbe, Tajikistan
| | - Rezvaneh Alvandi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Zhaleh Abdi
- National Institute of Health Research (NIHR), Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Quartey T, Peprah C, Morgan AK. Determinants of national health insurance enrolment among people at risk of statelessness in the Awutu Senya East Municipality and Gomoa East District of Ghana. BMC Health Serv Res 2023; 23:153. [PMID: 36788530 PMCID: PMC9927045 DOI: 10.1186/s12913-022-08738-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 10/25/2022] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND This paper investigates the factors influencing the decision to enrol in Ghana's National Health Insurance Scheme (NHIS) among people at risk of statelessness, with emphasis on the individual's demographic and socioeconomic factors. METHODS: The study used data from a cross-sectional household survey undertaken in the Awutu Senya East Municipality and Gomoa East District of Ghana's Central Region between March 9 and June 26, 2021, on healthcare utilization culture among people at risk of statelessness. Descriptive statistics and binary logistic regression were used in analysing data from a sample of 384 people at risk of statelessness. RESULTS: The results reveal that about 51% of the at-risk population have ever enrolled while 48% of the respondents were enrolled on the NHIS at the time of the survey (active members). The majority of the enrolled members acquired their membership through self-payment of the enrolment fee. Additionally, respondents aged 26-35 had higher odds of enrolling, whiles those within 56-65 years had lower odds of enrolling in health insurance. Also, persons who are married and have a high school education or an equivalent qualification were more likely to enrol, while persons with no employment were less likely to enrol. CONCLUSION According to the paper, while the gap in coverage between rich and poor, married and single appears to have narrowed, these factors continue to determine NHIS coverage among people at risk of statelessness. The same is true for education. Efforts must be increased to ensure equal access to healthcare financing interventions for better access to health services.
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Affiliation(s)
- Theophilus Quartey
- grid.9829.a0000000109466120Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Charles Peprah
- grid.9829.a0000000109466120Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Anthony Kwame Morgan
- Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
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Thomas AR, Dash U, Sahu SK. Illnesses and hardship financing in India: an evaluation of inpatient and outpatient cases, 2014-18. BMC Public Health 2023; 23:204. [PMID: 36717824 PMCID: PMC9887799 DOI: 10.1186/s12889-023-15062-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/16/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Progress towards universal health coverage requires strengthening the country's health system. In developing countries, the increasing disease burden puts a lot of stress on scarce household finances. However, this burden is not the same for everyone. The economic burden varies across the disease groups and care levels. Government intervention is vital in formulating policies in addressing financial distress at the household level. In India, even when outpatient care forms a significant proportion of out-of-pocket expenditure, government schemes focus on reducing household expenditure on inpatient care alone. Thus, people resort to hardship financing practices like informal borrowing or selling of assets in the event of health shocks. In this context, the present study aims to identify the disease(s) that correlates with maximum hardship financing for outpatients and inpatients and to understand the change in hardship financing over time. METHODS We used two waves of National Sample Survey Organisation's data on social consumption on health- the 71st and the 75th rounds. Descriptive statistics are reported, and logistic regression is carried out to explain the adjusted impact of illness on hardship financing. Pooled logistic regression of the two rounds is estimated for inpatients and outpatients. Marginal effects are reported to study the changes in hardship financing over time. RESULTS The results suggest that cancer had the maximum likelihood of causing hardship financing in India for both inpatients (Odds ratio 2.41; 95% Confidence Interval (CI): 2.03 - 2.86 (71st round), 2.54; 95% CI: 2.21 - 2.93 (75th round)) and outpatients (Odds ratio 6.11; 95% CI: 2.95 - 12.64 (71st round), 3.07; 95% CI: 2.14 - 4.40 (75th round)). In 2018, for outpatients, the hardship financing for health care needs was higher at public health facilities, compared to private health facilities (Odds ratio 0.72; 95% CI: 0.62 - 0.83 (75th round). The marginal effects model of pooled cross-section analysis reveals that from 2014 to 2018, the hardship financing had decreased for inpatients (Odds ratio 0.747; 95% CI:0.80 - -0.70), whereas it had increased for outpatients (Odds ratio 0.0126; 95% CI: 0.01 - 0.02). Our results also show that the likelihood of resorting to hardship financing for illness among women was lesser than that of men. CONCLUSION Government intervention is quintessential to decrease the hardship financing caused by cancer. The intra-household inequalities play an important role in explaining their hardship financing strategies. We suggest the need for more financial risk protection for outpatient care to address hardship financing.
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Affiliation(s)
- Arya Rachel Thomas
- Department of Humanities and Social Sciences, Indian Institute of Technology Madras, Chennai, India.
| | - Umakant Dash
- grid.462428.e0000 0004 0500 1504Institute of Rural Management Anand (IRMA), Anand, India
| | - Santosh Kumar Sahu
- grid.417969.40000 0001 2315 1926Department of Humanities and Social Sciences, Indian Institute of Technology Madras, Chennai, India
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Rajalakshmi E, Sasidharan A, Bagepally BS, Kumar MS, Manickam P, Selva Vinayagam TS, Sampath P, Parthipan K. Household catastrophic health expenditure for COVID-19 during March-August 2021, in South India: a cross-sectional study. BMC Public Health 2023; 23:47. [PMID: 36609295 PMCID: PMC9821347 DOI: 10.1186/s12889-022-14928-6] [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: 09/09/2022] [Accepted: 12/22/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The Coronavirus disease 2019 (COVID-19) pandemic increased the utilisation of healthcare services. Such utilization could lead to higher out-of-pocket expenditure (OOPE) and catastrophic health expenditures (CHE). We estimated OOPE and the proportion of households that experienced CHE by conducting a cross-sectional survey of 1200 randomly selected confirmed COVID-19 cases. METHODS A cross-sectional survey was conducted by telephonic interviews of 1200 randomly selected COVID-19 patients who tested positive between 1 March and 31 August 2021. We collected household-level information on demographics, income, expenditure, insurance coverage, direct medical and non-medical costs incurred toward COVID-19 management. We estimated the proportion of CHE with a 95% confidence interval. We examined the association of household characteristics; COVID-19 cases, severity, and hospitalisation status with CHE. A multivariable logistic regression analysis was conducted to ascertain the effects of variables of interest on the likelihood that households face CHE due to COVID-19. RESULTS The mean (95%CI) OOPE per household was INR 122,221 (92,744-1,51,698) [US$1,643 (1,247-2,040)]. Among households, 61.7% faced OOPE, and 25.8% experienced CHE due to COVID-19. The odds of facing CHE were high among the households; with a family member over 65 years [OR = 2.89 (2.03-4.12)], with a comorbid individual [OR = 3.38 (2.41-4.75)], in the lowest income quintile [OR = 1.82 (1.12-2.95)], any member visited private hospital [OR = 11.85 (7.68-18.27)]. The odds of having CHE in a household who have received insurance claims [OR = 5.8 (2.81- 11.97)] were high. Households with one and more than one severe COVID-19 increased the risk of CHE by more than two-times and three-times respectively [AOR = 2.67 (1.27-5.58); AOR = 3.18 (1.49-6.81)]. CONCLUSION COVID-19 severity increases household OOPE and CHE. Strengthening the public healthcare and health insurance with higher health financing is indispensable for financial risk protection of households with severe COVID-19 from CHE.
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Affiliation(s)
- Elumalai Rajalakshmi
- grid.419587.60000 0004 1767 6269ICMR-National Institute of Epidemiology, Chennai, India
| | - Akhil Sasidharan
- grid.419587.60000 0004 1767 6269ICMR-National Institute of Epidemiology, Chennai, India ,grid.419587.60000 0004 1767 6269Health Technology Assessment Resource Centre, ICMR-National Institute of Epidemiology, Tamil Nadu Housing Board, Phase I and II, Ayapakkam, Chennai, India
| | - Bhavani Shankara Bagepally
- grid.419587.60000 0004 1767 6269ICMR-National Institute of Epidemiology, Chennai, India ,grid.419587.60000 0004 1767 6269Health Technology Assessment Resource Centre, ICMR-National Institute of Epidemiology, Tamil Nadu Housing Board, Phase I and II, Ayapakkam, Chennai, India
| | | | - Ponnaiah Manickam
- grid.419587.60000 0004 1767 6269ICMR-National Institute of Epidemiology, Chennai, India
| | | | - P. Sampath
- Tamil Nadu Directorate of Public Health and Preventive Medicine, Chennai, India
| | - K Parthipan
- Tamil Nadu Directorate of Public Health and Preventive Medicine, Chennai, India
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Usability and acceptance of a mobile health wallet for pregnancy-related healthcare: A mixed methods study on stakeholders' perceptions in central Madagascar. PLoS One 2023; 18:e0279880. [PMID: 36595530 PMCID: PMC9810191 DOI: 10.1371/journal.pone.0279880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/16/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Several sub-Saharan African countries use digital financial services to improve health financing, especially for maternal and child health. In cooperation with the Malagasy Ministry of Health, the NGO Doctors for Madagascar is implementing a mobile health wallet for maternal health care in public-sector health facilities in Madagascar. Our aim was to explore the enabling and limiting factors related to the usability and acceptance of the Mobile Maternal Health Wallet (MMHW) intervention during its implementation. METHODS We conducted a cross-sectional, mixed methods study with mothers and pregnant women and facility- (FBHWs) and community-based (CHWs) health workers from public-sector health facilities in three districts of the Analamanga region in Madagascar. We used a convergent design in collecting and analyzing quantitative and qualitative data. We performed one-stage proportional sampling of women who had signed up for the MMHW. All FBHWs and CHWs at primary care facilities in the intervention area were eligible to participate. RESULTS AND SIGNIFICANCE 314 women, 76 FBHWs, and 52 CHWs were included in the quantitative survey. Qualitative data were extracted from in-depth interviews with 12 women and 12 FBHWs and from six focus group discussions with 39 CHWSs. The MMHW intervention was accepted and used by health workers and women from different socioeconomic backgrounds. Main motivations for women to enroll in the intervention were the opportunity to save money for health (30.6%), electronic vouchers for antenatal ultrasound (30.2%), and bonus payments upon reaching a savings goal (27.9%). Main motivation for health workers was enabling pregnant women to save for health, thus encouraging facility-based deliveries (57.9%). Performance-based payments had low motivational value for health workers. Key facilitators were community sensitization, strong women-health worker relationship, decision making at the household level, and repetitive training on the use of the MMHW. Key barriers included limited phone ownership, low level of digital literacy, disinformation concerning the effects of the intervention, and technical problems like slow payout processes.
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Taiwo AB, Fatunla OA, Ogundare OE, Oluwayemi OI, Babatola AO, Ajite AB, Ajibola AE, Olajuyin A, Sola-Oniyide B, Olatunya OS. Households Health Care Financing Methods: Social Status Differences, Economic Implications and Clinical Outcomes Among Patients Admitted in a Pediatric Emergency Unit of a Tertiary Hospital in South West Nigeria. Glob Pediatr Health 2023; 10:2333794X231159792. [PMID: 36922939 PMCID: PMC10009042 DOI: 10.1177/2333794x231159792] [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: 11/21/2022] [Accepted: 02/08/2023] [Indexed: 03/13/2023] Open
Abstract
Background. The affordability of health care services by households within a country is determined by the health care financing methods used by her citizens. In accordance with World Health Organization (WHO), health services must be delivered equitably and without imposing financial hardship on the citizens. Aim. This study aimed to determine the pattern of households health care financing method and relate it to the social-background, economic implication and clinical outcome of care in pediatric emergency situations. Method: It is a cross-sectional descriptive study. Result. 210 children from different households were recruited. Majority (75.9%) of the children were aged 0 to 5 years, males (61.2%) and belonged to the low socio-economic status (95.7%). The overall median (IQR) cost of care, income and percentage of income spent on care were ₦10 700 (₦7580-₦19 700), ₦ 65000(₦38000-₦110 000) and 17.6% (7.1%-39.7%) respectively. Though 70 (34.8%) of the respondents were aware of health insurance scheme, only 12.8% were enrolled. There were significant differences in the households' health care financing methods with respect to the socioeconomic status (P = .010), paternal level of education (P < .001), maternal occupation (P = .020), paternal occupation (P = .030) and distribution of income (P < .001). Catastrophic spending was experienced by 67.4% of the household, all of whom paid via out-of-pocket payment (OOPP) (P < .001), catastrophic health spending (CHS) was significantly associated with death and discharge against medical advice (DAMA) (P = .023). All cases of mortality and 93% cases of DAMA occurred with paying out of pocket (OOP) (P = .168). Conclusion. health care services were majorly paid for OOP among households in this study and CHS are high among these households. Clinical and financial outcomes were worse when health care services were paid through OOP.
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Affiliation(s)
- Adekunle Bamidele Taiwo
- Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria.,Zankli Medical Services, Utako, Abuja, Nigeria
| | - Odunayo Adebukola Fatunla
- Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria.,Afe-babalola University, Ado Ekiti, Nigeria
| | - Olatunde Ezra Ogundare
- Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria.,Ekiti State University, Ado Ekiti, Nigeria
| | - Oludare Isaac Oluwayemi
- Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria.,Ekiti State University, Ado Ekiti, Nigeria
| | - Adefunke Olarinre Babatola
- Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria.,Ekiti State University, Ado Ekiti, Nigeria
| | - Adebukola Bidemi Ajite
- Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria.,Ekiti State University, Ado Ekiti, Nigeria
| | | | | | | | - Oladele Simeon Olatunya
- Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria.,Zankli Medical Services, Utako, Abuja, Nigeria
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Is there an ex-ante moral hazard on Indonesia's health insurance? An impact analysis on household waste management behavior. PLoS One 2022; 17:e0276521. [PMID: 36520868 PMCID: PMC9754289 DOI: 10.1371/journal.pone.0276521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 10/10/2022] [Indexed: 12/23/2022] Open
Abstract
The presence of ex-ante moral hazard could undermine the potential gain from expanding health insurance coverage in developing nations. To test the proposition, this study utilizes a nationally representative longitudinal survey with Indonesia's health insurance for poor policy in 2014 as the quasi-experimental case study. The country represents developing nations that undergo a massive and rapid expansion of health insurance coverage. The empirical approach combines a matching and difference-in-differences method to obviate potential bias of the selectivity nature of health insurance provision and time-invariant unobserved factors. The findings suggest the presence of ex-ante moral hazard in the form of the less people using trash cans associated with the introduction of the subsidized health insurance premium. The results add empirical findings of a negative side effect of expanding health insurance coverage in developing nations.
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Zhang H, Chen S, Dong D. Association of migration status with quality of life among rural and urban adults with rare diseases: A cross-sectional study from China. Front Public Health 2022; 10:1030828. [PMID: 36438276 PMCID: PMC9686420 DOI: 10.3389/fpubh.2022.1030828] [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: 08/29/2022] [Accepted: 10/26/2022] [Indexed: 12/15/2022] Open
Abstract
Background A considerable proportion of rare disease patients decide to migrate to access a definitive diagnosis or appropriate care, which could affect their quality of life in a long term. Objective To compare quality of life (QoL) between migrants and residents and explore the possible mechanism of how migration influence the QoL among rural and urban adults with rare diseases, respectively. Methods A cross-sectional study at national level was conducted in a study sample of 1,150 adult patients in China. Migration was defined as being away from one's original place of residence for at least 12 months. Patients who remained in their place of residence in the past 12 months ("resident") were treated as a comparison group for "migrants". Original area of residence (rural vs. urban) for both residents and migrants was used for comparison. The brief version of the World Health Organization Quality of Life instrument was used to measure QoL. Multiple linear regression analyses were adopted to assess the direct association between migration status and QoL after controlling for the confounders that affect QoL. The indirect associations between migration status and QoL, mediated by potential mediators including number of family members living together, individual income, catastrophic health expenditure, and social support, were estimated using the mediation model. Results Among the group of rural participants, migration was directly associated with physical QoL (β = 5.07, 95% CI 2.01-8.13) and environmental QoL (3.95, 1.37-6.53), indirectly associated with physical QoL (0.58, 0.05-1.28) and social QoL (0.50, 0.01-1.16) via individual income, and also indirectly associated with environmental QoL (-0.47, -1.12 to -0.50) via tangible support. On the other hand, neither direct nor indirect associations of migration with four domain scores of QoL were significant among the group of urban participants. Conclusion Among rural adults with rare diseases, migration was found to have positive direct effect on physical and environmental QoL, positive indirect effect on physical and social QoL through increased individual income, and negative indirect effect on environmental QoL via reduced tangible support. By contrast, neither direct nor indirect associations of migration with QoL were significant among the group of urban participants.
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Affiliation(s)
- Huanyu Zhang
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Shanquan Chen
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Dong Dong
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China,JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, China,*Correspondence: Dong Dong
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Anderson R, Williams A, Jess N, Read JM, Limmer M. The impact of professional midwives and mentoring on the quality and availability of maternity care in government sub-district hospitals in Bangladesh: a mixed-methods observational study. BMC Pregnancy Childbirth 2022; 22:827. [PMID: 36348362 PMCID: PMC9644636 DOI: 10.1186/s12884-022-05096-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 10/04/2022] [Indexed: 11/09/2022] Open
Abstract
Background This study compared government sub-district hospitals in Bangladesh without globally standard midwives, with those with recently introduced midwives, both with and without facility mentoring, to see if the introduction of midwives was associated with improved quality and availability of maternity care. In addition, it analysed the experiences of the newly deployed midwives and the maternity staff and managers that they joined. Methods This was a mixed-methods observational study. The six busiest hospitals from three pre-existing groups of government sub-district hospitals were studied; those with no midwives, those with midwives, and those with midwives and mentoring. For the quantitative component, observations of facility readiness (n = 18), and eight quality maternity care practices (n = 641) were carried out using three separate tools. Willing maternity staff (n = 237) also completed a survey on their knowledge, perceptions, and use of the maternity care interventions. Descriptive statistics and logistic regression were used to identify differences between the hospital types. The qualitative component comprised six focus groups and 18 interviews involving midwives, other maternity staff, and managers from the three hospital types. Data were analysed using an inductive cyclical process of immersion and iteration to draw out themes. The quantitative and qualitative methods complemented each other and were used synergistically to identify the study’s insights. Results Quantitative analysis found that, of the eight quality practices, hospitals with midwives but no mentors were significantly more likely than hospitals without midwives to use three: upright labour (94% vs. 63%; OR = 22.57, p = 0.001), delayed cord clamping (88% vs. 11%; OR = 140.67, p < 0.001), skin-to-skin (94% vs. 13%; OR = 91.21, p < 0.001). Hospitals with mentors were significantly more likely to use five: ANC card (84% vs. 52%; OR = 3.29, p = 0.002), partograph (97% vs. 14%; OR = 309.42, p = 0.002), upright positioning for labour (95% vs. 63%; OR = 1850, p < 0.001), delayed cord clamping (98% vs. 11%; OR = 3400, p = 0.003), and skin-to-skin contact following birth (93% vs. 13%; OR = 70.89, p < 0.001) Qualitative analysis identified overall acceptance of midwives and the transition to improved quality care; this was stronger with facility mentoring. The most resistance to quality care was expressed in facilities without midwives. In facilities with midwives and mentoring, midwives felt proud, and maternity staff conveyed the greatest acceptance of midwives. Conclusion Facilities with professional midwives had better availability and quality of maternity care across multiple components of the health system. Care quality further improved with facility mentors who created enabling environments, and facilitated supportive relationships between existing maternity staff and managers and the newly deployed midwives. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05096-x.
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Chen S, Dong D. Improving Insurance Protection for Rare Diseases: Economic Burden and Policy Effects - Simulation of People With Pompe Disease in China. Int J Health Policy Manag 2022; 12:6282. [PMID: 36404504 PMCID: PMC10125180 DOI: 10.34172/ijhpm.2022.6282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/28/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The economic burden of Pompe disease (PD) is under-researched. This study aimed to fill this gap and provide evidence-based suggestions for policy improvement based on policy simulation. METHODS Data were derived from a nationally based cross-sectional survey on rare diseases in early 2018. Answers from 92 PD patients were used for data analysis and simulation. Catastrophic health expenditure (CHE) and impoverishment due to illness (IDI) were adopted to measure PD patients' economic burden. Two typical reimbursement patterns, a dosage-based model and a cost-based model, in China were simulated. RESULTS Twenty-four pediatric and 68 adult PD patients were investigated. Families with pediatric PD patients on average had lower annual household incomes than families with adult PD patients (RMB 37 890 vs. RMB 66 120). The direct medical expense and out-of-pocket expenses were almost double for pediatric patients compared with adult patients (RMB 120 050 vs. RMB 66 350; RMB 112 710 vs. RMB 57 940, respectively). The direct non-medical expense for patients was almost six times the expense of adult patients (RMB 73 790 vs. RMB 13 080, respectively). About 88.24% of families with pediatric PD patients and 67.21% of families with adult PD patients suffered from CHE. Around 84.21% of families with pediatric PD patients and 45.90% of families with adult PD patients were forced to live in poverty due to illness. The simulation indicated that, although the two current reimbursement schemes helped reduce CHE, they almost had no effect on reducing IDI; the dosage-based model was more sensitive to changes in policy parameters. CONCLUSION Our study highlighted the alarmingly high disease burden faced by PD patients with first-hand patient-reported evidence. Our series of simulations could be a good reference for China and other countries to improve their reimbursement policy regarding PD.
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Affiliation(s)
- Shanquan Chen
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Dong Dong
- Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
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Kim CO. Effect of Health Shocks on Poverty Status in South Korea: Exploring the Mechanism of Medical Impoverishment. Int J Health Policy Manag 2022; 11:2090-2102. [PMID: 34523865 PMCID: PMC9808294 DOI: 10.34172/ijhpm.2021.97] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/04/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND South Korea has the highest out-of-pocket burden for medical expenses among the Organisation for Economic Co-operation and Development (OECD) member countries and has no formal sickness benefit system, along with United States and Switzerland, greatly increasing the risk of poverty due to a sudden illness. METHODS We identify the causal effect of health shocks on poverty status and explore the mechanisms of medical impoverishment by analyzing longitudinal data from 13 670 households that participated in the representative Korean Welfare Panel Study (KOWEPS) from 2007 to 2016. In this study, we define a health shock as a case in which no household members were hospitalized in the previous year, but together they had more than 30 days of hospitalization in this year. The propensity score matching method was combined with a mediation analysis in this work. RESULTS The proportion of households in absolute poverty increased by 4.6-8.0 percentage points among households that experienced a health shock compared with matched controls. The selection effects due to health shock were estimated to be 5.6-8.2 percentage points. On average, a sudden hospitalization reduces annual non-medical expenditures and equivalized disposable income by just over 3.2 million KRW (2500 USD) and 1.2 million KRW (1000 USD), respectively. Health shock induces impoverishment after one year through both the medical expense and work capacity pathways, which explain 12.8% and 12.8% of the total effect, respectively. However, when we decompose the mediation effect of a health shock on poverty status after two years, we find that a health shock leads to poverty mainly through labor force nonparticipation (9.9%). CONCLUSION Income stabilizing scheme to protect households that experience a health shock should be introduced as a policy alternative to confront the issue of medical impoverishment.
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Affiliation(s)
- Chang-O Kim
- Visiting Doctors Program of Medical Home, Seoul, Republic of Korea
- Institute of Social Welfare, SungKongHoe University, Seoul, Republic of Korea
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Pagiwa V, Shiell A, Barraclough S, Seitio-Kgokgwe O. A Review of the User Fees Policy for Primary Healthcare Consultations in Botswana: Problems With Effective Planning, Implementation and Evaluation. Int J Health Policy Manag 2022; 11:2228-2235. [PMID: 34814676 PMCID: PMC9808281 DOI: 10.34172/ijhpm.2021.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/06/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The Government of Botswana introduced user-fees for primary healthcare consultations in 1975. The policy has remained in place since then, although the fee has remained largely unaltered despite rising inflation. Early reviews of the policy pointed to problems in its implementation, but there has been no evaluation in the past 20 years. The aim of this study was to review the policy to assess whether documented issues with its implementation have been addressed. METHODS This qualitative study involved interviews with 32 key informants: 18 policy-makers and 14 front-line revenue collectors. Data were analysed thematically using a template approach with constructs from an established organizational capacity assessment framework used as predetermined categories to guide data collection and analysis. RESULTS Limited administrative and management capacity has been a major hindrance to effective implementation of the policy. The lack of infrastructure for effective revenue collection led to misappropriation of funds. Lack of clear guidelines for health facilities on how to implement the policy generated interdepartmental conflicts. Study participants believed the current policy was unlikely to be cost-effective since the cost of collecting fees probably exceeded the revenue it generated. CONCLUSION If the Botswana Government persists with the policy then it needs to improve organizational capacity to collect and manage revenues efficiently. However, policy thinking since the turn of the century has turned away from user-charges in healthcare as they impede the move towards universal access. It is timely therefore to consider alternative financing approaches that are more effective and a more equitable means of paying for healthcare.
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Affiliation(s)
- Vincent Pagiwa
- Okavango Research Institute, University of Botswana, Maun, Botswana
| | - Alan Shiell
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Simon Barraclough
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
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Chadha VK, Praseeja P, Srivastava R, Shivashankar BA, Hemanth Kumar NK, Padmesha R, Suganthi P, Umadevi G, Narayana L, Magesh V, Nagendra N, Puttaswamy G, Jaiswal R, Somashekar N. Pre-treatment delay and out of pocket expenses by notified new tuberculosis patients in an Indian mega city. Indian J Tuberc 2022; 69:446-452. [PMID: 36460374 DOI: 10.1016/j.ijtb.2021.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/21/2021] [Accepted: 07/01/2021] [Indexed: 06/17/2023]
Abstract
BACKGROUND Study was carried out to find out delay from onset of symptoms and out of pocket expenditure (OOPE) until initiation of anti-TB treatment (ATT) by new Tuberculosis (TB) patients registered in public health facilities in Bengaluru. METHODS Notified patients (N = 228) selected purposively were interviewed at initiation of ATT regarding number and type of facilities visited and delay in initiating ATT. OOPE was elicited separately for in- and out-patient visits, towards consultation, purchase of medicines, diagnostic tests, transportation, hospitalization and food. Dissaving or money borrowed was ascertained. RESULTS Two-thirds of participants were 15-44 years of age and 56% were males, mean annual household income was $4357. About 75% first visited a private health facility; 68% and 87% respectively were diagnosed and started on ATT in public sector after visiting an average of three facilities and after a mean delay of 68 days; the median delay was 44 days. Of mean OOPE of $402, 54% was direct medical expenditure, 5% non-medical direct and 41% indirect. OOPE was higher for Extra-pulmonary TB compared to PTB and when number of health facilities visited before initiating treatment was >3 compared to those who visited ≤3 and when the time interval between onset of symptoms and treatment initiation (total delay) was >28 days compared to when this interval was ≤28 days. About 20% suffered catastrophic expenditure; 34% borrowed money and 37% sold assets. CONCLUSION Concerted efforts are needed to reduce delay and OOPE in pre-treatment period and social protection to account for indirect expenditure.
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Affiliation(s)
- V K Chadha
- National Tuberculosis Institute, Ministry of Health and Family Welfare, Bengaluru, India.
| | - P Praseeja
- National Tuberculosis Institute, Ministry of Health and Family Welfare, Bengaluru, India; Data Processing Center, National Statistical Office, Ministry of Statistics and Program Implementation, Bengaluru, India
| | - R Srivastava
- National Tuberculosis Institute, Ministry of Health and Family Welfare, Bengaluru, India
| | - B A Shivashankar
- National Tuberculosis Institute, Ministry of Health and Family Welfare, Bengaluru, India
| | - N K Hemanth Kumar
- National Tuberculosis Institute, Ministry of Health and Family Welfare, Bengaluru, India
| | - R Padmesha
- National Tuberculosis Institute, Ministry of Health and Family Welfare, Bengaluru, India
| | - P Suganthi
- National Tuberculosis Institute, Ministry of Health and Family Welfare, Bengaluru, India
| | - G Umadevi
- National Tuberculosis Institute, Ministry of Health and Family Welfare, Bengaluru, India
| | - Lakshmi Narayana
- National Tuberculosis Institute, Ministry of Health and Family Welfare, Bengaluru, India
| | - V Magesh
- National Tuberculosis Institute, Ministry of Health and Family Welfare, Bengaluru, India
| | - N Nagendra
- National Tuberculosis Institute, Ministry of Health and Family Welfare, Bengaluru, India
| | - G Puttaswamy
- National Tuberculosis Institute, Ministry of Health and Family Welfare, Bengaluru, India
| | - R Jaiswal
- National Tuberculosis Institute, Ministry of Health and Family Welfare, Bengaluru, India; National Pharmaceutical Pricing Authority, Ministry of Chemical and Fertilizers, New Delhi, India
| | - N Somashekar
- National Tuberculosis Institute, Ministry of Health and Family Welfare, Bengaluru, India
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Opoku Duku SK, Nketiah‐Amponsah E, Fenenga CJ, Janssens W, Pradhan M. The effect of community engagement on healthcare utilization and health insurance enrollment in Ghana: Results from a randomized experiment. HEALTH ECONOMICS 2022; 31:2120-2141. [PMID: 35944042 PMCID: PMC9545140 DOI: 10.1002/hec.4556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/05/2021] [Accepted: 05/25/2022] [Indexed: 06/15/2023]
Abstract
Health insurance enrollment in many Sub-Saharan African countries is low, even with highly subsidized premiums and exemptions for vulnerable populations. One possible explanation is low service quality, which results in a low valuation of health insurance. Using a randomized control trial in 64 primary health care facilities in Ghana, this study assesses the impact of a community engagement intervention designed to improve the quality of healthcare and health insurance services on households living nearby the facilities. Although the intervention improved the medical-technical quality of health services, our results show that households' subjective perceptions of the quality of healthcare and insurance services did not increase. Nevertheless, the likelihood of illness and concomitant healthcare utilization reduced, and especially households who were not insured at baseline were more likely to enroll in health insurance. The results show that solely increasing the technical quality of care is not sufficient to increase households' subjective assessments of healthcare quality. Still, improving technical quality can directly contribute to health outcomes and further increase health insurance coverage, especially among the previously uninsured.
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Affiliation(s)
| | | | - Christine J. Fenenga
- Department of Health ScienceUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Wendy Janssens
- Vrije Universiteit (VU) Amsterdam and Amsterdam Institute of Global Health and Development (AIGHD)AmsterdamThe Netherlands
| | - Menno Pradhan
- Vrije Universiteit (VU) AmsterdamUniveristy of Amsterdam and Amsterdam Institute of Global Health and Development (AIGHD)AmsterdamThe Netherlands
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Palileo-Villanueva LM, Palafox B, Amit AML, Pepito VCF, Ab-Majid F, Ariffin F, Balabanova D, Isa MR, Mat-Nasir N, My M, Renedo A, Seguin ML, Yusoff K, Dans AL, Mckee M. Prevalence, determinants and outcomes of traditional, complementary and alternative medicine use for hypertension among low-income households in Malaysia and the Philippines. BMC Complement Med Ther 2022; 22:252. [PMID: 36180884 PMCID: PMC9526286 DOI: 10.1186/s12906-022-03730-x] [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: 12/09/2021] [Accepted: 09/19/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Traditional, complementary and alternative medicine (TCAM) is used to treat a broad range of conditions. In low- and middle-income countries (LMICs), TCAM use is particularly common among those with low socio-economic status. To better understand the patterns and impact of TCAM use on the management of non-communicable diseases in these populations, this study examines the prevalence and characteristics of TCAM use for hypertension, its determinants, and its association with hypertension management outcomes and wellbeing among low-income adults in two Southeast Asian countries at different levels of economic and health system development, Malaysia and the Philippines. METHODS We analysed cross-sectional data from 946 randomly selected adults diagnosed with hypertension from low-income rural and urban communities in Malaysia (n = 495) and the Philippines (n = 451). We compared the prevalence, characteristics and household expenditure on TCAM use between countries and used multi-level, mixed-effects regression to estimate associations between TCAM use and its determinants, and five hypertension management outcomes and wellbeing. RESULTS The prevalence of TCAM use to manage hypertension was higher in the Philippines than in Malaysia (18.8% vs 8.8%, p < 0.001). Biologically-based modalities, e.g. herbal remedies, were the most common type of TCAM used in both countries, mainly as a complement, rather than an alternative to conventional treatment. Households allocated around 10% of health spending to TCAM in both countries. Belief that TCAM is effective for hypertension was a positive predictor of TCAM use, while belief in conventional medicine was a negative predictor. TCAM use was not strongly associated with current use of medications for hypertension, self-reported medication adherence, blood pressure level and control, or wellbeing in either country. CONCLUSIONS A small, but significant, proportion of individuals living in low-income communities in Malaysia and the Philippines use TCAM to manage their hypertension, despite a general lack of evidence on efficacy and safety of commonly used TCAM modalities. Recognising that their patients may be using TCAM to manage hypertension will enable health care providers to deliver safer, more patient-centred care.
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Affiliation(s)
| | - Benjamin Palafox
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Centre for Global Chronic Conditions, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Arianna Maever L Amit
- College of Medicine, University of the Philippines Manila, Manila, Philippines.,School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
| | - Veincent Christian F Pepito
- College of Medicine, University of the Philippines Manila, Manila, Philippines.,School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
| | - Fadhlina Ab-Majid
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - Farnaza Ariffin
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - Dina Balabanova
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Centre for Global Chronic Conditions, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Mohamad-Rodi Isa
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - Nafiza Mat-Nasir
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - Mazapuspavina My
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - Alicia Renedo
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Centre for Global Chronic Conditions, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Maureen L Seguin
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Centre for Global Chronic Conditions, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Khalid Yusoff
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia.,Faculty of Medicine and Health Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Antonio L Dans
- College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Martin Mckee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Centre for Global Chronic Conditions, 15-17 Tavistock Place, London, WC1H 9SH, UK
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Ihyauddin Z, Marthias T, Anindya K, Ng N, Dewi FST, Hulse ESG, Aji RP, Putri DAD, Lee JT. The relative impact of underweight, overweight, smoking, and physical inactivity on health and associated costs in Indonesia: propensity score matching of a national sample. BMC Health Serv Res 2022; 22:1170. [PMID: 36115979 PMCID: PMC9482737 DOI: 10.1186/s12913-022-08546-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/21/2022] [Indexed: 12/02/2022] Open
Abstract
Background Indonesia is in the middle of a rapid epidemiological transition with an ageing population and increasing exposure to risk factors for chronic conditions. This study examines the relative impacts of obesity, tobacco consumption, and physical inactivity, on non-communicable diseases multimorbidity, health service use, catastrophic health expenditure (CHE), and loss in employment productivity in Indonesia. Methods Secondary analyses were conducted of cross-sectional data from adults aged ≥ 40 years (n = 12,081) in the Indonesian Family Life Survey 2014/2015. We used propensity score matching to assess the associations between behavioural risk factors and health service use, CHE, employment productivity, and multimorbidity. Results Being obese, overweight and a former tobacco user was associated with a higher number of chronic conditions and multimorbidity (p < 0.05). Being a former tobacco user contributed to a higher number of outpatient and inpatient visits as well as CHE incidences and work absenteeism. Physical inactivity relatively increased the number of outpatient visits (30% increase, p < 0.05) and work absenteeism (21% increase, P < 0.06). Although being underweight was associated with an increased outpatient care utilisation (23% increase, p < 0.05), being overweight was negatively associated with CHE incidences (50% decrease, p < 0.05). Conclusion Combined together, obesity, overweight, physical inactivity and tobacco use contributed to an increased number of NCDs as well as medical costs and productivity loss in Indonesia. Interventions addressing physical and behavioural risk factors are likely to have substantial benefits for individuals and the wider society in Indonesia. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08546-6.
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Atreya K, Rimal NS, Makai P, Baidya M, Karki J, Pohl G, Bhattarai S. Dalit's livelihoods in Nepal: income sources and determinants. ENVIRONMENT, DEVELOPMENT AND SUSTAINABILITY 2022; 25:1-29. [PMID: 35909425 PMCID: PMC9325665 DOI: 10.1007/s10668-022-02582-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 07/15/2022] [Indexed: 06/15/2023]
Abstract
This paper focuses on the lack of income opportunities for Dalits in Nepal, as they are the most affected group in any disaster. The presence of vulnerable family members in Dalit households may further increase their income deprivation. We therefore studied Dalit households' income sources and identified income determinants in Gandaki Rural Municipality in Gorkha District-the epicentre of the 2015 earthquake. We observed a higher dependency of Dalit households on daily wages, livestock sales, social security allowances, and vegetables sales; however, remittance and seasonal job earnings represented the largest share of household incomes. We observed a significant difference in per capita income between farm (US$46) and non-farm (US$273) income sources, with the difference smallest in the lowest income quantile and the largest in the highest quantile. When the household head was a single woman, we observed a reduction in non-farm (by 29%) and total incomes (by 23%). Likewise, when the household head had a chronic health problem, or the household included an elderly family member, there was a reduction in the household's income. We suggest economic interventions for Dalit households to prevent increased social exclusion in the development process, specifically focusing on vulnerable individuals and households in the lowest income quantile.
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Affiliation(s)
- Kishor Atreya
- School of Forestry and Natural Resource Management, Institute of Forestry, Tribhuvan University, Kathmandu, Nepal
- Department of Watershed Management and Environmental Science, Institute of Forestry, Pokhara Campus, Tribhuvan University, Pokhara, Nepal
| | | | | | | | - Jiban Karki
- PHASE Nepal, GPO Box 12888, Kathmandu, Nepal
| | - Gerda Pohl
- PHASE Nepal, GPO Box 12888, Kathmandu, Nepal
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Adeniji FIP, Lawanson AO, Osungbade KO. The microeconomic impact of out-of-pocket medical expenditure on the households of cardiovascular disease patients in general and specialized heart hospitals in Ibadan, Nigeria. PLoS One 2022; 17:e0271568. [PMID: 35849602 PMCID: PMC9292125 DOI: 10.1371/journal.pone.0271568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 07/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Cardiovascular diseases (CVDs) present a huge threat to population health and in addition impose severe economic burden on individuals and their households. Despite this, there is no research evidence on the microeconomic impact of CVDs in Nigeria. Therefore, this study estimated the incidence and intensity of catastrophic health expenditures (CHE), poverty headcount due to out-of-pocket (OOP) medical spending and the associated factors among the households of a cohort of CVDs patients who accessed healthcare services in public and specialized heart hospitals in Ibadan, Nigeria.
Methods
This study adopts a descriptive cross-sectional study design. A standardized data collection questionnaire developed by the Initiative for Cardiovascular Health Research in Developing Countries was adapted to electronically collect data from all the 744 CVDs patients who accessed healthcare services in public and specialized heart hospitals in Ibadan between 4th November 2019 to the 31st January 2020. A sensitivity analysis, using rank-dependent thresholds of CHE which ranged from 5%-40% of household total expenditures was carried out. The international poverty line of $1.90/day recommended by the World Bank was utilized to ascertain poverty headcounts pre-and post OOP payments for healthcare services. Categorical variables like household socio-demographic and clinical characteristics, CHE and poverty headcounts, were presented using percentages and proportions. Unadjusted and adjusted logistic regression models were used to assess the factors associated with CHE and poverty. Data were analyzed using STATA version 15 and estimates were validated at 5% level of significance.
Results
Catastrophic OOP payment ranged between 3.9%-54.6% and catastrophic overshoot ranged from 1.8% to 12.6%. Health expenditures doubled poverty headcount among households, from 8.13% to 16.4%. Having tertiary education (AOR: 0.49, CI: 0.26–0.93, p = 0.03) and household size (AOR: 0.40, CI: 0.24–0.67, p = 0.001) were significantly associated with CHE. Being female (AOR: 0.41, CI: 0.18–0.92, p = 0.03), household economic status (AOR: 0.003, CI: 0.0003–0.25, p = <0.001) and having 3–4 household members (AOR: 0.30, CI: 0.15–0.61, p = 0.001) were significantly associated with household poverty status post payment for medical services.
Conclusion
OOP medical spending due to CVDs imposed enormous strain on household resources and increased the poverty rates among households. Policies and interventions that supports universal health coverage are highly recommended.
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Affiliation(s)
- Folashayo Ikenna Peter Adeniji
- Department of Health Policy & Management, College of Medicine, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
- * E-mail:
| | - Akanni Olayinka Lawanson
- Department of Economics, Faculty of Economics & Management Sciences, University of Ibadan, Ibadan, Nigeria
| | - Kayode Omoniyi Osungbade
- Department of Health Policy & Management, College of Medicine, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
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Binyaruka P, Borghi J. An equity analysis on the household costs of accessing and utilising maternal and child health care services in Tanzania. HEALTH ECONOMICS REVIEW 2022; 12:36. [PMID: 35802268 PMCID: PMC9264712 DOI: 10.1186/s13561-022-00387-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 06/30/2022] [Indexed: 05/30/2023]
Abstract
BACKGROUND Direct and time costs of accessing and using health care may limit health care access, affect welfare loss, and lead to catastrophic spending especially among poorest households. To date, limited attention has been given to time and transport costs and how these costs are distributed across patients, facility and service types especially in poor settings. We aimed to fill this knowledge gap. METHODS We used data from 1407 patients in 150 facilities in Tanzania. Data were collected in January 2012 through patient exit-interviews. All costs were disaggregated across patients, facility and service types. Data were analysed descriptively by using means, medians and equity measures like equity gap, ratio and concentration index. RESULTS 71% of patients, especially the poorest and rural patients, accessed care on foot. The average travel time and cost were 30 minutes and 0.41USD respectively. The average waiting time and consultation time were 47 min and 13 min respectively. The average medical cost was 0.23 USD but only18% of patients paid for health care. The poorest and rural patients faced substantial time burden to access health care (travel and waiting) but incurred less transport and medical costs compared to their counterparts. The consultation time was similar across patients. Patients spent more time travelling to public facilities and dispensaries while incurring less transport cost than accessing other facility types, but waiting and consultation time was similar across facility types. Patients paid less amount in public than in private facilities. Postnatal care and vaccination clients spent less waiting and consultation time and paid less medical cost than antenatal care clients. CONCLUSIONS Our findings reinforce the need for a greater investment in primary health care to reduce access barriers and cost burdens especially among the worse-offs. Facility's construction and renovation and increased supply of healthcare workers and medical commodities are potential initiatives to consider. Other initiatives may need a multi-sectoral collaboration.
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Affiliation(s)
- Peter Binyaruka
- Department of Health System, Impact Evaluation and Policy, Ifakara Health Institute, PO Box 78373, Dar es Salaam, Tanzania
| | - Josephine Borghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
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Paul SS, Schröder-Butterfill E. The Psychological and Economic Impacts of Caregiving on Family Carers for People with Probable Dementia in Rural South India. J Cross Cult Gerontol 2022; 37:201-219. [PMID: 35779164 DOI: 10.1007/s10823-022-09455-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2022] [Indexed: 11/29/2022]
Abstract
Informal carers play a vital role in the care and well-being of older people with dementia. This article examines the psychological and economic impacts caregiving has on carers of people with suspected dementia and the mechanisms by which they cope with challenges. A mixed-method design was adopted. A baseline survey of 123 older people was undertaken in a resource-poor setting in Kerala, India, using Addenbrooke's Cognitive Examination - Malayalam Version (ACE-m) to identify those with probable dementia. This was followed by in-depth interviews with ten carers of those identified as having cognitive impairment. The data were later transcribed and thematically analysed using N-Vivo to identify main concepts and themes. Analysis of the in-depth interviews with carers revealed that dementia was often interpreted as a 'second childhood', but that this conceptualisation aided carers to cope better. Anger and irritation were the commonly expressed psychological reactions which got accentuated by lack of reciprocation of emotion on the part of care recipient. Government support through social security measures and medical care, along with traditional social practises, helped carers to tide over care expenses. These support systems lessened the psychological and economic impacts of caring. Misconstruction of the disease nature, for example by considering it a normal part of ageing, also seem inadvertently to have helped in coping with care requirements, although this comes at a cost of lower than optimal healthcare access for older people with cognitive impairment.
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Affiliation(s)
- Sherin S Paul
- Department of Community Medicine, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India, 689101.
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Sinha A, Kerketta S, Ghosal S, Kanungo S, Pati S. Multimorbidity Among Urban Poor in India: Findings From LASI, Wave-1. Front Public Health 2022; 10:881967. [PMID: 35719649 PMCID: PMC9201724 DOI: 10.3389/fpubh.2022.881967] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/06/2022] [Indexed: 12/17/2022] Open
Abstract
Background Multimorbidity has become a norm in low-and middle-income countries such as India requiring notable health system improvements to combat. Urban population is a heterogeneous group where poor are at a risk of facing inequity in accessing healthcare services which can jeopardize our efforts to attain universal health coverage (UHC). We aimed to estimate the prevalence, assess correlates and patterns of multimorbidity among urban poor. Further, we assessed the outcomes of multimorbidity such as healthcare utilization, expenditure and self-rated health. Methods Longitudinal Aging Study in India (LASI), wave-1 is a nationally representative survey conducted amongst participants aged ≥45 years in 2017–18. We included 9,327 participants residing in urban areas, categorized as poor based on monthly per capita expenditure. Descriptive statistics computed prevalence with 95% uncertainty interval. Multivariable logistic regression was executed to assess the association between multimorbidity and various correlates, expressed as adjusted odds ratio. An ordinal regression model was run between self-rated health and number of chronic conditions. Results The prevalence of multimorbidity was 45.26% among the urban poor. Hypertension and oral morbidities were the most commonly observed dyad. Respondents who were poorer [AOR: 1.27 (1.06–1.51)] had higher chances of having multimorbidity than the poorest. Respondents with a health insurance [AOR: 1.40 (1.14–1.70)] had a higher risk of having multimorbidity. In-patient admission was significantly higher among participants having multimorbidity. Out of pocket expenditure increased while self-rated health deteriorated with each additional morbid condition. Conclusion Multimorbidity is found to be increasingly prevalent among urban poor and individuals having health insurance which demonstrates the need to expand healthcare insurance schemes such as Ayushman Bharat for urban poor to achieve UHC.
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Affiliation(s)
- Abhinav Sinha
- Department of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar, India
| | - Sushmita Kerketta
- Department of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar, India
| | - Shishirendu Ghosal
- Department of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar, India
| | - Srikanta Kanungo
- Department of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar, India
| | - Sanghamitra Pati
- Department of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar, India
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MORROW J, LAHER AE. Financial burden associated with attendance at a public hospital emergency department in Johannesburg. Afr J Emerg Med 2022; 12:102-105. [PMID: 35251920 PMCID: PMC8886001 DOI: 10.1016/j.afjem.2022.02.002] [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: 10/02/2021] [Revised: 01/01/2022] [Accepted: 02/08/2022] [Indexed: 11/19/2022] Open
Abstract
Poverty and inequality are two of the most significant issues affecting people living in Africa Catastrophic health care expenditure (CHCE), which is out-of-pocket expenditure on medical care that leads to a severe financial burden for the individual or household, affects 44 million individuals from 150 million households globally Various expenses including transport costs, general practitioner fees acquired prior to the EC visit, loans and loss of usual daily income contribute to the financial burden associated with a visit to the EC
Introduction: More than half of South Africans live below the poverty line. Indirect medical costs can contribute significantly to the financial burden of patients seeking medical care. The aim of this study was to determine the expenses incurred by patients and/or their escorts during a visit to the emergency centre (EC). Methods: Patients and/or their escorts presenting to an EC in Johannesburg were asked to complete the study questionnaire relating to expenses incurred during a visit to the EC. Results: Of the total 396 participants that completed the questionnaire, 108 (27.2%) did not have any source of income, 146 (36.9%) were the sole breadwinner in their household and 36 (9.1%) belonged to zero-income households. Among those earning ≤R2000 per month, the mean expenses relating to the EC visit was R240 (SD R372), equating to an average of 33.2% of mean monthly income. Transport costs were the most common expense (n=302, 76.3%), while general practitioner (GP) fees incurred prior to the EC visit accounted for the bulk of the expenses (median R450, IQR 350-820). Participants that earned >R2000 per month were significantly more likely to incur GP fees (p =0.012), while those earning ≤R2000 per month were significantly more likely to take a loan to cover EC related expenses (p =0.014). Conclusion: A visit to the EC can have a substantial financial impact on patients and their accompanying escorts in South Africa. Strategies should be aimed at identifying and assisting those that are in need of financial assistance to cover indirect healthcare costs.
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Ogundare EO, Taiwo AB, Olatunya OS, Afolabi MO. Incidence of Catastrophic Health Expenditures Amongst Hospitalized Neonates in Ekiti, Southwest Nigeria. CLINICOECONOMICS AND OUTCOMES RESEARCH 2022; 14:383-394. [PMID: 35607411 PMCID: PMC9123901 DOI: 10.2147/ceor.s360650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background Neonatal illnesses require huge spending due to prolonged hospital stay. The management of these illnesses is usually financed by individual families which in most instances are living below the poverty line. This healthcare financing method can readily push families into catastrophic spending on health. Aim To ascertain the average cost of managing common neonatal illnesses and the financial burden, it constitutes to families in Ekiti State, southwest Nigeria. Methods We conducted a cross-sectional study on the out-of-pocket spending involved in managing neonates admitted into and discharged from the SCBU of the Ekiti State University Teaching Hospital, Ado-Ekiti, southwest Nigeria. Data collected included the monthly family income, the money spent on drugs, laboratory investigations and the hospital bill using a purposely designed structured questionnaire. Healthcare spending greater than 10% of the overall family income was described as catastrophic health spending (CHS). Results The medical bills for most (95%) of the 119 study participants were paid through the out-of-pocket means and 81.5% of the families spent more than 10% of their monthly earnings (CHS) to settle medical bills. Close to 50% of the families belonged to the lower social economic class. The median (IQR) duration of hospital stay was 2.75 days (3.0–8.0). The median (IQR) total expenditure was N24,500.00 (N13,615.00–N41,487.50). The median (IQR) expenditure for the treatment of prematurity was highest at N55,075.00 (USD 133.10) [N27,350.00 (USD 66.10)–N105,737.50 (USD 255.53)] and more than 60.5% of the expenses was on hospital utilities and consumables. The length of hospital stay showed a robust positive correlation with the total hospital bill (r = 0.576, P < 0.001). Conclusion Neonatal illnesses put many households at risk of catastrophic health spending. There is need for increased government investment in health and extension of the health insurance scheme to all the citizens of the country.
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Affiliation(s)
- Ezra O Ogundare
- Department of Paediatrics, Ekiti State University, Ado-Ekiti, Nigeria
- Department of Paediatrics and Child Health, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria
- Correspondence: Ezra O Ogundare, Department of Paediatrics, Ekiti State University, Ado-Ekiti, Nigeria, Tel +234-803-501-7416, Email
| | - Adekunle B Taiwo
- Department of Paediatrics, Zankli Medical Services, Abuja, Nigeria
| | - Oladele S Olatunya
- Department of Paediatrics, Ekiti State University, Ado-Ekiti, Nigeria
- Department of Paediatrics and Child Health, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria
| | - Muhammed O Afolabi
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Jung H, Kwon YD, Noh JW. Financial burden of catastrophic health expenditure on households with chronic diseases: financial ratio analysis. BMC Health Serv Res 2022; 22:568. [PMID: 35477404 PMCID: PMC9047277 DOI: 10.1186/s12913-022-07922-6] [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: 05/28/2021] [Accepted: 04/08/2022] [Indexed: 11/28/2022] Open
Abstract
Background The financial status of households is vulnerable to chronic diseases which entail high medical expenses and income loss. Financial strain can be assessed by four indicators: a household surplus indicator, the liquid asset/debt ratio, a solvency indicator, and a liquidity indicator. We investigated the association between catastrophic health expenditure (CHE) and financial ratio indicators in households with chronic diseases in South Korea. Methods This study applied thresholds to the financial ratios to determine the financial strain. We conducted multiple logistic regression analyses to determine whether CHE is associated with financial strain. Furthermore, we analyzed the relationship between CHE and basic financial indicators, absolute finance size, using multiple linear regression. Results When CHE occurred, all financial ratio indicators deteriorated. However, this was not due to decreases in the absolute size of wealth and income, but rather the relative balance between finances. In particular, the loss of liquid assets was a major factor in the deterioration. In addition, all types of labor-related income deteriorated; only private transfer income increased. Conclusions This study revealed that CHE in households with chronic diseases negatively impacts household finances. It was found that financial coping strategies are only resource consuming. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07922-6.
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Affiliation(s)
- Hyunwoo Jung
- Post Doc, Department of Health Administration, Graduate School·BK21 Graduate Program of Developing Glocal Experts in Health Policy and Management, Yonsei University, Wonju, South Korea
| | - Young Dae Kwon
- Department of Humanities and Social Medicine, College of Medicine and Catholic Institute, for Healthcare Management, The Catholic University of Korea, Seoul, South Korea
| | - Jin-Won Noh
- Division of Health Administration, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, South Korea.
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Kilale AM, Pantoja A, Jani B, Range N, Ngowi BJ, Makasi C, Majaha M, Manga CD, Haule S, Wilfred A, Hilary P, Mahamba V, Nkiligi E, Muhandiki W, Matechi E, Mutayoba B, Nishkiori N, Ershova J. Economic burden of tuberculosis in Tanzania: a national survey of costs faced by tuberculosis-affected households. BMC Public Health 2022; 22:600. [PMID: 35351063 PMCID: PMC8961947 DOI: 10.1186/s12889-022-12987-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 03/11/2022] [Indexed: 12/05/2022] Open
Abstract
Background Although tuberculosis (TB) care is free in Tanzania, TB-associated costs may compromise access to services and treatment adherence resulting in poor outcomes and increased risk of transmission in the community. TB can impact economically patients and their households. We assessed the economic burden of TB on patients and their households in Tanzania and identified cost drivers to inform policies and programs for potential interventions to mitigate costs. Methods We conducted a nationally representative cross-sectional survey using a standard methodology recommended by World Health Organization. TB patients of all ages and with all types of TB from 30 clusters across Tanzania were interviewed during July – September 2019. We used the human capital approach to assess the indirect costs and a threshold of 20% of the household annual expenditure to determine the proportion of TB-affected households experiencing catastrophic cost. We descriptively analyzed the cost data and fitted multivariable logistic regression models to identify potential predictors of catastrophic costs. Results Of the 777 TB-affected households, 44.9% faced catastrophic costs due to TB. This proportion was higher (80.0%) among households of patients with multi-drug resistant TB (MDR-TB). Overall, cost was driven by income loss while accessing TB services (33.7%), nutritional supplements (32.6%), and medical costs (15.1%). Most income loss was associated with hospitalization and time for picking up TB drugs. Most TB patients (85.9%) reported worsening financial situations due to TB, and over fifty percent (53.0%) borrowed money or sold assets to finance TB treatment. In multivariable analysis, the factors associated with catastrophic costs included hospitalization (adjusted odds ratio [aOR] = 34.9; 95% confidence interval (CI):12.5–146.17), living in semi-urban (aOR = 1.6; 95% CI:1.0–2.5) or rural areas (aOR = 2.6; 95% CI:1.8–3.7), having MDR-TB (aOR = 3.4; 95% CI:1.2–10.9), and facility-based directly-observed treatment (DOT) (aOR = 7.2; 95% CI:2.4–26.6). Conclusion We found that the cost of TB care is catastrophic for almost half of the TB-affected households in Tanzania; our findings support the results from other surveys recently conducted in sub-Saharan Africa. Collaborative efforts across health, employment and social welfare sectors are imperative to minimize household costs due to TB disease and improve access to care, patient adherence and outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12987-3.
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FERNANDES ANTUNES A, JACOBS B, JITHITIKULCHAI T, NAGPAL S, TONG K, FLESSA S. Sensitivity Analysis and Methodological Choices on Health-Related Impoverishment Estimates in Cambodia, 2009 to 2017. Health Policy Plan 2022; 37:791-807. [DOI: 10.1093/heapol/czac028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 02/10/2022] [Accepted: 03/25/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
The measurement of health-expenditure related impoverishment as a proxy of financial risk protection is regularly used as an indicator of progress towards universal health coverage. However, the use of this indicator is greatly sensitive to analysts’ choices and data sources, making comparisons across time and countries challenging.
We report the results of a sensitivity analysis of critical methodological choices in estimating health-related financial impoverishment in Cambodia from 2009 to 2017. We include in our analysis: the construction and data sources for consumption aggregates and out-of-pocket health estimates; the use of international and national absolute and relative poverty thresholds (defined by share of household food consumption); and, time and regional price adjustment methods and index sources.
Marginal changes substantially affected estimates at the national and regional levels among households. In most cases, the choice of poverty thresholds and temporal and regional deflators had a significant effect. An increase of 0.01 USD in the average daily per capita poverty line resulted in relative increases in impoverished incidences of 2.90% to 2.62% for 2009, and 3.06% to 2.95% for 2014. From 2013 onwards, estimates for impoverishment in rural areas based on median food consumption were often significantly higher than estimates using official poverty lines.
The high sensitivity of the impoverishment indicator cautions against its use in assessing health-related financial hardship and protection, especially with low and absolute poverty lines. In the context of low- and middle-income countries, assessing financial hardship in relative terms by using measures such as catastrophic health expenditure, complemented with research on coping strategies and their socio-economic effects on households, may be more conducive to policymaking goals and progress toward achieving universal health coverage.
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Affiliation(s)
- Adélio FERNANDES ANTUNES
- SOCIEUX+ EU Expertise on Social Protection, Labour and Employment; Brussels, Belgium
- University of Greifswald, Department of Health Care Management, Greifswald, Germany
| | | | - Theepakorn JITHITIKULCHAI
- Thammasat University, Faculty of Economics, Bangkok, Thailand
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, USA
- The World Bank
| | - Somil NAGPAL
- Global Practice on Health, Nutrition and Population
- East Asia and Pacific Region, The World Bank
| | - Kimsun TONG
- East Asia and Pacific Region, The World Bank
| | - Steffen FLESSA
- University of Greifswald, Department of Health Care Management, Greifswald, Germany
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Mohd Hassan NZA, Mohd Nor Sham Kunusagaran MSJ, Zaimi NA, Aminuddin F, Ab Rahim FI, Jawahir S, Abdul Karim Z. The inequalities and determinants of Households' Distress Financing on Out-off-Pocket Health expenditure in Malaysia. BMC Public Health 2022; 22:449. [PMID: 35255884 PMCID: PMC8900333 DOI: 10.1186/s12889-022-12834-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/22/2022] [Indexed: 01/02/2023] Open
Abstract
Background Out-of-pocket (OOP) payments for healthcare services potentially have severe consequences on households, especially among the poor. Under certain circumstances, healthcare payments are financed through selling household assets, or borrowings. This certainly could influence households’ decision, which likely resorts to forgoing healthcare services. Thus, the focal point of this study is aimed to identify the inequalities and determinants of distress financing among households in Malaysia. Methods This study used secondary data from the National Health and Morbidity Survey (NHMS) 2019, a national cross-sectional household survey that used a two-stage stratified random sampling design involving 5,146 households. The concentration curve and concentration index were used to determine the economic inequalities in distress financing. Whereas, the determinants of distress financing were identified using the modified Poisson regression model. Results The prevalence of borrowing without interest was the highest (13.86%), followed by borrowing with interest (1.03%) while selling off assets was the lowest (0.87%). Borrowing without interest was highest among rural (16.21%) and poor economic status (23.34%). The distribution of distress financing was higher among the poor, with a concentration index of -0.245. The modified Poisson regression analysis revealed that the poor, middle, rich, and richest had 0.57, 0.58, 0.40 and 0.36 times the risk to develop distress financing than the poorest socio-economic group. Whereas, the presence of one and two or more elderly were associated with a 1.94 and 1.59 times risk of experiencing distress financing than households with no elderly members. The risk of developing distress financing was also 1.28 and 1.58 times higher among households with one and two members receiving inpatient care in the past 12 months compared to none. Conclusions The findings implied that the improvement of health coverage should be emphasized to curtail the prevalence of distress financing, especially among those caring for the elderly, requiring admission to hospitals, and poor socio-economic groups. This study could be of interest to policymakers to help achieve and sustain health coverage for all.
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Affiliation(s)
- Nor Zam Azihan Mohd Hassan
- Centre of Health Economics Research (CHEeR), Institute for Health Systems Research (IHSR), Ministry of Health Malaysia, Kompleks Institut Kesihatan Negara (NIH), Blok B2, No.1, Jalan Setia Murni U13/52, Seksyen 13 Setia Alam, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia.
| | - Mohd Shaiful Jefri Mohd Nor Sham Kunusagaran
- Centre of Health Economics Research (CHEeR), Institute for Health Systems Research (IHSR), Ministry of Health Malaysia, Kompleks Institut Kesihatan Negara (NIH), Blok B2, No.1, Jalan Setia Murni U13/52, Seksyen 13 Setia Alam, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Nur Amalina Zaimi
- Centre of Health Economics Research (CHEeR), Institute for Health Systems Research (IHSR), Ministry of Health Malaysia, Kompleks Institut Kesihatan Negara (NIH), Blok B2, No.1, Jalan Setia Murni U13/52, Seksyen 13 Setia Alam, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Farhana Aminuddin
- Centre of Health Economics Research (CHEeR), Institute for Health Systems Research (IHSR), Ministry of Health Malaysia, Kompleks Institut Kesihatan Negara (NIH), Blok B2, No.1, Jalan Setia Murni U13/52, Seksyen 13 Setia Alam, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Fathullah Iqbal Ab Rahim
- Centre of Health Economics Research (CHEeR), Institute for Health Systems Research (IHSR), Ministry of Health Malaysia, Kompleks Institut Kesihatan Negara (NIH), Blok B2, No.1, Jalan Setia Murni U13/52, Seksyen 13 Setia Alam, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Suhana Jawahir
- Centre of Health Economics Research (CHEeR), Institute for Health Systems Research (IHSR), Ministry of Health Malaysia, Kompleks Institut Kesihatan Negara (NIH), Blok B2, No.1, Jalan Setia Murni U13/52, Seksyen 13 Setia Alam, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Zulkefly Abdul Karim
- Faculty of Economics and Management, Center for Sustainable and Inclusive Development (SID), Universiti Kebangsaan Malaysia (UKM), Bangi, Malaysia
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Guets W, Ameyaw EK, Yaya S. Explaining external economic support inequality among households affected by HIV/AIDS in Tanzania: an Oaxaca Blinder decomposition analysis. HEALTH ECONOMICS REVIEW 2022; 12:18. [PMID: 35244798 PMCID: PMC8897951 DOI: 10.1186/s13561-022-00363-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND HIV/AIDS remains the leading cause of death in sub-Saharan Africa. Due to multiple constraints experienced by households that seem to be disproportionally affected, families generally seek assistance from the community and external economic support. Previous researchers studied socioeconomic and gender inequality in HIV/AIDS prevalence in sub-Saharan African countries. However, very few researchers have paid attention to the external economic support for HIV/AIDS affected households in Tanzania. This study investigates the difference in economic support among households affected or not affected by the HIV/AIDS epidemic in Tanzania. METHODS Data used stemmed from the Tanzania HIV Impact Survey 2016-2017 (THIS) of the Population-based HIV Impact Assessment (PHIA) project, collected between 2016 and 2017 in Tanzania. The study population were the heads of households (adults) with age greater than 15. The dependent variable for the study was economic support. This consisted of both material and non-material assistance obtained from outside the household. Socio-demographic (economics) characteristics constituted the predictors of the study. Descriptive statistics and econometric modelling were used to analyse determinants associated with external economic support. Oaxaca-Blinder decomposition method was also performed to investigate the difference in economic support depending on households' serological status in Tanzania. RESULTS A total of 12,008 households were included. Almost 11% of the household heads indicated that their households received economic support. HIV/AIDS affected 7% of households. The mean age of the household heads was 45 years (SD ± 15) with a range of 16-80. The majority of household heads were men (72%). Being a household head affected by HIV/AIDS increases the probability to receive external economic support (p < 0.05). The difference in external economic support between the two groups (HIV/AIDS and no- HIV/AIDS households) was - 0.032 (p < 0.01). This gap was observed to favour households affected by HIV/AIDS. Almost 72% (- 0.023/- 0.032) of this difference was explained by characteristics such as the wealth index (p < 0.01), residence area (urban) (p < 0.01), marital status (widowed (p < 0.05) and divorced or separated) (p < 0.1) and age (p < 0.01). CONCLUSION The difference in economic support across households affected or not affected by HIV/AIDS was explained by wealth index, residence area, marital status and age. These findings represent important implications for health policy regarding future economic support strategies for HIV/AIDS-affected households.
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Affiliation(s)
- Wilfried Guets
- Health, Nutrition, and Population Unit, The World Bank, Washington, DC USA
| | - Edward Kwabena Ameyaw
- The Australian Centre for Public and Population Health Research (ACPPHR), Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, Imperial College London, London, UK
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Sriram S, Albadrani M. A STUDY OF CATASTROPHIC HEALTH EXPENDITURES IN INDIA - EVIDENCE FROM NATIONALLY REPRESENTATIVE SURVEY DATA: 2014-2018. F1000Res 2022; 11:141. [PMID: 35464045 PMCID: PMC9005991 DOI: 10.12688/f1000research.75808.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background: India is taking steps to provide Universal Health Coverage (UHC). Out-of-pocket (OOP) health care payment is the most important mechanism for health care payment in India. This study aims to investigate the effect of OOP health care payments on catastrophic health expenditures (CHE). Methods: Data from the National Sample Survey Organization, Social Consumption in Health 2014 and 2018 are used to investigate the effect of OOP health expenditure on household welfare in India. Three aspects of catastrophic expenditure were analyzed in this paper: (i) incidence and intensity of ‘catastrophic’ health expenditure, (ii) socioeconomic inequality in catastrophic health expenditures, and (iii) factors affecting catastrophic health expenditures. Results: The odds of incidence and intensity of CHE were higher for the poorer households. Using the logistic regression model, it was observed that the odds of incidence of CHE was higher among the households with at least one child aged less than 5 years, one elderly person, one secondary educated female member, and if at least one member in the household used a private healthcare facility for treatment. The multiple regression model showed that the intensity of CHE was higher among households with members having chronic illness, and if members had higher duration of stay in the hospital. Subsidizing healthcare to the households having elderly members and children is necessary to reduce CHE. Conclusion: Expanding health insurance coverage, increasing coverage limits, and inclusion of coverage for outpatient and preventive services are vital to protect households. Strengthening public primary health infrastructure and setting up a regulatory organization to establish policies and conduct regular audits to ensure that private hospitals do not increase hospitalizations and the duration of stay is necessary.
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Affiliation(s)
- Shyamkumar Sriram
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Muayad Albadrani
- Department of Famiy and Community Medicine, Taibah University, Medina, Saudi Arabia
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