The importance of wage loss in the financial burden of illness: Longitudinal evidence from India

Validation of the Spanish version of the Health Literacy Survey (HLS19-Q12) in secondary care specialty consultations

OBJECTIVES

This study sought to validate the HLS19-Q12 in Spain and in the Spanish language, as well as describe the sociodemographic profile and the general health literacy of the study population.

STUDY DESIGN

Descriptive cross-sectional.

METHODS

Factor analysis and Cronbach's alpha were used to validate the Spanish version of the HLS19-Q12. Health literacy scores and associated categories were calculated using the scale factsheet, and the patient population sociodemographic profile was determined using frequency analysis.

RESULTS

The HLS19-Q12 used in Spain in the Spanish language was found to be both valid and reliable (Cronbach's alpha = 0.87). The sociodemographic profile was primarily male and aged, and the majority of patients were of Spanish origin and had diabetes. General patient health literacy was limited, with 60% of participants having general health literacy categorized as inadequate or problematic, and 40 % sufficient or excellent.

CONCLUSIONS

This study validated the HLS19-Q12 in Spain, created a sociodemographic profile of the sample population, and calculated their health literacy scores. This contribution provides another valuable validated tool and associated data to the increasingly important field of health literacy.

Measuring general health literacy using the HLS19-Q12 in specialty consultations in Spain

BACKGROUND

General health literacy (general HL) affects both individual and population health on numerous levels, with low general HL leading to increased morbidity, poor health service utilization, and increased healthcare spending. This study calculated health literacy scores of a population attending specialty consultations in the community of Aragon, Spain. It further produced a sociodemographic profile and examined the relationships between patients' scores and sociodemographic variables.

METHODS

A sample of 150 patients from specialty consultations completed the internationally- validated HLS19-Q12 to measure adult general HL. A 4-point-Likert scale gathered information regarding 12 items of health literacy. Final scores were divided into four categorical levels: excellent, sufficient, problematic, or inadequate. Independent sample t-test, one-way ANOVA, and a generalized linear model (GLM) analysis were performed to examine key relationships with respect to sociodemographic variables and health literacy scores.

RESULTS

The survey was completed by 150 subjects aged 18 and over in specialty clinics in Aragon, Spain. 59% of respondents had inadequate or problematic general HL, while 41% had sufficient or excellent general HL. Income level had a significant effect on health literacy scores, F = 2.129, (p < 0.05), as did different work situations, F = 3.762, (p < 0.001). Patients who self-reported as having diabetes had a significantly higher health literacy score, t = 2.356 (p < 0.05) than those reporting other health conditions. According to GLM analysis, education, health status, income, and the number of appointments were the strongest predictors of the heath literacy score.

CONCLUSIONS

General HL in this patient population was limited, and lower than in some comparable studies. The sociodemographic profile constructed, and associations with health literacy established, provide policy makers, healthcare administrators, and clinicians with information to consider new policies, processes and strategies to improve general HL in this specific population.

Persistency of catastrophic out-of-pocket health expenditures: Measurement with evidence from three African countries - Malawi, Tanzania, and Uganda

Catastrophic out-of-pocket health expenditure (CHE) remain high in Sub-Saharan Africa and may not conform to the sporadic random pattern of acute illnesses that shapes insurance arrangements intended to avoid the risk of financial loss. The persistency of CHE remains a largely unexplored issue due to the lack of relevant methods and scarcity of panel data. This paper addresses the first shortcoming by presenting three different approaches to incorporating the timeframes into the analysis, considering dynamics between two periods, average over time and the recurrence of CHE incidence. Through the application of the complementary approaches, we identify (i) those at risk of persistent CHE in the short-term; (ii) those facing transient versus persistent CHE in the long-term; and (iii) those facing multiple CHE spells. The methods are applied to different definitions of CHE using panel data from three sub-Saharan countries: Malawi (3 waves: 2010, 2013, and 2016) with 4983 observations; Tanzania (3 waves: 2008, 2010, and 2012) with 8715 observations; and Uganda (5 waves: 2009, 2010, 2011, 2013, and 2015) with 6475 observations. All datasets are balanced panels. Additionally, we employ empirical strategies to identify the underlying factors contributing to these persistent and relatively high OOP. Across the three countries, we find that at least 27% of the people facing CHE in one period, because they spent more than 5% of their household budget on health out-of-pocket, will face it again in the next period. The lower-bound risk for those spending more than 10% of their household budget is 9% and for those spending more than 25% of their household capacity to pay is 13%. Between 11% and 45% of the population incurred CHE at least twice during the observation period when using the 5% budget definition of CHE. The double recurrence rate ranges between 7% and 13% when using the 25% capacity-to-pay definition and between 3% and 20% when using the 10% budgetshare definition. Between 22% and 32% of the population experienced chronic CHE at the 5% of the budgetshare definition (6%-10% at the 10% of the budgetshare definition of CHE; 2%-11% at 25% of capacity-to-pay). Our panel regression analysis consistently highlights the susceptibility of certain groups to face persistence CHE, notably those residing in rural areas, individuals with lower levels of education, the elderly, and those who have undergone hospitalizations.

Health and health system effects on poverty: A narrative review of global evidence

Ill-health causes poverty. The effect runs through multiple mechanisms that span lifetimes and cross generations. Health systems can reduce poverty by improving health and weakening links from ill-health to poverty. This paper maps routes through which ill-health can cause poverty and identifies those that are potentially amenable to health policy. The review confirms that ill-health is an important contributor to poverty and it finds that the effect through health-related loss of earnings is often larger than that through medical expenses. Both effects are smaller in countries that are closer to universal health coverage and have higher social safety nets. The paper also reviews evidence from low- and middle-income countries (LMICs) and the United States (US) on the poverty-reduction effectiveness of public health insurance (PubHI) for low-income households. This reveals that PubHI does not always deliver financial protection to its targeted population in LMICs. Countries that have succeeded in achieving this goal often combine extension of coverage with supply-side interventions to build capacity and avoid perverse provider incentives in response to insurance. In the US, PubHI is effective in reducing poverty by shielding low-income households with children from healthcare costs and, consequently, generating long-run improvements in health that increase lifetime earnings. Poverty reduction is a potentially important co-benefit of health systems.