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Gamage A, Darshana N, Gunasekara T, Attygalle D, Sridharan S. Variations in out-of-pocket spending and factors influencing catastrophic health expenditure of households with patients suffering from chronic conditions in four districts in Sri Lanka. BMC Health Serv Res 2024; 24:1055. [PMID: 39267067 PMCID: PMC11396008 DOI: 10.1186/s12913-024-11553-4] [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: 02/28/2024] [Accepted: 09/06/2024] [Indexed: 09/14/2024] Open
Abstract
INTRODUCTION Healthcare financing systems, dependent on out-of-pocket expenditure(OOPE), impose a heavy burden on those who use the services regularly, such as patients suffering from chronic diseases. High OOPE for health services leads to decreased utilization of the services and/or catastrophic health expenditure, which would significantly impede the achievement of Universal Health coverage. OBJECTIVE We aimed to determine variations in OOPE and factors associated with Catastrophic Health Expenditure (CHE) of households with patients suffering from non-communicable diseases(NCDs) in four districts. METHODS A survey was conducted among 2344 adult patients having selected NCD/s. Multi-stage stratified cluster sampling selected respondents from 4 districts representing urban, rural, semi-urban, and estate. Data was collected using a validated interviewer-administered questionnaire. Logistic regression identified the predictors of CHE(> 40%). Significance was considered as 0.05. RESULTS Common NCDs were hypertension(29.1%), diabetes(26.8.0%), hyperlipidaemia(9.8%) and asthma(8.2%). Only 13% reported complications associated with NCDs. Fifty-six percent(N = 1304) were on regular clinic follow-up, and majority utilized western-medical government hospitals(N = 916,70.2%). There were 252 hospital admissions for chronic-disease management in the past 12 months. Majority(86%) were admitted to government sector hospitals. Most patients incurred nearly SLR 3000 per clinic visit and SLR 3300 per hospital admission. CHE was beyond 40% for 13.5% of the hospital admissions and 6.1% of the regular clinic follow-up. Patients admitted to private sector hospitals had 2.61 times higher CHE than those admitted to government sector hospitals. CONCLUSIONS Patients with NCDs incurred high OOPE and faced CHE during healthcare seeking in Sri Lanka. The prevalence of NCDs and complications were high among the participants. Patients with chronic conditions incur high OOPE for a single clinic visit and a hospital admission. Patients incur high OOPE on direct medical costs, and district-wise variations were observed. The proportion with more than 40% CHE on monthly clinic care was high. Patients being followed up in the government sector are more likely to have CHE when obtaining healthcare and are more likely to face barriers in obtaining needed health services. The services rendered to patients with chronic conditions warrant a more integrative approach to reduce the burden of costs and related complications.
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Affiliation(s)
- Anuji Gamage
- Specialist in Community Medicine/ Professor in Public Health, Paraclinical Department Faculty of Medicine, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka.
| | - Nuwan Darshana
- Senior Lecturer, Department of Community Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Therani Gunasekara
- Faculty of Medicine, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - Deepika Attygalle
- Senior Health Specialist, World Bank South Asia Region, Colomobo, Sri Lanka
| | - S Sridharan
- Deputy Director General Planning, Management Development and Planning Unit, Ministry of Health, Colombo, Sri Lanka
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Bodjongo MJM. How to increase acceptance of the COVID-19 vaccine among poor people in Africa? INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2024; 24:173-210. [PMID: 38451447 DOI: 10.1007/s10754-024-09370-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 02/10/2024] [Indexed: 03/08/2024]
Abstract
This study aims to analyze whether good government management of the COVID-19 pandemic can increase the likelihood of vaccine uptake among poor people in Africa. The analysis is based on a sample of 18,010 people living in 34 African countries, drawn from data collected by Afrobarometer (Merged Round 8 data (34 countries), database, 2022). The econometric results, obtained using a bivariate probit regression, show that poverty significantly reduces the odds of accepting the said COVID-19 vaccine. However, acceptance of the vaccine increases among poor individuals when there is (i) trust in the government's published statistics on COVID-19, (ii) control of corruption by the government in managing the pandemic, (iii) individual confidence in the government's ability to ensure the safety of the COVID-19 vaccine, and (iv) belief that the Covid 19 vaccine will be more effective than religious prayer in the fight against this pandemic.
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Wickramarachchi BI, Siop SJ, Perera B. Associated factors of doctor visits made by urban-dwelling older adults in Sri Lanka: an application of Anderson's model of health service utilization. BMC Geriatr 2022; 22:571. [PMID: 35820836 PMCID: PMC9275041 DOI: 10.1186/s12877-022-03249-3] [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: 03/01/2022] [Accepted: 06/20/2022] [Indexed: 11/19/2022] Open
Abstract
Background Although universal free healthcare is available for all Sri Lankan citizens, older adults face somewhat unique obstacles when utilizing available healthcare services. The aim of this study was to examine some vital predisposing, enabling, and need factors associated with doctor visits made by urban-dwelling older adults in Sri Lanka. Methods A representative sample of 880 urban-dwelling older adults (aged 60 years and above) was surveyed using an interviewer-administered questionnaire. Number of doctor visits, self-rated health, physical activity, and socio-demographic and self-report health conditions were collected. The data were analyzed using chi-squared tests and multinomial logistic regression. Results Participants’ mean age was 70.01 (± 6.02) years. The majority was women (75.0%). The mean number of doctor visits was 6.77 (± 5.92) per year. Nearly half of the participants (47.0%) had made, on average, at least one doctor visit per month. Older men and those of aged 80 years and above were the least likely to make frequent doctor visits. Participants who were physically active and who rated their health as poor were more likely to make frequent doctor visits after adjustment for age, gender, and educational level. Conclusions Doctor visits made by Sri Lankan older adults are satisfactory. The factors that best explain high frequency of doctor visits by older adults are female gender, younger age, higher physical activity and poor self-rated health. Attention should be paid to examine possible accessible and affordable issues related to doctor visits by bedridden or physically dependent older adults in advanced age categories. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03249-3.
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Affiliation(s)
- Bimba I Wickramarachchi
- Department of Nursing, Faculty of Medicine and Heath Sciences, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.,Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Galle, Sri Lanka
| | - Sidiah J Siop
- Department of Nursing, Faculty of Medicine and Heath Sciences, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Bilesha Perera
- Department of Community Medicine, Faculty of Medicine, University of Ruhuna, Galle, 80000, Sri Lanka.
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Karunaratna S, Weerasinghe MC, Ranasinghe T, Jayasuriya R, Chandraratne N, Herath H, Quaife M. Improving Uptake of Non-Communicable Disease Screening in Sri Lanka: Eliciting Peoples' Preferences using a Discrete Choice Experiment. Health Policy Plan 2021; 37:218-231. [PMID: 34893842 DOI: 10.1093/heapol/czab141] [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: 03/23/2021] [Revised: 11/11/2021] [Accepted: 12/10/2021] [Indexed: 11/15/2022] Open
Abstract
A national programme to universally screen the population between 35 - 65 years for non-communicable diseases was established at 'Healthy Lifestyle Centres (HLCs)' in 2011 in Sri Lanka. Despite several efforts by policy makers, the uptake of screening remained below 10% of the target population and with disparities in uptake across districts and among men and women. Considering service beneficiaries as a vital stakeholder, a discrete choice experiment was carried out to estimate people's preference for a NCD screening service delivery model in rural, urban and estate sectors in a district in Sri Lanka. The choice design and the general survey questionnaire was developed through focus group discussions, literature reviews and stakeholder consultations. Data was collected by stratified random sampling, with 187 participants from the urban sector, 253 from the rural sector and 152 from the estate/plantation sector. Peoples' preference was assessed as utility estimates derived using multinomial logistic regression. Reliability was assessed within test among all study participants and with test-retest among 40 participants showed 80% precision. Urban and rural sectors gave the highest priority to workplace screening over screening at HLCs. The estates attributed the highest priority for cost free screening. If cost free screening is offered with having to spend 1-2 hours at the most preferred opening times for each sector with warm and friendly staff, the uptake of screening can predicted to be increased by 65, 29 and 21 times respectively in urban, rural and estate sectors relative to having to attend HLCs from 8am - 4 pm, spending more than 2 hours and Rs. 1000 with unfriendly staff. Thus, peoples' preferences on service delivery aspects seemed to have differed from government priorities. Preferences when ill and apparently healthy differed, as they preferred to spend less time and money when healthy than when ill.
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Affiliation(s)
- Sumudu Karunaratna
- Office of the Deputy Director General/ Public Health Services, Ministry of Health, Sri Lanka
| | - Manuj C Weerasinghe
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Sri Lanka
| | | | - Rohan Jayasuriya
- School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia
| | - Nadeeka Chandraratne
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Sri Lanka
| | | | - Matthew Quaife
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom
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Pallegedara A, Kumara AS. Impacts of firewood burning for cooking on respiratory health and healthcare utilisation: Empirical evidence from Sri Lankan micro-data. Int J Health Plann Manage 2021; 37:465-485. [PMID: 34655271 DOI: 10.1002/hpm.3350] [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: 05/02/2020] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/07/2022] Open
Abstract
Despite escalating income levels of Sri Lankan households, 70.3% of them still depend on firewood for cooking. This might lead to bad respiratory health and thereby, increased healthcare utilisation. With this backdrop, this paper examines how firewood burning for cooking influences respiratory health and healthcare utilisation of Sri Lankans. The study proposes a theoretical model to explain effects of firewood burning on respiratory health and healthcare utilisation and empirically tests it using nation-wide micro-data of 79,170 individuals belonging to 21,748 households. The data are drawn from the most recent wave of Sri Lankan household income and expenditure survey. After addressing potential endogeneity by applying instrumental variable regression models, the study finds that firewood burning increases households' probability of asthma prevalence by 10.9 percentage points (P < 0.001), out-patient care utilisation by 33.1 percentage points (P < 0.001), and in-patient care utilisation by 17.5 percentage points (P < 0.001), on average. Our individual level analysis demonstrates that females are more vulnerable to bad respiratory health induced by firewood burning (β = 0.055, P < 0.001) compared to males (β = 0.008, P > 0.1). The results imply policies on promoting improved-cooking stoves, separated-kitchen designs, and switching more towards cleaner energy sources, including LP gas and solar power.
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Affiliation(s)
- Asankha Pallegedara
- Department of Industrial Management, Wayamba University of Sri Lanka, Kuliyapitiya, Sri Lanka
| | - Ajantha Sisira Kumara
- Department of Public Administration, University of Sri Jayewardenepura, Gangodawila-Nugegoda, Sri Lanka
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Doherty S, Sureshkumar DS, Thayakaran R, Surenthirakumaran R. Characteristics and Influencing Factors of Healthcare Utilization in Post-conflict Primary Care Attendees in Northern Sri Lanka. FRONTIERS IN HEALTH SERVICES 2021; 1:719617. [PMID: 36926487 PMCID: PMC10012669 DOI: 10.3389/frhs.2021.719617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022]
Abstract
Sri Lanka's healthcare systems attempts to provides access to universal healthcare services for all citizens and is designed to be free of out-of-pocket payments. Despite a 30-year civil conflict, natural disasters, and COVID-19, the healthcare system within the country remains robust and strong. However, due to a lack of formalized pathways and centralized record keeping, the pattern of service utilization is still relatively unknown, which raises concerns regarding effective allocation of scarce resources and efficiency of referral pathways. To address this gap in knowledge, part of the parent study (COMGAP-S), consisted of a survey on healthcare service use conducted among adults attending primary care facilities. The results from this quantitative data analysis indicate the majority of people seeking care originate from rural areas, are older (50+), attend divisional hospitals, and report paying fees at point of contact. Our findings indicate a need for more efficient use of healthcare services, creation of referral routes to ensure limited healthcare resources are used effectively. Additionally, further investment in services is needed to ensure Sri Lanka's healthcare system meets the standard of universal healthcare as proposed by the World Health Organization. These findings address a gap in knowledge for national decision-makers within Sri Lanka along with other similar post-conflict healthcare settings across the globe.
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Affiliation(s)
- Shannon Doherty
- School of Allied Health, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, United Kingdom
| | - Diliniya Stanislaus Sureshkumar
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Service Development, Queen Mary University of London, London, United Kingdom
| | - Rasiah Thayakaran
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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Tsai TF, Rajagopalan M, Chu CY, Encarnacion L, Gerber RA, Santos-Estrella P, Llamado LJQ, Tallman AM. Burden of atopic dermatitis in Asia. J Dermatol 2019; 46:825-834. [PMID: 31436343 DOI: 10.1111/1346-8138.15048] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 07/22/2019] [Indexed: 11/28/2022]
Abstract
Atopic dermatitis is a chronic, inflammatory skin disease characterized by intense pruritus and eczematous lesions. It is considered one of the most common chronic conditions, with an estimated global prevalence of nearly 230 million. As in the rest of the world, prevalence of atopic dermatitis has been increasing in Asian countries over the last few decades. This increased prevalence in Asian countries has been attributed to factors such as rapid urbanization, increasingly Westernized lifestyles, and improved standards of living and education. As a result, it is important to understand the increasing burden of disease in Asian countries and the differences between the countries in terms of epidemiology, diagnostic criteria, management, quality of life and economic burden.
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Affiliation(s)
- Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | | | - Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Sisira Kumara A, Samaratunge R. Relationship between healthcare utilization and household out-of-pocket healthcare expenditure: Evidence from an emerging economy with a free healthcare policy. Soc Sci Med 2019; 235:112364. [PMID: 31208779 DOI: 10.1016/j.socscimed.2019.112364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 06/06/2019] [Accepted: 06/10/2019] [Indexed: 12/28/2022]
Abstract
Despite the free public healthcare policy in Sri Lanka, households' out-of-pocket healthcare expenditures are steadily increasing. Parallel to this, there is an emerging private healthcare sector based on a user-pays approach. This study, therefore, examines the relationship between healthcare utilization and out-of-pocket healthcare expenses at household level. Using a double-hurdle model with 42,288 household observations drawn from the household income and expenditure survey (2012/2013 and 2016 waves), we find that out- and in-patient care in public hospitals under 'free healthcare policy' is positively associated with household out-of-pocket healthcare expenses, imposing a significant financial burden on the family budget. This relationship is even greater for utilization of private out- and in-patient care. The recent regulatory and fiscal interventions of the government have favourably moderated this relationship for out-patient care but not for in-patient care. The results recommend introducing public policies to further strengthen the monitoring process for private healthcare sector while ensuring the sustainability of free healthcare policy. The paper provides policy implications for richly categorized out-of-pocket healthcare expenditure and healthcare utilization types.
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Affiliation(s)
- Ajantha Sisira Kumara
- Department of Public Administration, University of Sri Jayewardenepura, Gangodawila-Nugegoda, Sri Lanka.
| | - Ramanie Samaratunge
- Department of Management, Monash Business School, Monash University, Menzies Building, Level 11, Clayton Campus, Victoria, 3800, Australia.
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Piyasena MMPN, Murthy GVS, Yip JLY, Gilbert C, Peto T, Premarathna M, Zuurmond M. A qualitative study on barriers and enablers to uptake of diabetic retinopathy screening by people with diabetes in the Western Province of Sri Lanka. Trop Med Health 2019; 47:34. [PMID: 31139011 PMCID: PMC6525343 DOI: 10.1186/s41182-019-0160-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 05/01/2019] [Indexed: 01/17/2023] Open
Abstract
Background Blindness and visual impairment from diabetic retinopathy (DR) are avoidable through early detection and timely treatment. The Western Province of Sri Lanka has the highest prevalence of diabetes mellitus (DM) (18.6%) in the country. A situational analysis identified a significant gap in DR screening services (DRSS) uptake in this region. Barriers that hinder people with DM (PwDM) from attending DRSS are poorly understood. The purpose of this study is to understand the factors which influence the uptake of DRSS and follow-up to inform health promotion strategies and improve the uptake of these services. Methods Eleven focus group discussions (FGDs) were conducted with PwDM who presented to medical, general eye and vitreoretinal services in three public sector institutions (two tertiary and one secondary level) in the Western Province between October 2016 and March 2017. We enrolled six groups (four Sinhala speaking, two Tamil) of women and five groups (three Sinhala and two Tamil) of men representing ethnicity and gender. We performed a thematic analysis and described the main themes and subthemes using the socio-ecological model as a framework. Results We identified lack of knowledge of both the condition and the need for screening as key barriers to access DRSS. Socio-cultural factors in the family environment, economic reasons and institutional factors were also important barriers. Additional reasons include long waiting time at eye clinics and poor referrals exacerbated by the lack of a systematic DRSS. In addition, attitudes to DRSS such as fear of discomfort from the procedure and the need for accompaniment following mydriasis were also deterrents to follow-up screening. Conclusion This study has shown that there are inter-related user, family, and institutional factors which affect the uptake of DRSS. Understanding how DR is conceptualised by PwDM in this region is essential to refine strategies to improve access to DRSS. Strategies to improve knowledge need to be more culturally acceptable and relevant to PwDM and their families, with increased availability of DRSS at convenient locations may increase timely uptake of screening. Electronic supplementary material The online version of this article (10.1186/s41182-019-0160-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Gudlavalleti Venkata S Murthy
- 1Clinical Research Department, Department of Infectious and Tropical Diseases, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
| | - Jennifer L Y Yip
- 1Clinical Research Department, Department of Infectious and Tropical Diseases, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
| | - Clare Gilbert
- 1Clinical Research Department, Department of Infectious and Tropical Diseases, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
| | - Tunde Peto
- 2School of Medicine, Dentistry and Biomedical Sciences, Queen's University, 97 - Lisburn Rd, Belfast, BT9 7BL Northern Ireland
| | - Mahesh Premarathna
- 3Department of Sociology, University of Colombo, Reid Avenue, Colombo 03, Colombo, Sri Lanka
| | - Maria Zuurmond
- 4Clinical Research Department, Department of Infectious and Tropical Diseases, International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
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