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Soleimanvandiazar N, Mohaqeqi Kamal SH, Basakha M, Karim S, Ahmadi S, Ghaedamini Harouni G, Sajjadi H, Setareh Forouzan A. Decomposition of Healthcare Utilization Inequality in Iran: The Prominent Role of Health Literacy and Neighborhood Characteristics. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241229622. [PMID: 38339828 PMCID: PMC10859068 DOI: 10.1177/00469580241229622] [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: 06/16/2023] [Revised: 12/27/2023] [Accepted: 01/11/2024] [Indexed: 02/12/2024]
Abstract
Unequal utilization in healthcare can potentially affect the right to health. Access to healthcare services and achieving positive health outcomes and health equity are essential principles in promoting human rights. This study aims to assess and analyze socioeconomic-related inequalities in outpatient health services utilization (OHSU) among various socio-demographic subgroups to inform policies that foster health equity. Data were collected through a cross-sectional survey of 1200 households in Tehran, Iran. Inequality in OHSU among the socio-demographic subgroups was calculated by concentration, Wagstaff, and Erigers indices. Decomposition was used to identify the factors contributing to inequality in OHSU. Marginal effect and elasticity were used to calculate the relative absolute shares of socio-demographic variables in the inequality. The rate of OHSU was 63.61% (CI: 60-66.80) which concentrated among households with better socioeconomic status. Based on the results, living in an affluent neighborhood (Relative share (RS): 85.48) and having a disabled member in the household (RS: 6.58) were the most important factors in the concentration of OHSU in favor of the privileged groups. In contrast, very low levels of health knowledge (RS: -83.79) and having basic insurance coverage (RS: -3.92) concentrated OHSU in favor of the lower socioeconomic households. The study was conducted based on survey data, and this may lead to some limitations. Given that this study was a cross-sectional study, we were unable to establish causal relationships between explanatory variables and outpatient health service utilization and its relevant predictors. Households with disabled member(s), as well as a member(s) with chronic diseases, may experience severe inequalities in access to healthcare services. Policies that facilitate access to health services for these households can play a significant role in improving health equity.
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Affiliation(s)
| | | | - Mehdi Basakha
- University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Sina Ahmadi
- Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Homeira Sajjadi
- University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Chen J, Zhao M, Zhou R, Ou W, Yao P. How heavy is the medical expense burden among the older adults and what are the contributing factors? A literature review and problem-based analysis. Front Public Health 2023; 11:1165381. [PMID: 37397714 PMCID: PMC10313336 DOI: 10.3389/fpubh.2023.1165381] [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: 02/14/2023] [Accepted: 05/12/2023] [Indexed: 07/04/2023] Open
Abstract
In recent years, the aging population and increasing medical expenses among the older adults have emerged as significant public health concerns. National governments must conduct medical expense accounting and implement measures to reduce the burden of medical costs on the older population. However, limited studies have focused on total medical expenditure from a macro perspective, with many researches exploring individual medical expenses from different perspectives. This review introduces the trend of population aging and its impact on health cost change, reviews research on the medical expense burden of the older population and contributing factors, and points out underlying problems and limitations of current studies. Based on the present studies, the review emphasizes the necessity of medical expense accounting and analyzes the medical expense burden of the older population. Future studies should explore the impacts of medical insurance funds and health service system reforms on reducing medical expenses and developing a supporting medical insurance reform plan.
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Affiliation(s)
- Jie Chen
- Department of Anesthesiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Meizhen Zhao
- Nursing Department, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Renyi Zhou
- Department of Orthopaedics, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Wenjing Ou
- College of Health Management, China Medical University, Shenyang, Liaoning, China
| | - Pin Yao
- Department of Health Management, Department of Health Policy and Hospital Management, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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Madullu MT, Thomas DSK, Nyanza EC, Seni J, Ngallaba SE, Kiluvia S, Asori M, Kangmennaang J. Spatial distribution of suspected and confirmed cholera cases in Mwanza City, Northern Tanzania. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001261. [PMID: 36962896 PMCID: PMC10022096 DOI: 10.1371/journal.pgph.0001261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/06/2022] [Indexed: 01/09/2023]
Abstract
Cholera, which is caused by Vibrio cholerae, persists as a devastating acute diarrheal disease. Despite availability of information on socio-cultural, agent and hosts risk factors, the disease continues to claim lives of people in Tanzania. The present study explores spatial patterns of cholera cases during a 2015-16 outbreak in Mwanza, Tanzania using a geographical information system (GIS) to identify concentrations of cholera cases. This cross-sectional study was conducted in Ilemela and Nyamagana Districts, Mwanza City. The two-phase data collection included: 1) retrospectively reviewing and capturing 852 suspected cholera cases from clinical files during the outbreak between August, 2015, and April, 2016, and 2) mapping of residence of suspected and confirmed cholera cases using global positioning systems (GPS). A majority of cholera patients were from Ilemela District (546, 64.1%), were males (506, 59.4%) and their median age was 27 (19-36) years. Of the 452 (55.1%) laboratory tests, 352 (77.9%) were confirmed to have Vibrio cholerae infection. Seven patients (0.80%) died. Cholera cases clustered in certain areas of Mwanza City. Sangabuye, Bugogwa and Igoma Wards had the largest number of confirmed cholera cases, while Luchelele Ward had no reported cholera cases. Concentrations may reflect health-seeking behavior as much as disease distribution. Topographical terrain, untreated water, physical and built environment, and health-seeking behaviors play a role in cholera epidemic in Mwanza City. The spatial analysis suggests patterns of health-seeking behavior more than patterns of disease. Maps similar to those generated in this study would be an important future resource for identifying an impending cholera outbreak in real-time to coordinate community members, community leaders and health personnel for guiding targeted education, outreach, and interventions.
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Affiliation(s)
- Monica T Madullu
- Department of Environmental, Occupational and Research GIS, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Deborah S K Thomas
- Department of Geography and Earth Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, United States of America
| | - Elias C Nyanza
- Department of Environmental, Occupational and Research GIS, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Jeremiah Seni
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Sospatro E Ngallaba
- Department of Environmental, Occupational and Research GIS, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Sophia Kiluvia
- Environmental Health Department, Mwanza City Council, Mwanza, Tanzania
| | - Moses Asori
- Department of Geography and Earth Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, United States of America
| | - Joseph Kangmennaang
- School of Kinesiology and Health Studies, Queens University, Kingston Ontario, Canada
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Ouma PO, Malla L, Wachira BW, Kiarie H, Mumo J, Snow RW, English M, Okiro EA. Geospatial mapping of timely access to inpatient neonatal care and its relationship to neonatal mortality in Kenya. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000216. [PMID: 36962323 PMCID: PMC10021833 DOI: 10.1371/journal.pgph.0000216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 05/27/2022] [Indexed: 11/18/2022]
Abstract
Globally, 2.4 million newborns die in the first month of life, with neonatal mortality rates (NMR) per 1,000 livebirths being highest in sub-Saharan Africa. Improving access to inpatient newborn care is necessary for reduction of neonatal deaths in the region. We explore the relationship between distance to inpatient hospital newborn care and neonatal mortality in Kenya. Data on service availability from numerous sources were used to map hospitals that care for newborns with very low birth weight (VLBW). Estimates of livebirths needing VLBW services were mapped from population census data at 100 m spatial resolution using a random forest algorithm and adjustments using a systematic review of livebirths needing these services. A cost distance algorithm that adjusted for proximity to roads, road speeds, land use and protected areas was used to define geographic access to hospitals offering VLBW services. County-level access metrics were then regressed against estimates of NMR to assess the contribution of geographic access to VLBW services on newborn deaths while controlling for wealth, maternal education and health workforce. 228 VLBW hospitals were mapped, with 29,729 births predicted as requiring VLBW services in 2019. Approximately 80.3% of these births were within 2 hours of the nearest VLBW hospital. Geographic access to these hospitals, ranged from less than 30% in Wajir and Turkana to as high as 80% in six counties. Regression analysis showed that a one percent increase in population within 2 hours of a VLBW hospital was associated with a reduction of NMR by 0.24. Despite access in the country being above the 80% threshold, 17/47 counties do not achieve this benchmark. To reduce inequities in NMR in Kenya, policies to improve care must reduce geographic barriers to access and progressively improve facilities' capacity to provide quality care for VLBW newborns.
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Affiliation(s)
- Paul O. Ouma
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Lucas Malla
- Health Services Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | | | - Hellen Kiarie
- Health Sector Monitoring and Evaluation Unit, Ministry of Health, Nairobi, Kenya
| | - Jeremiah Mumo
- Health Sector Monitoring and Evaluation Unit, Ministry of Health, Nairobi, Kenya
| | - Robert W. Snow
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Mike English
- Health Services Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Emelda A. Okiro
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
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Kamwesiga J, Bergström A, Bii A, von Koch L, Guidetti S. Experiences of participation in everyday activities for people with stroke in Nairobi, Kenya. Top Stroke Rehabil 2022; 30:483-492. [PMID: 35491997 DOI: 10.1080/10749357.2022.2070360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Stroke is currently one of the greatest causes of disability and death in Kenya. Previous research indicates a lack of knowledge regarding how participation in everyday life is experienced after a stroke in Sub-Sahara Africa. OBJECTIVES The aim was to explore and describe experiences of participation in everyday life for people who had had a stroke living in Nairobi, Kenya. METHODS A qualitative study design using semi-structured interviews with nine people who have had a stroke, together with their caregivers. The inclusion criteria were: 1) stroke diagnosis 2) no psychiatric diagnosis, and 3) ability to understand and respond to instructions in English, or local language. All participants were living in the community, members of the Stroke Association of Kenya, and participated voluntarily. The transcribed interviews were analyzed using qualitative content analysis. RESULTS The participants expressed their experiences of participation in everyday life, along with how resources and barriers affected their participation. Three categories were found:1) A sense of satisfaction at being involved in everyday life, 2) Challenges in doing everyday activities and social participation, and 3) Dependence as enabling or hindering participation. CONCLUSIONS After stroke, people's experiences of participation in everyday life changed. Performing activities that the person found meaningful added a sense of increased participation and satisfaction. The experience of being dependent in everyday activities and finances appeared to reduce perceived participation. Participation in a group connected to a patient association with like-minded people contributed to a new role, and a sense of belonging.
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Affiliation(s)
- Julius Kamwesiga
- Division of Occupational Therapy, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Sweden
| | - Aileen Bergström
- Division of Occupational Therapy, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Sweden
| | - Andrew Bii
- Department of Occupational Therapy, Kenya Medical Training College (KMTC), Nairobi, Kenya
| | - Lena von Koch
- Division of Family Medicine and Primary Care. Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Susanne Guidetti
- Division of Occupational Therapy, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Sweden
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Tweedie Model for Predicting Factors Associated with Distance Traveled to Access Inpatient Services in Kenya. JOURNAL OF PROBABILITY AND STATISTICS 2022. [DOI: 10.1155/2022/2706504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim. This study aims to examine which factors influence the distance traveled by patients for inpatient care in Kenya. Methods. We used data from the fourth round of the Kenya Household Health Expenditure and Utilization survey. Our dependent variable was the self-reported distance traveled by patients to access inpatient care at public health facilities. As the clustered data were correlated, we used the generalized estimating equations approach with an exchangeable correlation under a Tweedie distribution. To select the best-fit covariates for predicting distance, we adopted a variable selection technique using the
and
criteria, wherein the lowest (highest) value for the former (latter) is preferred. Results. Using data for 451 participants from 47 counties, we found that three-fifths were admitted between 1 and 5 days, two-thirds resided in rural areas, and 90% were satisfied with the facilities’ service. Wealth quintiles were evenly distributed across respondents. Most admissions (81%) comprised
15,
65, and 25–54 years. Many households were of medium size (4–6 members) and had low education level (48%), and nine-tenths had no access to insurance. While two-thirds reported employment-based income, the same number reported not having cash to pay for inpatient services; 6 out of 10 paid over 3000 KES. Thus, differences in employment, ability to pay, and household size influence the distance traveled to access government healthcare facilities in Kenya. Interpretation. Low-income individuals more likely have large households and live in rural areas and, thus, are forced to travel farther to access inpatient care. Unlike the unemployed, the employed may have better socioeconomic status and possibly live near inpatient healthcare facilities, thereby explaining their short distances to access these services. Policymakers must support equal access to inpatient services, prioritize rural areas, open job opportunities, and encourage smaller families.
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Amu H, Dickson KS, Adde KS, Kissah-Korsah K, Darteh EKM, Kumi-Kyereme A. Prevalence and factors associated with health insurance coverage in urban sub-Saharan Africa: Multilevel analyses of demographic and health survey data. PLoS One 2022; 17:e0264162. [PMID: 35245301 PMCID: PMC8896727 DOI: 10.1371/journal.pone.0264162] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/04/2022] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION With the vision of achieving Universal Health Coverage (UHC) by the year 2030, many sub-Saharan African (SSA) countries have implemented health insurance schemes that seek to improve access to healthcare for their populace. In this study, we examined the prevalence and factors associated with health insurance coverage in urban sub-Saharan Africa (SSA). MATERIALS AND METHODS We used the most recent Demographic and Health Survey (DHS) data from 23 countries in SSA. We included 120,037 women and 54,254 men residing in urban centres in our analyses which were carried out using both bivariable and multivariable analyses. RESULTS We found that the overall prevalence of health insurance coverage was 10.6% among females and 14% among males. The probability of being covered by health insurance increased by level of education. Men and women with higher education, for instance, had 7.61 times (95%CI = 6.50-8.90) and 7.44 times (95%CI = 6.77-8.17) higher odds of being covered by health insurance than those with no formal education. Males and females who read newspaper or magazine (Males: AOR = 1.47, 95%CI = 1.37-1.57; Females: AOR = 2.19, 95%CI = 1.31-3.66) listened to radio (Males: AOR = 1.29, 95%CI = 1.18-1.41; Females: AOR = 1.42, 95%CI = 1.35-1.51), and who watched television (Males: AOR = 1.80, 95%CI = 1.64-1.97; Females: AOR = 1.86, 95%CI = 1.75-1.99) at least once a week had higher odds of being covered by health insurance. CONCLUSION The coverage of health insurance in SSA is generally low among urban dwellers. This has negative implications for the achievement of universal health coverage by the year 2030. We recommend increased public education on the benefits of being covered by health insurance using the mass media which we found to be an important factor associated with health insurance coverage. The focus of such mass media education could target the less educated urban dwellers, males in the lowest wealth quintile, and young adults (15-29 years).
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Affiliation(s)
- Hubert Amu
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | | | - Kenneth Setorwu Adde
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Kwaku Kissah-Korsah
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | | | - Akwasi Kumi-Kyereme
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
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Rudasingwa M, Yeboah E, Ridde V, Bonnet E, De Allegri M, Muula AS. How equitable is health spending on curative services and institutional delivery in Malawi? Evidence from a quasi-longitudinal benefit incidence analysis. Int J Equity Health 2022; 21:25. [PMID: 35180861 PMCID: PMC8856874 DOI: 10.1186/s12939-022-01624-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 01/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background Malawi is one of a handful of countries that had resisted the implementation of user fees, showing a commitment to providing free healthcare to its population even before the concept of Universal Health Coverage (UHC) acquired global popularity. Several evaluations have investigated the effects of key policies, such as the essential health package or performance-based financing, in sustaining and expanding access to quality health services in the country. Understanding the distributional impact of health spending over time due to these policies has received limited attention. Our study fills this knowledge gap by assessing the distributional incidence of public and overall health spending between 2004 and 2016. Methods We relied on a Benefit Incidence Analysis (BIA) to measure the socioeconomic inequality of public and overall health spending on curative services and institutional delivery across different health facility typologies. We used data from household surveys and National Health Accounts. We used a concentration index (CI) to determine the health benefits accrued by each socioeconomic group. Results Socioeconomic inequality in both public and overall health spending substantially decreased over time, with higher inequality observed in overall spending, non-public health facilities, curative health services, and at higher levels of care. Between 2004 and 2016, the inequality in public spending on curative services decreased from a CI of 0.037 (SE 0.013) to a CI of 0.004 (SE 0.011). Whiles, it decreased from a CI of 0.084 (SE 0.014) to a CI of 0.068 (SE 0.015) for overall spending in the same period. For institutional delivery, inequality in public and overall spending decreased between 2004 and 2016 from a CI of 0.032 (SE 0.028) to a CI of -0.057 (SE 0.014) and from a CI of 0.036 (SE 0.022) to a CI of 0.028 (SE 0.018), respectively. Conclusions Through its free healthcare policy, Malawi has reduced socioeconomic inequality in health spending over time, but some challenges still need to be addressed to achieve a truly egalitarian health system. Our findings indicate a need to increase public funding for the health sector to ensure access to care and financial protection. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-022-01624-5.
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Affiliation(s)
- Martin Rudasingwa
- Heidelberg Institute of Global Health, University Hospital & Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Edmund Yeboah
- Heidelberg Institute of Global Health, University Hospital & Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Valéry Ridde
- CEPED, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Paris, France
| | - Emmanuel Bonnet
- IRD, UMR 215 Prodig, CNRS, Université Paris 1 Panthéon-Sorbonne, AgroParisTech, 5, Cours des Humanités, F-93 322, Aubervilliers, Cedex, France
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, University Hospital & Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Adamson Sinjani Muula
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi. .,Kamuzu University of Health Sciences, Blantyre, Malawi.
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Ma WJ, He B, Wang YH, Huang W, Zhou J. Relationships between Kazakh elders' disability severity and informal care time in far north-western low-income areas in China: The mediating roles of caregiver health and home-based care quality. Int J Nurs Pract 2021; 28:e13022. [PMID: 34687110 DOI: 10.1111/ijn.13022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 07/02/2021] [Accepted: 09/24/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Elders' disability severity and caregiver health could predict elders' informal care time, but the mechanism by which the degree of disability in the elderly affects informal care time is unclear. AIM The aim of this works is to explore the mediating roles of caregiver health and home-based care quality between disability severity of elders and informal care time in far north-western low-income areas in China. METHOD From September 2017 to February 2018, three hundred fifty-two dyads of Kazakh disabled elders and informal caregivers in Xinjiang were interviewed. Structural equation modelling analyses were applied. RESULTS Significant positive correlations were observed between elders' disability severity and informal care time, caregiver health and informal care time, elders' disability severity and caregiver health. Significant negative correlations were observed between home-based care quality and informal care time, elders' disability severity and home-based care quality, caregiver health and home-based care quality. Elders' disability severity had 71.94% direct effect on informal care time, 28.06% indirect effect on informal care time mediated by home-based care quality and caregiver health. CONCLUSION Caregiver health and home-based care quality play mediating roles on the path relationship between the elders' disability severity and informal care time.
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Affiliation(s)
- Wen Juan Ma
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.,West China College of Nursing, Sichuan University, Chengdu, China
| | - Bin He
- Department of joint surgery, The People's Hospital of Shihezi City, Shihezi, Xinjiang, China
| | - Yu Huan Wang
- Department of Medical Humanities, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Wei Huang
- Department of Medical Humanities, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Jia Zhou
- Department of Medical Humanities, Shihezi University School of Medicine, Shihezi, Xinjiang, China
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Mwenda N, Nduati R, Kosgei M, Kerich G. What Drives Outpatient Care Costs in Kenya? An Analysis With Generalized Estimating Equations. Front Public Health 2021; 9:648465. [PMID: 34631637 PMCID: PMC8492944 DOI: 10.3389/fpubh.2021.648465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 08/25/2021] [Indexed: 12/01/2022] Open
Abstract
Objective: This study aimed to identify the factors associated with outpatient expenses incurred by households in Kenya. Background: The problem of outpatient healthcare expenses incurred by citizens in countries with limited resources has received little attention. Thus, this study aimed to determine the predictors of household spending on outpatient expenses in Kenya. Method: We conducted a cross-sectional analysis on households in Kenya using data from the 2018 Kenya Household Health Expenditure and Utilization Survey. We applied the generalized estimating equations method to determine the best subset of predictors of outpatient care cost. Findings: The best predictors of outpatient care expenses in Kenya are age, wealth index, and education level of the household head. Conclusions: There were no differences regarding age in the mean spending on outpatient care. Moreover, we found that the cost of outpatient care changes with age in a sinusoidal manner. We observed that rich households spent more on outpatient care, mostly owing to their financial ability. Households whose heads reported primary or secondary school education level spent less on outpatient costs than households headed by those who never went to school.
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Affiliation(s)
- Ngugi Mwenda
- School of Aerospace and Physical Science, Department of Mathematics, Physics and Computing, Moi University, Eldoret, Kenya
| | - Ruth Nduati
- Department of Pediatrics, University of Nairobi, Nairobi, Kenya
| | - Mathew Kosgei
- School of Aerospace and Physical Science, Department of Mathematics, Physics and Computing, Moi University, Eldoret, Kenya
| | - Gregory Kerich
- School of Aerospace and Physical Science, Department of Mathematics, Physics and Computing, Moi University, Eldoret, Kenya
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Opara CC, Du Y, Kawakatsu Y, Atala J, Beaton AZ, Kansiime R, Nakitto M, Ndagire E, Nalubwama H, Okello E, Watkins DA, Su Y. Household Economic Consequences of Rheumatic Heart Disease in Uganda. Front Cardiovasc Med 2021; 8:636280. [PMID: 34395548 PMCID: PMC8363312 DOI: 10.3389/fcvm.2021.636280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 06/08/2021] [Indexed: 01/22/2023] Open
Abstract
Background: Rheumatic heart disease (RHD) has declined dramatically in wealthier countries in the past three decades, but it remains endemic in many lower-resourced regions and can have significant costs to households. The objective of this study was to quantify the economic burden of RHD among Ugandans affected by RHD. Methods: This was a cross-sectional cost-of-illness study that randomly sampled 87 participants and their households from the Uganda National RHD registry between December 2018 and February 2020. Using a standardized survey instrument, we asked participants and household members about outpatient and inpatient RHD costs and financial coping mechanisms incurred over the past 12 months. We used descriptive statistics to analyze levels and distributions of costs and the frequency of coping strategies. Multivariate Poisson regression models were used to assess relationships between socioeconomic characteristics and utilization of financial coping mechanisms. Results: Most participants were young or women, demonstrating a wide variation in socioeconomic status. Outpatient and inpatient costs were primarily driven by transportation, medications, and laboratory tests, with overall RHD direct and indirect costs of $78 per person-year. Between 20 and 35 percent of households experienced catastrophic healthcare expenditure, with participants in the Northern and Western Regions 5-10 times more likely to experience such hardship and utilize financial coping mechanisms than counterparts in the Central Region, a wealthier area. Increases in total RHD costs were positively correlated with increasing use of coping behaviors. Conclusion: Ugandan households affected by RHD, particularly in lower-income areas, incur out-of-pocket costs that are very high relative to income, exacerbating the poverty trap. Universal health coverage policy reforms in Uganda should include mechanisms to reduce or eliminate out-of-pocket expenditures for RHD and other chronic diseases.
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Affiliation(s)
- Chinonso C. Opara
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Yuxian Du
- Hutchinson Institute for Cancer Outcome Research, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Yoshito Kawakatsu
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Community-Based Rehabilitation Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Jenifer Atala
- Department of RHD Research, Uganda Heart Institute, Kampala, Uganda
| | - Andrea Z. Beaton
- Department of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, School of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | | | - Miriam Nakitto
- Department of RHD Research, Uganda Heart Institute, Kampala, Uganda
| | - Emma Ndagire
- Division of Cardiology, Uganda Heart Institute, Kampala, Uganda
| | - Haddy Nalubwama
- Department of RHD Research, Uganda Heart Institute, Kampala, Uganda
| | - Emmy Okello
- Division of Cardiology, Uganda Heart Institute, Kampala, Uganda
| | - David A. Watkins
- Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Community-Based Rehabilitation Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yanfang Su
- Department of Community-Based Rehabilitation Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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Mhlanga D. A Dynamic Analysis of the Demand for Health Care in Post-Apartheid South Africa. NURSING REPORTS 2021; 11:484-494. [PMID: 34968223 PMCID: PMC8608092 DOI: 10.3390/nursrep11020045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/07/2021] [Accepted: 04/12/2021] [Indexed: 11/18/2022] Open
Abstract
The study aimed to investigate the drivers of demand for healthcare in South Africa 26 years after democracy. The pattern healthcare demand by households in South Africa is that most households use public healthcare services particularly public clinics compared to private and traditional healthcare facilities. Using conditional probability models, the logit model to be more specific, the results revealed that households head who is unemployed, households who do not have a business, households who were not receiving pension money, had a greater probability of demand for public healthcare institutions. On the other hand, being male, being White, Indian and Coloured, being a property owner and being not a grant beneficiary, reduces the probability of demand for public healthcare facilities in South Africa. As a result, the study recommends more investment in public healthcare but more in public clinics in South Africa due to the high percentage of households using these services. Also, the government must consider investing more in the maintenance and improvement of the welfare of nurses in the country considering the huge role they play in the delivery of healthcare to the citizens.
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Affiliation(s)
- David Mhlanga
- Department of Accountancy, The University of Johannesburg, Auckland Park, P.O. Box 524, Johannesburg 2006, South Africa
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Simkovich SM, Thompson LM, Clark M, Balakrishnan K, Bussalleu A, Checkley W, Clasen T, Davila-Roman V, Diaz-Artiga A, de Las Fuentes L, Harvey S, Kirby M, Lovvorn A, McCollum E, Peel J, Quinn A, Rosa G, Underhill L, Williams K, Young B, Rosenthal J. A Risk Assessment Tool for Resumption of Research Activities During the COVID-19 Pandemic. RESEARCH SQUARE 2020:rs.3.rs-103997. [PMID: 33200126 PMCID: PMC7668754 DOI: 10.21203/rs.3.rs-103997/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
RATIONALE The spread of severe acute respiratory syndrome coronavirus-2 has suspended many non-COVID-19 related research activities. Where restarting research activities is permitted, investigators need to evaluate the risks and benefits of resuming data collection and adapt procedures to minimize risk. OBJECTIVES In the context of the multicountry Household Air Pollution Intervention (HAPIN) trial, we developed a framework to assess the risk of each trial activity and to guide protective measures. Our goal is to maximize integrity of reseach aims while minimizing infection risk based on the latest understanding of the virus. METHODS We drew on a combination of expert consultations, risk assessment frameworks, institutional guidance and literature to develop our framework. We then systematically graded clinical, behavioral, laboratory and field environmental health research activities in four countries for both adult and child subjects using this framework. RESULTS Our framework assesses risk based on staff proximity to the participant, exposure time between staff and participants, and potential aerosolization while performing the activity. One of of four risk levels, from minimal to unacceptable, is assigned and guidance on protective measures is provided. Those activities which can potentially aerosolize the virus are deemed the highest risk. CONCLUSIONS By applying a systematic, procedure-specific approach to risk assessment for each trial activity, we can compare trial activities using the same criteria. This approach allows us to protect our participants and research team and to uphold our ability to deliver on the research commitments we have made to our participants, local communities, and funders. The trial is registered with clinicaltrials.gov (NCT02944682).
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de Broucker G, Sim SY, Brenzel L, Gross M, Patenaude B, Constenla DO. Cost of Nine Pediatric Infectious Illnesses in Low- and Middle-Income Countries: A Systematic Review of Cost-of-Illness Studies. PHARMACOECONOMICS 2020; 38:1071-1094. [PMID: 32748334 PMCID: PMC7578143 DOI: 10.1007/s40273-020-00940-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Cost-of-illness data from empirical studies provide insights into the use of healthcare resources including both expenditures and the opportunity cost related to receiving treatment. OBJECTIVE The objective of this systematic review was to gather cost data and relevant parameters for hepatitis B, pneumonia, meningitis, encephalitis caused by Japanese encephalitis, rubella, yellow fever, measles, influenza, and acute gastroenteritis in children in low- and middle-income countries. DATA SOURCES Peer-reviewed studies published in public health, medical, and economic journals indexed in PubMed (MEDLINE), Embase, and EconLit. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS Studies must (1) be peer reviewed, (2) be published in 2000-2016, (3) provide cost data for one of the nine diseases in children aged under 5 years in low- and middle-income countries, and (4) generated from primary data collection. LIMITATIONS We cannot exclude missing a few articles in our review. Measures were taken to reduce this risk. Several articles published since 2016 are omitted from the systematic review results, these articles are included in the discussion. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS The review yielded 37 articles and 267 sets of cost estimates. We found no cost-of-illness studies with cost estimates for hepatitis B, measles, rubella, or yellow fever from primary data. Most estimates were from countries in Gavi preparatory (28%) and accelerated (28%) transition, followed by those who are initiating self-financing (22%) and those not eligible for Gavi support (19%). Thirteen articles compared household expenses to manage illnesses with income and two articles with other household expenses, such as food, clothing, and rent. An episode of illness represented 1-75% of the household's monthly income or 10-83% of its monthly expenses. Articles that presented both household and government perspectives showed that most often governments incurred greater costs than households, including non-medical and indirect costs, across countries of all income statuses, with a few notable exceptions. Although limited for low- and middle-income country settings, cost estimates generated from primary data collection provided a 'real-world' estimate of the economic burden of vaccine-preventable diseases. Additional information on whether common situations preventing the application of official clinical guidelines (such as medication stock-outs) occurred would help reveal deficiencies in the health system. Improving the availability of cost-of-illness evidence can inform the public policy agenda about healthcare priorities and can help to operationalize the healthcare budget in local health systems to respond adequately to the burden of illness in the community.
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Affiliation(s)
- Gatien de Broucker
- International Vaccine Access Center, 415 North Washington Street, Suite #530, Baltimore, MD, 21231, USA.
| | - So Yoon Sim
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Margaret Gross
- Welch Medical Library, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Bryan Patenaude
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dagna O Constenla
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- GlaxoSmithKline Plc, Panama City, Panama
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15
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Ilinca S, Di Giorgio L, Salari P, Chuma J. Socio-economic inequality and inequity in use of health care services in Kenya: evidence from the fourth Kenya household health expenditure and utilization survey. Int J Equity Health 2019; 18:196. [PMID: 31849334 PMCID: PMC6918604 DOI: 10.1186/s12939-019-1106-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 12/09/2019] [Indexed: 11/27/2022] Open
Abstract
Background Kenya is experiencing persistently high levels of inequity in health and access to care services. In 2018, decades of sustained policy efforts to promote equitable, affordable and quality health services have culminated in the launch of a universal health coverage scheme, initially piloted in four Kenyan counties and planned for national rollout by 2022. Our study aims to contribute to monitoring and evaluation efforts alongside policy implementation, by establishing a detailed, baseline assessment of socio-economic inequality and inequity in health care utilization in Kenya shortly before the policy launch. Methods We use concentration curves and corrected concentration indexes to measure socio-economic inequality in care use and the horizontal inequity index as a measure of inequity in care utilization for three types of care services: outpatient care, inpatient care and preventive and promotive care. Further insights into the individual and household level characteristics that determine observed inequality are derived through decomposition analysis. Results We find significant inequality and inequity in the use of all types of care services favouring richer population groups, with particularly pronounced levels for preventive and inpatient care services. These are driven primarily by differences in living standards and educational achievement, while the region of residence is a key driver for inequality in preventive care use only. Pro-rich inequalities are particularly pronounced for care provided in privately owned facilities, while public providers serve a much larger share of individuals from lower socio-economic groups. Conclusions Through its focus on increasing affordability of care for all Kenyans, the newly launched universal health coverage scheme represents a crucial step towards reducing disparities in health care utilization. However in order to achieve equity in health and access to care such efforts must be paralleled by multi-sectoral approaches to address all key drivers of inequity: persistent poverty, disparities in living standards and educational achievement, as well as regional differences in availability and accessibility of care.
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Affiliation(s)
- Stefania Ilinca
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland. .,European Centre for Social Welfare Policy and Research, Vienna, Austria.
| | | | - Paola Salari
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
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Attia-Konan AR, Oga ASS, Touré A, Kouadio KL. Distribution of out of pocket health expenditures in a sub-Saharan Africa country: evidence from the national survey of household standard of living, Côte d'Ivoire. BMC Res Notes 2019; 12:25. [PMID: 30646940 PMCID: PMC6332523 DOI: 10.1186/s13104-019-4048-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/04/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The purpose and objective of our research is to identify the determinants of the out of pocket (OOP) health expenditures in the population of Ivory Coast and the ratios across three different area; Abidjan, the rural and urban area. We used data from the 2015 standard households living survey conducted by the National Institute of Statistic. RESULTS About 6315 (13.3%) of the participants had experienced OOP health expenditure. There was significant differences in the self-reported OOP between these three areas (p < 0.001). The overall mean of OOP expenditure among all participants was 16,034.33 XOF (29 USD). People in Abidjan spent an average of 1.6 and 1.5 times more than those in the rural and urban areas respectively (p < 0.001). Hospitalization is the highest expenditure item in terms of money spent, while drugs are the most common item of expenditure in terms of frequency, regardless of the place of residence. Female gender, high social economic status and large household size increase OOP health expenditure significantly in all areas of residence when insurance reduce it. To reduce the impact of the direct payments there is a need to take into account social demographic factors in addition to economic factor in health policy development.
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Affiliation(s)
- Akissi Régine Attia-Konan
- Department of Public Health, Hydrology and Toxicology, UFR Pharmaceutical and Biological Sciences, University of Félix Houphouet Boigny, BP V34 Abidjan, Côte d’Ivoire
| | - Agbaya Stéphane Serge Oga
- Department of Public Health, Hydrology and Toxicology, UFR Pharmaceutical and Biological Sciences, University of Félix Houphouet Boigny, BP V34 Abidjan, Côte d’Ivoire
| | - Amadou Touré
- National Institute of Statistic of Côte D’Ivoire, Abidjan, Côte d’Ivoire
| | - Kouakou Luc Kouadio
- Department of Public Health, Hydrology and Toxicology, UFR Pharmaceutical and Biological Sciences, University of Félix Houphouet Boigny, BP V34 Abidjan, Côte d’Ivoire
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