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Ahmad F, Mohanty PC. Incidence and intensity of catastrophic health expenditure and impoverishment among the elderly: an empirical evidence from India. Sci Rep 2024; 14:15908. [PMID: 38987298 PMCID: PMC11237111 DOI: 10.1038/s41598-024-55142-1] [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: 10/04/2023] [Accepted: 02/20/2024] [Indexed: 07/12/2024] Open
Abstract
World health statistics (2022) report that about 1.4 billion people have incurred catastrophic health expenditure (CHE), and half of its population have pushed into extreme poverty due to healthcare payments. The elderly population faces a higher risk of ill health, and seeking treatment reflects in high out-of-pocket health spending (OOPHS) that results in CHE and further impoverishment. This study aims to investigate the incidence and intensity of OOPHS, CHE, and impoverishment among the older adults in India. Data utilizes from the 75th round of the national sample survey (NSS) based on household social consumption: health (schedule 25.0), 2018. The incidence and intensity of CHE and impoverishment among older adults in India estimated by using standard measures. The older adults spend about 17.4% of household consumption expenditure on healthcare services. The poorest older adults are spending the highest share of consumption expenditure (24.8%) on healthcare among economic quantiles. Similarly, the elderly from rural (20.3%), male (18.4%), scheduled castes (21.5%), and Hinduism (17.9%) show a larger share of consumption expenditure on healthcare services. The incidence and intensity of CHE among older adults are 46.5% and 16.1% at 10% threshold level of household consumption expenditure, respectively. However, as the threshold level rises the incidence and intensity of CHE decline. The estimates of normalized poverty gap using the poverty line of Tendulkar committee as well as Rangarajan committee show that the intensity of impoverishment among older adults are 56.4% and 57.9% respectively, which is quite high. Financial protection along with vision might mitigate the risk of CHE and impoverishment among older adults in India.
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Affiliation(s)
- Fahimuddin Ahmad
- Department of Humanities and Social Sciences, Indian Institute of Technology Roorkee, Roorkee, Uttarakhand, 247667, India.
| | - Pratap Chandra Mohanty
- Department of Humanities and Social Sciences, Indian Institute of Technology Roorkee, Roorkee, Uttarakhand, 247667, India.
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Ji S, Lee M, Choi M, Park S. The impact of the expanded health insurance coverage policy on healthcare spending: evidence from Korea. Int J Equity Health 2024; 23:126. [PMID: 38907297 PMCID: PMC11191158 DOI: 10.1186/s12939-024-02206-3] [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: 01/30/2024] [Accepted: 05/29/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND South Korea's National Health Insurance (NHI) system pursues universal health coverage, but it has not been able to alleviate patients' financial burden owing to limited coverage and a high proportion of out-of-pocket expenses. In 2017, the government announced a plan to strengthen universality by providing coverage for all unincluded services, expanding coverage, and alleviating household financial burden. We aimed to evaluate the effect of "Moon Care" with a focus on changes in health expenditures following policy implementation, and to provide empirical evidence for future policies to strengthen the NHI system's universality. METHODS Using data from the 2016 and 2018 Korea Health Panel (KHP), we established a treatment group affected by the policy and an unaffected control group; we ensured homogeneity between the groups using propensity score matching (PSM). Subsequently, we examined changes in NHI payments, non-payments, and out-of-pocket payments (OOP); we performed difference-in-differences (DID) analysis to evaluate the policy's effect. RESULTS Following policy implementation, the control group had a higher increase than the treatment group in all categories of health expenditures, including NHI payments, non-payments, and OOP. We noted significant decreases in all three categories of health expenditures when comparing the differences before and after policy implementation, as well as between the treatment and control groups. However, we witnessed a significant decrease in the interaction term, which confirms the policy's effect, but only for non-payments. CONCLUSIONS We observed the policy's intervention effect over time as a decrease in non-payments, on the effectivity of remunerating covered medical services. However, the policy did not work for NHI payments and OOP, suggesting that it failed to control the creation of new non-covered services as noncovered services were converted into covered ones. Thus, it is crucial to discuss the financial spending of health insurance regarding the inclusion of non-covered services in the NHI benefits package.
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Affiliation(s)
- Seokmin Ji
- Department of Health Policy & Management, College of Health Science, Korea University, Seoul, South Korea
- BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, South Korea
| | - Munjae Lee
- Department of Medical Science, Ajou University School of Medicine, Suwon, 16499, South Korea
| | - Mankyu Choi
- Department of Health Policy & Management, College of Health Science, Korea University, Seoul, South Korea.
- BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, South Korea.
| | - Sewon Park
- Department of Medical Science, Ajou University School of Medicine, Suwon, 16499, South Korea.
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Meshkat SAM, Kassaeian SS, Danaei N, Gharibi F. Households catastrophic health expenditure among older people with noncommunicable diseases: A cross-sectional study from Iran. Health Sci Rep 2024; 7:e1992. [PMID: 38505679 PMCID: PMC10948590 DOI: 10.1002/hsr2.1992] [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: 05/06/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/21/2024] Open
Abstract
Background and Aims Noncommunicable diseases are one of the main difficulties faced by older adults in many countries. The study aimed to investigate the households' catastrophic health expenditure (CHE) among older people with noncommunicable diseases. Methods This cross-sectional study was conducted between October and December 2022 in Semnan, Iran, with the participation of 400 older individuals suffering from diabetes and hypertension. The Content Validity Ratio (which is calculated based on necessity criterion) and Content Validity Index (which calculated based on relevance, transparency, and simplicity criteria) values of 0.94 and 0.89, respectively, confirmed the content validity of the researcher-made questionnaire. The occurrence of CHE was estimated using the World Health Organization's rule of "allocating at least 40% of non-food household costs to healthcare." Due to the qualitative nature of the data, the χ 2 test was utilized to assess the statistical association between demographic and background variables and occurrence of CHE. Results Older people with diabetes and hypertension had an annual direct medical costs of $821 averagely, which includes 9.7% for diagnosis, 23.9% for doctor visits, and 66.4% for treatment. Direct medical costs account for around 0.26 of nonfood costs, with 12.5% of seniors facing high medical charges. Age, marital status, type of basic health insurance, diabetes, the time elapsed since initial diabetes diagnosis, the severity of diabetes complications, and the development of diabetes-related visual impairments, are associated with CHE (p < 0.05). Conclusion While the prevalence of CHE among elderly individuals with diabetes and hypertension is reasonably manageable, targeted promotional efforts are still necessary to protect those at high risk.
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Affiliation(s)
| | - Sayed Saeed Kassaeian
- Department of Community Medicine, School of MedicineSemnan University of Medical SciencesSemnanIran
| | - Navid Danaei
- Department of Pediatrics, School of MedicineSemnan University of Medical SciencesSemnanIran
| | - Farid Gharibi
- Social Determinants of Health Research CenterSemnan University of Medical SciencesSemnanIran
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Brindley C, Wijemunige N, Dieteren C, Bom J, Meessen B, Bonfrer I. Health seeking behaviours and private sector delivery of care for non-communicable diseases in low- and middle-income countries: a systematic review. BMC Health Serv Res 2024; 24:127. [PMID: 38263128 PMCID: PMC10807218 DOI: 10.1186/s12913-023-10464-0] [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: 02/22/2023] [Accepted: 12/09/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Globally, non-communicable diseases (NCDs) are the leading cause of mortality and morbidity placing a huge burden on individuals, families and health systems, especially in low- and middle-income countries (LMICs). This rising disease burden calls for policy responses that engage the entire health care system. This study aims to synthesize evidence on how people with NCDs choose their healthcare providers in LMICs, and the outcomes of these choices, with a focus on private sector delivery. METHODS A systematic search for literature following PRISMA guidelines was conducted. We extracted and synthesised data on the determinants and outcomes of private health care utilisation for NCDs in LMICs. A quality and risk of bias assessment was performed using the Mixed Methods Appraisal Tool (MMAT). RESULTS We identified 115 studies for inclusion. Findings on determinants and outcomes were heterogenous, often based on a particular country context, disease, and provider. The most reported determinants of seeking private NCD care were patients having a higher socioeconomic status; greater availability of services, staff and medicines; convenience including proximity and opening hours; shorter waiting times and perceived quality. Transitioning between public and private facilities is common. Costs to patients were usually far higher in the private sector for both inpatient and outpatient settings. The quality of NCD care seems mixed depending on the disease, facility size and location, as well as the aspect of quality assessed. CONCLUSION Given the limited, mixed and context specific evidence currently available, adapting health service delivery models to respond to NCDs remains a challenge in LMICs. More robust research on health seeking behaviours and outcomes, especially through large multi-country surveys, is needed to inform the effective design of mixed health care systems that effectively engage both public and private providers. TRIAL REGISTRATION PROSPERO registration number CRD42022340059 .
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Affiliation(s)
- Callum Brindley
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands.
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands.
| | - Nilmini Wijemunige
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
- Institute for Health Policy, Colombo, Sri Lanka
| | - Charlotte Dieteren
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
| | - Judith Bom
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
| | | | - Igna Bonfrer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
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Serván-Mori E, Gómez-Dantés O, Contreras D, Flamand L, Cerecero-García D, Arreola-Ornelas H, Knaul FM. Increase of catastrophic and impoverishing health expenditures in Mexico associated to policy changes and the COVID-19 pandemic. J Glob Health 2023; 13:06044. [PMID: 37883200 PMCID: PMC10602209 DOI: 10.7189/jogh.13.06044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
Background In 2003, the Mexican Congress approved a major reform to provide health care services to the poor population through the public insurance scheme Seguro Popular. This program was dismantled in 2019 as part of a set of health system reforms and substituted with the Health Institute for Welfare (INSABI). These changes were implemented during the initial phases of the coronavirus (COVID-19) pandemic. We aimed to examine the impact of these reforms and the COVID-19 pandemic on financial risk protection in Mexico between 2018 and 2020. Methods We performed a population-based analysis using cross-sectional data from the 2018 and 2020 rounds of the National Household Income and Expenditures Survey. We used a pooled fixed-effects multivariable two-stage probit model to determine the likelihood of catastrophic health expenditure (CHE), impoverishing health expenditure (IHE), and excessive health expenditure (EHE) among Mexican households. We also mapped the quintiles of changes in EHE in households without health insurance by state. Results The percentage of households without health insurance almost doubled from 8.8% (three million households) in 2018 to 16.5% (5.8 million households) in 2020. We also found large increases in the proportion of households incurring in CHE (18.4%; 95% confidence interval (CI) = 6.1, 30.7) and EHE (18.7%; 95% CI = 7.9, 29.5). Significant increases in CHE, IHE, and EHE were only observed among households without health insurance (CHE: 90.7%; 95% CI = 31.6, 149.7, EHE: 73.5%; 95% CI = 25.3, 121.8). Virtually all Mexican states (n/N = 31/32) registered an increase in EHE among households without health insurance. This increase has a systematic territorial component affecting mostly central and southern states (range = -1.0% to 194.4%). Conclusions The discontinuation of the Seguro Popular Program and its substitution with INSABI during the first stages of the COVID-19 pandemic reduced the levels of health care coverage in Mexico. This reduction and the pandemic increased out-of-pocket expenditure in health and the portion of CHE and EHE in the 2018-2020 period. The effect was higher in households without health insurance and households in central and southern states of the country. Further studies are needed to determine the specific effect both of recent policy changes and of the COVID-19 pandemic on the levels of financial protection in health in Mexico.
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Affiliation(s)
- Edson Serván-Mori
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Octavio Gómez-Dantés
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - David Contreras
- Institute for Obesity Research, Tecnologico de Monterrey, Mexico
- School Government and Public Transformation, Tecnologico de Monterrey, Mexico
| | - Laura Flamand
- Center for International Studies, El Colegio de Mexico, Mexico City, Mexico
| | - Diego Cerecero-García
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
- Public Health Policy Evaluation Unit, Imperial College London, London, United Kingdom
| | - Héctor Arreola-Ornelas
- Institute for Obesity Research, Tecnologico de Monterrey, Mexico
- School Government and Public Transformation, Tecnologico de Monterrey, Mexico
- Mexican Health Foundation (FUNSALUD), Mexico
- Tomatelo a Pecho, A.C., Mexico
| | - Felicia M Knaul
- Mexican Health Foundation (FUNSALUD), Mexico
- Tomatelo a Pecho, A.C., Mexico
- The University of Miami Institute for Advanced Study of the Americas, USA
- Miller School of Medicine, University of Miami, USA
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Mukhopadhyay P, De M, Lahiri S, Sarkar M, Haldar A. Evaluation of community-based care delivered by primary healthcare providers in management of hypertension in a rural area of West Bengal. J Family Med Prim Care 2023; 12:1685-1691. [PMID: 37767422 PMCID: PMC10521822 DOI: 10.4103/jfmpc.jfmpc_2435_22] [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: 12/14/2022] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 09/29/2023] Open
Abstract
Background Lifestyle modifications and medication compliance are key strategies. Objectives To evaluate the effect of community-based care delivered by trained primary healthcare providers in management of hypertension. Materials and Methods A longitudinal study was conducted between two groups of newly diagnosed hypertensive patients to evaluate the impact of an educational intervention. Six blocks in a district were chosen with pairwise matching. All primary healthcare providers of one block in each pair were randomized to receive the intervention and the other was controlled. Next screening for risk factors, detection of hypertension, counseling, and follow-up care were provided. The patients within the control group received usual care as per clinician's discretion. A total of 227 patients in the "study" group and 230 patients in the "control" group were recruited from 12 subcenters selected randomly. Data analysis was done by χ2 test, t test, and GLM analysis using SPSS 16. Results Patients in the intervention blocks demonstrated a statistically significant mean reduction in SBP of 16.14 ± 0.82 and DBP by 11.65 ± 0.53 compared to 9.83 ± 1.02 and 7.68 ± 0.66, respectively, in the control blocks after adjusting for age, sex, and baseline blood pressure at one-year follow-up. Regarding lifestyle-related cardiovascular risk factors, statistically significant differences were found in favor of the intervention group. Conclusion The study supports and reinforces the utilization of trained primary healthcare providers under the NPCDCS program in screening and promoting blood pressure control by preventive services to hypertensive patients in the community.
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Affiliation(s)
- Prianka Mukhopadhyay
- Department of Community Medicine, Bankura Sammilani Medical College, Bankura, West Bengal, India
| | - Maumita De
- Department of Community Medicine, NRS Medical College, Kolkata, West Bengal, India
| | - Surajit Lahiri
- Department of Community Medicine, Bankura Sammilani Medical College, Bankura, West Bengal, India
| | - Manisha Sarkar
- Department of Community Medicine, Bankura Sammilani Medical College, Bankura, West Bengal, India
| | - Anima Haldar
- Department of Community Medicine, ID and BG Hospital, Beliaghata, Kolkata, West Bengal, India
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Hamiduzzaman M, De Bellis A, Abigail W, Harrington A, Fletcher A. "When I suffer from fever, I eat mangos." Determinants of health-seeking beliefs and behaviors of rural older women in Sylhet, Bangladesh. J Women Aging 2023; 35:4-21. [PMID: 34724877 DOI: 10.1080/08952841.2021.1996195] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Poverty, poor living conditions, religious values and norms, lack of education, and gender discrimination influence the beliefs and behaviors of rural older women in many low-income countries. This paper aims to report the socio-ecological determinants of health-seeking beliefs and behaviors of rural older women in North-eastern Bangladesh and how these behaviors impact their recognition within the setting. It involved semi-structured interviews with 25 older women and 11 healthcare professionals. The findings revealed various determinants at the personal level (awareness of illness, mistrust toward medical treatment, self-treatment, and religious values and norms), the interpersonal level (isolation in family and communication with clinicians), community level (community perception of aging, neighboring and community organizations), and in the sphere of human rights (care affordability, social safety-net coverage and national policy). Four core determinants (poverty, education, gender and religiosity) were intertwined in shaping beliefs and behaviors.
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Affiliation(s)
- Mohammad Hamiduzzaman
- College of Health, Medicine & Wellbeing, The University of Newcastle, Taree, New South Wales, 2430, Australia
| | - Anita De Bellis
- College of Nursing & Health Sciences, Flinders University, Adelaide, Australia
| | - Wendy Abigail
- College of Nursing & Health Sciences, Flinders University, Adelaide, Australia
| | - Ann Harrington
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia.,Public and Contextual Theology Research Centre, Australian Centre for Christianity & Culture, Charles Sturt University, Barton, Australia
| | - Amber Fletcher
- Department of Sociology & Social Studies, University of Regina, Regina, Saskatchewan, Canada
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Mahumud RA, Gow J, Mosharaf MP, Kundu S, Rahman MA, Dukhi N, Shahajalal M, Mistry SK, Alam K. The burden of chronic diseases, disease-stratified exploration and gender-differentiated healthcare utilisation among patients in Bangladesh. PLoS One 2023; 18:e0284117. [PMID: 37130132 PMCID: PMC10153713 DOI: 10.1371/journal.pone.0284117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 03/13/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Chronic diseases are considered one of the major causes of illness, disability, and death worldwide. Chronic illness leads to a huge health and economic burden, especially in low- and middle-income countries. This study examined disease-stratified healthcare utilisation (HCU) among Bangladesh patients with chronic diseases from a gender perspective. METHODS Data from the nationally representative Household Income and Expenditure Survey 2016-2017 consisting of 12,005 patients with diagnosed chronic diseases was used. Gender differentiated chronic disease stratified-analytical exploration was performed to identify the potential factors to higher or lower utilisation of healthcare services. Logistic regression with step-by-step adjustment for independent confounding factors was the method used. RESULTS The five most prevalent chronic diseases among patients were gastric/ulcer (Male/Female, M/F: 16.77%/16.40%), arthritis/rheumatism (M/F: 13.70%/ 13.86%), respiratory diseases/asthma/bronchitis (M/F: 12.09% / 12.55%), chronic heart disease (M/F: 8.30% / 7.41%), and blood pressure (M/F: 8.20% / 8.87%). Eighty-six percent of patients with chronic diseases utilised health care services during the previous 30 days. Although most patients received outpatient healthcare services, a substantial difference in HCU among employed male (53%) and female (8%) patients were observed. Chronic heart disease patients were more likely to utilise health care than other disease types, which held true for both genders while the magnitude of HCU was significantly higher in males (OR = 2.22; 95% CI:1.51-3.26) than their female counterparts (OR = 1.44; 1.02-2.04). A similar association was observed among patients with diabetes and respiratory diseases. CONCLUSION A burden of chronic diseases was observed in Bangladesh. Patients with chronic heart disease utilised more healthcare services than patients experiencing other chronic diseases. The distribution of HCU varied by patient's gender as well as their employment status. Risk-pooling mechanisms and access to free or low-cost healthcare services among the most disadvantaged people in society might enhance reaching universal health coverage.
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Affiliation(s)
- Rashidul Alam Mahumud
- Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- School of Business, Faculty of Business, Education, Law and Arts, University of Southern Queensland, Toowoomba, Australia
| | - Jeff Gow
- School of Business, Faculty of Business, Education, Law and Arts, University of Southern Queensland, Toowoomba, Australia
- School of Accounting, Economics and Finance, College of Law and Management Studies, University of KwaZulu-Natal, Durban, South Africa
| | - Md Parvez Mosharaf
- Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
- School of Business, Faculty of Business, Education, Law and Arts, University of Southern Queensland, Toowoomba, Australia
| | - Satyajit Kundu
- Global Health Institute, North South University, Dhaka, Bangladesh
- Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| | - Md Ashfikur Rahman
- Development Studies Discipline, Social Science School, Khulna University, Khulna, Bangladesh
| | - Natisha Dukhi
- Human Sciences Research Council, Cape Town, South Africa
| | - Md Shahajalal
- Department of Public Health, School of Health and Life Sciences, North South University, Dhaka, Bangladesh
| | - Sabuj Kanti Mistry
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
- ARCED Foundation, Dhaka, Bangladesh
- Department of Public Health, Daffodil International University, Dhaka, Bangladesh
- Brain and Mond Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Khorshed Alam
- School of Business, Faculty of Business, Education, Law and Arts, University of Southern Queensland, Toowoomba, Australia
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Health Services Utilization Barriers for Rural Elderly Women in Bangladesh: Narratives of Clinicians, Pharmacists and Public Health Assistants. J Cross Cult Gerontol 2022; 37:407-426. [PMID: 36469229 DOI: 10.1007/s10823-022-09465-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] [Accepted: 11/22/2022] [Indexed: 12/12/2022]
Abstract
Bangladesh has the third largest population of poor older adults in the world and 73% of them live in rural areas. Disparity in the country's health services is evident that creates a substantial pressure, especially on rural elderly women who live in a compromised socio-cultural atmosphere. This is true that we know about rural elderly women's self-reported health and service use barriers, but no studies captured the views of health staff. This study presents a qualitative exploration of the views held by rural health staff whose role is to provide care to local elderly women. We conducted 11 interviews with clinicians, pharmacists and public health assistants in Sylhet district, Bangladesh. A critical thematic discourse analysis, using the critical social constructs of Habermas and Honneth, of the data informed the women's inadequate healthcare access and associated barriers that were complex and overlapping but had explicit institutional, subjective and material consequences. Five major themes emerged including: unequal distribution of health services; marginalization in patient-staff relationships; living with poverty; social relegation; and mistrust of clinical treatment. Rural areas were viewed with inequitably distributed health services and traditionally a large proportion of elderly women living in poverty who lacked social support and demonstrated a mistrust towards healthcare system. No recognition of the women and power differences were underpinned by economic factors and cultural societal values. The findings suggest a need for health policy solutions and education of healthcare staff and elderly women regarding accessing healthcare.
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Panda BK, Mohanty SK. Catastrophic health spending among older adults in India: Role of multiple deprivation. AGING AND HEALTH RESEARCH 2022. [DOI: 10.1016/j.ahr.2022.100100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Zhang X, Xia Q, Lai Y, Wu B, Tian W, Miao W, Feng X, Xin L, Miao J, Wang N, Wu Q, Jiao M, Shan L, Du J, Li Y, Shi B. Spatial effects of air pollution on the economic burden of disease: implications of health and environment crisis in a post-COVID-19 world. Int J Equity Health 2022; 21:161. [PMCID: PMC9664438 DOI: 10.1186/s12939-022-01774-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 10/12/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Air pollution has been identified as related to the diseases of susceptible population, but the spatial heterogeneity of its economic burden and its determinants are rarely investigated. The issue is of great policy significance, especially after the epidemic of COVID-19, when human are facing the joint crisis of health and environment, and some areas is prone to falling into poverty.
Methods
The geographical detector was adopted to study the spatial distribution characteristics of the incidence of catastrophic health expenditure (ICHE) for older adults in 100 rural areas in China at the prefecture-city level. The health factors, sociological factors, policy factors and environmental factors and their interactions are identified.
Results
First, most health service factors had strong explanatory power for ICHE whether it interacts with air pollution. Second, 50 single-factor high-risk areas of ICHE were found in the study, but at the same time, there were 21 areas dominated by multiple factors.
Conclusion
The different contributions and synergy among the factors constitute the complex mechanism of factors and catastrophic health expenditure. Moreover, during this process, air pollution aggravates the contribution of health service factors toward ICHE. In addition, the leading factors of ICHE are different among regions. At the end, this paper also puts forward some policy suggestions from the perspective of health and environment crisis in the post-COVID-19 world: environmental protection policies should be combined with the prevention of infectious diseases; advanced health investment is the most cost-effective policy for the inverse health sequences of air pollution and infectious diseases such as coronavirus disease 2019 (COVID-19); integrating environmental protection policy into healthy development policy, different regions take targeted measures to cope with the intertwined crisis.
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López-López S, Del Pozo-Rubio R, Ortega-Ortega M, Escribano-Sotos F. Catastrophic household expenditure associated with out-of-pocket payments for dental healthcare in Spain. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:1187-1201. [PMID: 35066677 DOI: 10.1007/s10198-021-01420-y] [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: 03/19/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To estimate the prevalence of catastrophic health expenditure due to dental healthcare (CHED) in Spain, quantify its intensity and examine the related sociodemographic household characteristics. METHODS Data from the Spanish Household Budget Survey, which addresses more than 20,000 households each year for the period 2008-2015 were included, and the methodology proposed by Wagstaff and van Doorslaer was followed. The prevalence (number of households that devote more than a certain threshold of their income to such payments) and intensity (amount that exceeds a certain percentage of income) were estimated. Ordered logistic regression models were estimated to analyse the sociodemographic factors associated with the prevalence of catastrophic payments. RESULTS The prevalence and intensity remained stable during the period under analysis. In terms of prevalence, a mean proportion of 7.36% of the population dedicated, in terms of intensity, more than 10% of their resources to dental care payments [mean: €292.75 per year (SD €2144.14)] and 2.05% dedicated more than 40% [mean: €143.02 per year (SD €1726.42)]. This represents 36.32% and 51.34% (for the thresholds of 10% and 40%) of the total catastrophic expenditure derived from out-of-pocket payments for dental healthcare in Spain. CONCLUSION This study shows that a significant proportion of catastrophic healthcare payments correspond to dental services. Being male, aged over 40 years, unattached (single, separated, divorced or widowed), having a low level of education, a low household income, being unemployed and living in an urban area are all associated with a greater risk of CHED. This finding highlights the need to establish policies aimed at increasing dental care coverage to mitigate related financial burdens on a large part of the Spanish population.
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Affiliation(s)
- Samuel López-López
- Castilla-La Mancha Health Services, SESCAM, Hospital of Cuenca, C/ Hermandad de Donantes de Sangre, 1, 16 002, Cuenca, Spain.
| | - Raúl Del Pozo-Rubio
- Department of Economic Analysis and Finance, University of Castilla-La Mancha, Avda. Los Alfares, 44, 16 071, Cuenca, Spain
- Research Group on Food, Economy and Society, University of Castilla-La Mancha, Albacete, Spain
| | - Marta Ortega-Ortega
- Department of Applied and Public Economics, and Political Economy, Complutense University of Madrid, Campus de Somosaguas s/n, Pozuelo de Alarcón, 28 223, Madrid, Spain
| | - Francisco Escribano-Sotos
- Department of Economic Analysis and Finance, University of Castilla-La Mancha, Plaza de la Universidad s/n, 02 001, Albacete, Spain
- Research Group on Food, Economy and Society, University of Castilla-La Mancha, Albacete, Spain
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Rahman T, Gasbarro D, Alam K. Financial risk protection from out-of-pocket health spending in low- and middle-income countries: a scoping review of the literature. Health Res Policy Syst 2022; 20:83. [PMID: 35906591 PMCID: PMC9336110 DOI: 10.1186/s12961-022-00886-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/05/2022] [Indexed: 11/26/2022] Open
Abstract
Background Financial risk protection (FRP), defined as households’ access to needed healthcare services without experiencing undue financial hardship, is a critical health systems target, particularly in low- and middle-income countries (LMICs). Given the remarkable growth in FRP literature in recent times, we conducted a scoping review of the literature on FRP from out-of-pocket (OOP) health spending in LMICs. The objective was to review current knowledge, identify evidence gaps and propose future research directions. Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines to conduct this scoping review. We systematically searched PubMed, Scopus, ProQuest and Web of Science in July 2021 for literature published since 1 January 2015. We included empirical studies that used nationally representative data from household surveys to measure the incidence of at least one of the following indicators: catastrophic health expenditure (CHE), impoverishment, adoption of strategies to cope with OOP expenses, and forgone care for financial reasons. Our review covered 155 studies and analysed the geographical focus, data sources, methods and analytical rigour of the studies. We also examined the level of FRP by disease categories (all diseases, chronic illnesses, communicable diseases) and the effect of health insurance on FRP. Results The extant literature primarily focused on India and China as research settings. Notably, no FRP study was available on chronic illness in any low-income country (LIC) or on communicable diseases in an upper-middle-income country (UMIC). Only one study comprehensively measured FRP by examining all four indicators. Most studies assessed (lack of) FRP as CHE incidence alone (37.4%) or as CHE and impoverishment incidence (39.4%). However, the LMIC literature did not incorporate the recent methodological advances to measure CHE and impoverishment that address the limitations of conventional methods. There were also gaps in utilizing available panel data to determine the length of the lack of FRP (e.g. duration of poverty caused by OOP expenses). The current estimates of FRP varied substantially among the LMICs, with some of the poorest countries in the world experiencing similar or even lower rates of CHE and impoverishment compared with the UMICs. Also, health insurance in LMICs did not consistently offer a higher degree of FRP. Conclusion The literature to date is unable to provide a reliable representation of the actual level of protection enjoyed by the LMIC population because of the lack of comprehensive measurement of FRP indicators coupled with the use of dated methodologies. Future research in LMICs should address the shortcomings identified in this review. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-022-00886-3.
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Affiliation(s)
- Taslima Rahman
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia. .,Institute of Health Economics, University of Dhaka, Dhaka, 1000, Bangladesh.
| | - Dominic Gasbarro
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia
| | - Khurshid Alam
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia
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14
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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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15
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Association of sensory impairment with healthcare use and costs among middle-aged and older adults in China. Public Health 2022; 206:20-28. [DOI: 10.1016/j.puhe.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/27/2022] [Accepted: 02/08/2022] [Indexed: 11/21/2022]
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16
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Zhao Y, Tang S, Mao W, Akinyemiju T. Socio-Economic and Rural-Urban Differences in Healthcare and Catastrophic Health Expenditure Among Cancer Patients in China: Analysis of the China Health and Retirement Longitudinal Study. Front Public Health 2022; 9:779285. [PMID: 35087783 PMCID: PMC8787105 DOI: 10.3389/fpubh.2021.779285] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/15/2021] [Indexed: 12/24/2022] Open
Abstract
Objective: In China, cancer accounts for one-fifth of all deaths, and exerts a heavy toll on patients, families, healthcare systems, and society as a whole. This study aims to examine the temporal trends in socio-economic and rural-urban differences in treatment, healthcare service utilization and catastrophic health expenditure (CHE) among adult cancer patients in China. We also investigate the relationship between different types of treatment and healthcare service utilization, as well as the incidence of CHE. Materials and Methods: We analyzed data from the 2011 and 2015 China Health and Retirement Longitudinal Study, a nationally representative survey including 17,224 participants (234 individuals with cancer) in 2011 and 19,569 participants (368 individuals with cancer) in 2015. The study includes six different types of cancer treatments: Chinese traditional medication (TCM); western modern medication (excluding TCM and chemotherapy medications); a combination of TCM & western medication; surgery; chemotherapy; and radiation therapy. Multivariable regression models were performed to investigate the association between cancer treatments and healthcare service utilization and CHE. Results: The age-adjusted prevalence of cancer increased from 1.37% to 1.84% between 2011 and 2015. More urban patients (54%) received cancer treatment than rural patients (46%) in 2015. Patients with high socio-economic status (SES) received a higher proportion of surgical and chemotherapy treatments compared to patients with low SES in 2015. Incidence of CHE declined by 22% in urban areas but increased by 31% in rural areas. We found a positive relationship between cancer treatment and outpatient visits (OR = 2.098, 95% CI = 1.453, 3.029), hospital admission (OR = 1.961, 95% CI = 1.346, 2.857) and CHE (OR = 1.796, 95% CI = 1.231, 2.620). Chemotherapy and surgery were each associated with a 2-fold increased risk of CHE. Conclusions: Significant improvements in health insurance benefit packages are necessary to ensure universal, affordable and patient-centered health coverage for cancer patients in China.
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Affiliation(s)
- Yang Zhao
- Duke Global Health Institute, Duke University, Durham, NC, United States.,Global Health Research Center, Duke Kunshan University, Kunshan, China.,The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, NC, United States.,Global Health Research Center, Duke Kunshan University, Kunshan, China.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Wenhui Mao
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Tomi Akinyemiju
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States.,Duke Cancer Institute, Duke University, Durham, NC, United States
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17
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Demir A, Alkan Ö, Bilgiç A, Florkowski WJ, Karaaslan A. Determinants of Turkish households' out-of-pocket expenditures on three categories of health care services: A multivariate probit approach. Int J Health Plann Manage 2022; 37:2303-2327. [PMID: 35365938 DOI: 10.1002/hpm.3470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 03/17/2022] [Accepted: 03/20/2022] [Indexed: 11/08/2022] Open
Abstract
This study identifies the driving forces that contribute to the probabilities of incidence of out-of-pocket (OOP) expenditures by households in Turkey. Factors affecting the probability of OOP expenditures on medical products/devices/supplies (MP), outpatient services (OTS), and inpatient services (ITS) are examined using the Household Budget Survey data gathered by the Turkish Statistical Institute in 2018. The study applies the multivariate probit model. The incidence of OOP spending varied with 48.9% of the households reporting OOP expenditure on MP, 22.4% on OTS, and 25.4% on ITS. The largest probability changes were associated with household disposable annual income, household type and size, age category, and having private health insurance. Gender and marital status also influenced expenditures in some categories. Lifestyle choices had small and mixed effects, with smoking and alcohol consumption lowering the probability of OOP spending. From a policy standpoint, households with the lowest incomes, large households, and those where the household head was 'others' (retiree, student, housewife, not actively working, etc.) or had a condition preventing employment seemed to report OOP expenditures less frequently and may have chosen not to receive healthcare services, leading to the need for more healthcare services later.
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Affiliation(s)
- Ayşenur Demir
- Department of Econometrics, Faculty of Economics and Administrative Sciences, Ataturk University, Erzurum, Turkey
| | - Ömer Alkan
- Department of Econometrics, Faculty of Economics and Administrative Sciences, Ataturk University, Erzurum, Turkey
| | - Abdulbaki Bilgiç
- Department of Management Information Systems, College of Economics and Administrative Sciences, Bilecik Seyh Edebali University, Bilecik, Turkey
| | - Wojciech J Florkowski
- Department of Agricultural & Applied Economics, University of Georgia, Athens, Georgia, USA
| | - Abdulkerim Karaaslan
- Department of Econometrics, Faculty of Economics and Administrative Sciences, Ataturk University, Erzurum, Turkey
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18
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Health Care Utilization and Out-of-Pocket Payments among Elderly with Cognitive Frailty in Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063361. [PMID: 35329059 PMCID: PMC8954898 DOI: 10.3390/ijerph19063361] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 01/27/2023]
Abstract
Background: Cognitive frailty (CF) as a potential risk factor for dementia, functional disability, poor quality of life, and mortality. The aim of this study was to explore the health care-related utilization and out-of-pocket (OOP) expenditures, sociodemographic characteristics, and comorbidities among elderly Malaysians with CF. Methods: A cross-sectional study targeting elderly Malaysian aged ≥65 years was conducted. The study included all participants of the fourth phase of the Malaysian representative Long-Term-Research-Grant-Scheme Towards-Useful-Aging (LRGS-TUA) community-based study. A structured and validated interview questionnaire was used. Results: In total, 1006 elderly were interviewed, with a 66.18% response rate. Only 730 respondents met the inclusion criteria. Of the eligible respondents, the CF prevalence was 4.5%. Around 60.6% of the participants with CF had utilized outpatient care at government clinics within the past 6 months. The estimated mean total OOP payments for CF during the past 6 months was 84 Malaysian Ringgit (RM) (SD 96.0). Conclusions: CF among elderly Malaysians is within the internationally recognized range of prevalence. The OOP payments for seeking health care among CF elderly are not different from that of other elderly categories. There is a high possibility of underutilization of the health care services of CF cases while they are still needy.
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Pires M, Shaha S, King C, Morrison J, Nahar T, Ahmed N, Jennings HM, Akter K, Haghparast-Bidgoli H, Khan AKA, Costello A, Kuddus A, Azad K, Fottrell E. Equity impact of participatory learning and action community mobilisation and mHealth interventions to prevent and control type 2 diabetes and intermediate hyperglycaemia in rural Bangladesh: analysis of a cluster randomised controlled trial. J Epidemiol Community Health 2022; 76:586-594. [PMID: 35277436 PMCID: PMC9118071 DOI: 10.1136/jech-2021-217293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 01/21/2022] [Indexed: 11/11/2022]
Abstract
Background A cluster randomised trial of mHealth and participatory learning and action (PLA) community mobilisation interventions showed that PLA significantly reduced the prevalence of intermediate hyperglycaemia and type 2 diabetes mellitus (T2DM) and the incidence of T2DM among adults in rural Bangladesh; mHealth improved knowledge but showed no effect on glycaemic outcomes. We explore the equity of intervention reach and impact. Methods Intervention reach and primary outcomes of intermediate hyperglycaemia and T2DM were assessed through interview surveys and blood fasting glucose and 2-hour oral glucose tolerance tests among population-based samples of adults aged ≥30 years. Age-stratified, gender-stratified and wealth-stratified intervention effects were estimated using random effects logistic regression. Results PLA participants were similar to non-participants, though female participants were younger and more likely to be married than female non-participants. Differences including age, education, wealth and marital status were observed between individuals exposed and those not exposed to the mHealth intervention. PLA reduced the prevalence of T2DM and intermediate hyperglycaemia in all age, gender and wealth strata. Reductions in 2-year incidence of T2DM of at least 51% (0.49, 95% CI 0.26 to 0.92) were observed in all strata except among the oldest and least poor groups. mHealth impact on glycaemic outcomes was observed only among the youngest group, where a 47% reduction in the 2-year incidence of T2DM was observed (0.53, 95% CI 0.28 to 1.00). Conclusion Large impacts of PLA across all strata indicate a highly effective and equitable intervention. mHealth may be more suitable for targeting higher risk, younger populations. Trial registration number ISRCTN41083256.
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Affiliation(s)
- Malini Pires
- Institute for Global Health, University College London, London, UK
| | - Sanjit Shaha
- Centre for Health Research and Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Carina King
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Joanna Morrison
- Institute for Global Health, University College London, London, UK
| | - Tasmin Nahar
- Centre for Health Research and Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Naveed Ahmed
- Centre for Health Research and Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Kohenour Akter
- Centre for Health Research and Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - A K Azad Khan
- Centre for Health Research and Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Anthony Costello
- Institute for Global Health, University College London, London, UK
| | - Abdul Kuddus
- Centre for Health Research and Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Kishwar Azad
- Centre for Health Research and Implementation, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Edward Fottrell
- Institute for Global Health, University College London, London, UK
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20
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Chakraborty S, Rai RK, Biswas AK, Barik A, Gurung P, Praveen D. Health care seeking behaviour and financial protection of patients with hypertension: A cross-sectional study in rural West Bengal, India. PLoS One 2022; 17:e0264314. [PMID: 35213621 PMCID: PMC8880395 DOI: 10.1371/journal.pone.0264314] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background Elevated blood pressure or hypertension is responsible for around 10 million annual deaths globally, and people residing in low and middle-income countries are disproportionately affected by it. India is no exception, where low rate of treatment seeking for hypertension coupled with widespread out-of-pocket payments (OOPs) have been a challenge. This study assessed the pattern of health care seeking behaviour and financial protection along with the associated factors among hypertensive individuals in rural West Bengal, India. Method and findings A cross-sectional study was conducted in Birbhum district of the state of West Bengal, India, during 2017–2018, where 300 individuals were recruited randomly from a list of hypertensives in a population cohort. Healthcare seeking for hypertension and related financial protection in terms of–OOPs and expenses relative to monthly per-capita family expenditure, were analysed. Findings indicated that 47% of hypertensives were not on treatment. Among those under treatment, 80% preferred non-public facilities, and 91% of them had wide-spread OOPs. Cost of medication was a major share of expenses followed by transportation cost to access public health care facility. Multivariable logistic regression analysis indicated longer duration of disease (adjusted odds ratio (aOR): 5.68, 95% Confidence Interval (CI) 1.24–25.99) and health care seeking from non-public establishment (aOR: 34.33, CI: 4.82–244.68) were associated with more incident of OOPs. Linear regression with generalized linear model revealed presence of co-morbidities (adjusted coefficient (aCoeff)10.28, CI: 4.96,15.61) and poorer economic groups (aCoeffpoorest 11.27, CI 3.82,18.71; aCoefflower-middle 7.83, CI 0.65,15.00 and aCoeffupper-middle 7.25, CI: 0.80,13.70) had higher relative expenditure. Conclusion This study suggests that individuals with hypertension had poor health care seeking behaviour, preferred non-public health facilities and had suboptimal financial protection. Economically poorer individuals had higher burden of health expenditure for treatment of hypertension, which indicated gaps in equitable health care delivery for the control of hypertension.
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Affiliation(s)
- Sandipta Chakraborty
- Institute of Public Health, Kalyani, West Bengal, India
- Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, West Bengal, India
| | - Rajesh Kumar Rai
- Society for Health and Demographic Surveillance, Suri, West Bengal, India
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Economics, University of Goettingen, Goettingen, Germany
- Centre for Modern Indian Studies, University of Goettingen, Goettingen, Germany
- * E-mail:
| | | | - Anamitra Barik
- Society for Health and Demographic Surveillance, Suri, West Bengal, India
- Suri District Hospital, Suri, West Bengal, India
| | | | - Devarsetty Praveen
- Primary Health Care Research, The George Institute for Global Health, Hyderabad, Telangana, India
- Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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21
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Hossain A, Alam MJ, Mydam J, Tareque M. Do the issues of religious minority and coastal climate crisis increase the burden of chronic illness in Bangladesh? BMC Public Health 2022; 22:270. [PMID: 35144577 PMCID: PMC8830131 DOI: 10.1186/s12889-022-12656-5] [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: 11/22/2020] [Accepted: 01/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic illness with disability and its out-of-pocket expenditure (OOPE) remains a big financial challenge in Bangladesh. The purpose of this study was to explore how religious minority problem and coastal climate crisis with other common risk factors determined chronic illness with a disability and its financial burden in Bangladesh. Existing policy responses, especially, social safety net programs and their governance were analyzed for suggesting better policy options that avoid distress financing. METHODS Binary logistic and multiple linear regression models were respectively used to identify the factors of disability, and high OOPE based on Bangladesh Household Income and Expenditure Survey 2016 data. RESULTS We found that disable people had relatively higher OOPE than their non-disabled counterparts and this OOPE further surges when the number of disabilities increases. In addition to the common factors, the novelty of our findings indicated that the religious minority problem as well as the coastal climate crisis have bearing on the disability burden in Bangladesh. The likelihood of having a chronic illness with a disability was 13.2% higher for the religious minorities compared to the majorities (Odds ratio (OR): 1.132, 95% confidence interval (CI): 1.033-1.241) and it was 21.6% higher for the people who lived in the exposed coast than those who lived in the non-exposed area (OR: 1.216, 95% CI: 1.107-1.335). With disabilities, people from the exposed coast incurred higher OOPE than those from the non-exposed areas. Although receiving assistance from social safety net programs (SSNPs) seemed to reduce their high OOPE and financial distress such as selling assets and being indebted, the distribution was not equitably and efficiently managed to confirm the process of inclusion leakage-free. On average, those who enrolled from the minority group and the exposed coast paid the relatively higher bribes. CONCLUSIONS To reduce burden, the government should strengthen and specify the existing SSNPs more for disable people, especially from the minority group and the exposed coast, and ensure the selection process more inclusive and leakage-free.
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Affiliation(s)
- Altaf Hossain
- Department of Statistics, Islamic University, Kushtia, 7003, Bangladesh.
| | - Md Jahangir Alam
- Department of Statistics, University of Rajshahi, Rajshahi, 6205, Bangladesh.
| | - Janardhan Mydam
- Division of Neonatology, Department of Pediatrics, John H. Stroger, Jr. Hospital of Cook County, 1969 Ogden Avenue, Chicago, IL, 60612, USA.,Department of Pediatrics, Rush Medical Center, Chicago, USA
| | - Mohammad Tareque
- Bangladesh Institute of Governance and Management, Dhaka, Bangladesh
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22
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Desai A, Jella TK, Cwalina TB, Wright CH, Wright J. Demographic Analysis of Financial Hardships Faced by Brain Tumor Survivors. World Neurosurg 2021; 158:e111-e121. [PMID: 34687933 DOI: 10.1016/j.wneu.2021.10.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Quantitative analysis of the financial hardship faced by patients with brain tumors is lacking. The present study sought to conduct a longitudinal analysis of responses to the National Health Interview Survey by patients diagnosed with brain tumors and characterize the impact of demographic factors on financial hardship indices. METHODS National Health Interview Survey respondents between 1997 and 2018 who reported previous diagnosis with cancer of the brain and who responded to 4 survey questions that assessed financial stress were included. Sociodemographic exposures included age, ethnicity/race, marriage status, insurance status, and degree of highest educational attainment. RESULTS Educational attainment, marital status, and insurance status were the most significant risk factors for temporary or indefinite delays to necessary medical care. Those with only a high-school diploma had 9.6 times higher odds (adjusted odds ratio, 9.68; 95% confidence interval, 2.96-31.70; P < 0.001) of reporting that, in the past 12 months, one of their family members had to limit their medical care in an effort to save money. Similarly, patients with brain tumors who were not married had 3.94 times greater odds (adjusted odds ratio, 3.94; 95% confidence interval, 1.49-10.44; P = 0.009) of avoiding necessary medical care because of an inability to afford it. CONCLUSIONS Given this variation in self-reported financial burden, demographics clearly have an impact on a patient's holistic experience after a brain cancer diagnosis. Therefore, by using the comparisons in this study, we hope that medical institutions and neurosurgical societies can more accurately predict which patients are most susceptible to significant financial stress and distribute resources accordingly.
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Affiliation(s)
- Ansh Desai
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Tarun K Jella
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Thomas B Cwalina
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Christina Huang Wright
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - James Wright
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
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Research on the economic risk of diseases in middle-aged and elderly patients with diabetes—evidence from China. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-020-01208-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Abstract
Objective
To measure the economic risk of diseases in Chinese middle-aged and elderly patients with diabetes.
Methods
The economic risk of diseases in Chinese middle-aged and elderly patients with diabetes was comprehensively analyzed using the family economic risk of diseases, catastrophic health expenditure, and relative risk of the disease.
Results
The proportions of families with low, medium, and high family economic risk of diseases were 64.73%, 8.56%, and 26.71%, respectively. When the defining criteria are 15%, 25%, and 40%, the incidences of catastrophic health expenditure were 66.71%, 60.07%, and 54.59%, respectively. The health expenditure of diabetic patients was 1.80 times that of non-diabetic patients when the difference in patients’ income was eliminated.
Conclusion
In general, Chinese middle-aged and elderly patients with diabetes face a large economic risk of diseases, which will seriously hinder the improvement of their family life quality. The sociodemographic characteristics related to diabetics will aggravate the patient’s economic risk, such as smoking, drinking, and low household income. Moreover, diabetes patients with different basic medical insurance have different economic risk of diseases.
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Maharana B, Ladusingh L. How Does the Change in Household Age-Sex Composition Affect Out of Pocket Healthcare Expenditure of Older Adults in India? AGEING INTERNATIONAL 2021. [DOI: 10.1007/s12126-021-09457-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Exploring the System Determinants Associated with Senior Women's Access to Medical Care in Rural Bangladesh. AGEING INTERNATIONAL 2021; 47:578-595. [PMID: 34366506 PMCID: PMC8326310 DOI: 10.1007/s12126-021-09444-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2021] [Indexed: 11/01/2022]
Abstract
Senior women's access to medical care in rural Bangladesh is a major public health concern. This study aims to explore the system determinants that impact on rural senior women's utilization of healthcare. Following a qualitative critical social research design, healthcare staff and senior women living in three rural villages of Bangladesh were approached to participate in face-to-face audio-recorded interviews. A total of 11 staff and 25 senior women were interviewed with questions about health policy, healthcare services and management of aged care. Data was analyzed using a blend of critical discourse and thematic analysis methods. Several healthcare system determinants were identified that were complex and cross-sectional. Three major themes emerged from the system determinants: legal framework of aged care; inadequate healthcare support; and professional knowledge and skills of healthcare staff that led the rural senior women to avoid or delay access to hospitals and clinics. The findings revealed that a lack of health focus and professional skills among healthcare staff can be considered as critical. This study recommends that policy and organizational changes are made to improve the women's access to rural hospitals and clinics in Bangladesh.
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Rattanavipapong W, Wang Y, Butchon R, Kittiratchakool N, Thammatacharee J, Teerawattananon Y, Isaranuwatchai W. Retrospective secondary data analysis to identify high-cost users in inpatient department of hospitals in Thailand, a middle-income country with universal healthcare coverage. BMJ Open 2021; 11:e047330. [PMID: 34321299 PMCID: PMC8319992 DOI: 10.1136/bmjopen-2020-047330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The study aims to identify high-cost users (HCUs) in the inpatient departments of hospitals in Thailand including their common characteristics, patterns of healthcare utilisation and expenditure compared with low-cost users, and to explore potential factors associated with HCUs so the healthcare system can be prepared to support the HCUs including those who have increased chances of becoming HCUs. DESIGN AND SETTING A retrospective secondary data analysis using hospitalisation data from Thailand's Universal Coverage Scheme (UCS) obtained from the National Health Security Office over a 5-year period from October 2014 to September 2019 (fiscal year 2014-2018). PARTICIPANTS Study participants included Thai citizens who had at least one inpatient admission to hospitals under the UCS over the study period. RESULTS Over the 5-year period, the top 5% of the hospitalised population (or HCUs) consumed almost 50% of the health expenditure each year. HCUs were more likely to have longer hospital stays, a higher annual number of visits and be admitted to multiple hospitals each year when compared with the low-cost users (the bottom 50% of the hospitalised population). The study further reported that the chance of becoming an HCU is associated with several factors such as increasing age, being male, having a comorbidity and being admitted to hospitals in Bangkok. CONCLUSIONS This study confirmed that the HCU phenomenon existed in Thailand, where a majority of inpatient care spending is concentrated in the top 5% of the hospitalised population. The study findings call attention to potential initiatives that can help monitor the magnitude and trend of HCUs and develop policies to prevent HCUs.
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Affiliation(s)
- Waranya Rattanavipapong
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Rukmanee Butchon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Nitichen Kittiratchakool
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | | | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
- Institute or Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Dwivedi R, Pradhan J, Athe R. Measuring catastrophe in paying for healthcare: A comparative methodological approach by using National Sample Survey, India. Int J Health Plann Manage 2021; 36:1887-1915. [PMID: 34196030 DOI: 10.1002/hpm.3272] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 06/19/2021] [Accepted: 06/20/2021] [Indexed: 11/07/2022] Open
Abstract
Healthcare expenditure significantly varies among various segments of the population. The appropriate measures of catastrophic health expenditure (CHE) will help to unravel the real burden of spending among households. Present study provides a link between the theoretical insights from Grossman's model and various methodological approaches for the estimation of CHE by using data from the three rounds of nationally representative Consumer Expenditure Surveys, India. Statistical analysis has been carried out by using multivariate logistic regression to identify the major determinants of CHE. Findings indicate that the occurrence of CHE has increased during 1993-2012. Rural residents and households with varying age composition such as with higher numbers of children and elderly were at higher risk. Economic status is significantly associated with CHE and increased demand for healthcare. The measurements differ as per the methodological approaches of CHE and definition of household's capacity to pay. Approach-based variations in the results can be of key importance in determining trends and magnitude in CHE. Despite these variations in measurements, study finds a limited incidence of CHE among the disadvantaged segment of the population though a greater share was devoted to health expenditure in recent years. Better risk pooling mechanism is required to address the healthcare needs of the disadvantaged segment such as elderly, children, poor and rural population in India.
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Affiliation(s)
- Rinshu Dwivedi
- Department of Science and Humanities, Indian Institute of Information Technology, Trichy, Tamil Nadu, India
| | - Jalandhar Pradhan
- Department of Humanities and Social Sciences, National Institute of Technology, Rourkela, Odisha, India
| | - Ramesh Athe
- Department of Humanities and Sciences, Indian Institute of Information Technology, Dharwad, Karnataka, India
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Sahoo H, Govil D, James K, Prasad RD. Health issues, health care utilization and health care expenditure among elderly in India: Thematic review of literature. AGING AND HEALTH RESEARCH 2021. [DOI: 10.1016/j.ahr.2021.100012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Boateng GO, Lartey ST, Baiden P, Si L, Biritwum RB, Kowal P, Magnussen CG, Ben Taleb Z, Palmer AJ, Luginaah I. Measuring Hypertension Progression With Transition Probabilities: Estimates From the WHO SAGE Longitudinal Study. Front Public Health 2021; 9:571110. [PMID: 33898368 PMCID: PMC8058215 DOI: 10.3389/fpubh.2021.571110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 03/10/2021] [Indexed: 01/21/2023] Open
Abstract
This paper assessed the transition probabilities between the stages of hypertension severity and the length of time an individual might spend at a particular disease state using the new American College of Cardiology/American Heart Association hypertension blood pressure guidelines. Data for this study were drawn from the Ghana WHO SAGE longitudinal study, with an analytical sample of 1884 across two waves. Using a multistate Markov model, we estimated a seven-year transition probability between normal/elevated blood pressure (systolic ≤ 129 mm Hg & diastolic <80 mm Hg), stage 1 (systolic 130-139 mm Hg & diastolic 80-89 mm Hg), and stage 2 (systolic ≥140mm Hg & diastolic≥90 mm Hg) hypertension and adjusted for the individual effects of anthropometric, lifestyle, and socio-demographic factors. At baseline, 22.5% had stage 1 hypertension and 52.2% had stage 2 hypertension. The estimated seven-year transition probability for the general population was 19.0% (95% CI: 16.4, 21.8) from normal/elevated blood pressure to stage 1 hypertension, 31.6% (95% CI: 27.6, 35.4%) from stage 1 hypertension to stage 2 hypertension, and 48.5% (45.6, 52.1%) for remaining at stage 2. Other factors such as being overweight, obese, female, aged 60+ years, urban residence, low education and high income were associated with an increased probability of remaining at stage 2 hypertension. However, consumption of recommended servings of fruits and vegetables per day was associated with a delay in the onset of stage 1 hypertension and a recovery to normal/elevated blood pressure. This is the first study to show estimated transition probabilities between the stages of hypertension severity across the lifespan in sub-Saharan Africa. The results are important for understanding progression through hypertension severity and can be used in simulating cost-effective models to evaluate policies and the burden of future healthcare.
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Affiliation(s)
- Godfred O. Boateng
- Department of Kinesiology, College of Nursing and Health Innovations, The University of Texas at Arlington, Arlington, TX, United States
| | - Stella T. Lartey
- Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University School of Public Health-Bloomington, Bloomington, IN, United States
| | - Philip Baiden
- School of Social Work, The University of Texas at Arlington, Arlington, TX, United States
| | - Lei Si
- The George Institute for Global Health, University of New South Wales, Kensington, NSW, Australia
| | | | - Paul Kowal
- World Health Organization, Geneva, Switzerland
- University of Newcastle Research Centre for Generational Health and Ageing, Newcastle, NSW, Australia
| | - Costan G. Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Ziyad Ben Taleb
- Department of Kinesiology, College of Nursing and Health Innovations, The University of Texas at Arlington, Arlington, TX, United States
| | - Andrew J. Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Isaac Luginaah
- Department of Geography, University of Western Ontario, London, ON, Canada
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Medical, transportation and spiritual out-of-pocket health expenditure on outpatient and inpatient visits in Bhutan. Soc Sci Med 2021; 273:113780. [PMID: 33647847 DOI: 10.1016/j.socscimed.2021.113780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 11/22/2022]
Abstract
Understanding the determinants of out-of-pocket health expenditure (OOP) is important for achieving and sustaining universal health coverage, as well as ensuring that no one is left behind. Focusing on major types of spending, including healthcare-related transportation and spiritual expenses, this study analyses OOP on outpatient and inpatient visits in Bhutan, using a two-part model and data from the nationally representative 2017 Bhutan Living Standards Survey. While OOP based on standard estimates is relatively low in Bhutan, the survey data show that expenses for healthcare-related transportation and spiritual ceremonies are substantive and by far exceed other components of OOP. Demographic, socio-economic, geographic and morbidity-related factors are found to affect the probability of incurring medical, transportation and spiritual OOP, as well as amounts spent. Disaggregating healthcare-related spending into its key components further reveals that living in rural areas increases the probability of incurring expenses for transportation and spiritual ceremonies, but decreases the odds of experiencing positive medical expenditure. Monthly equivalised household expenditure, functional disability, frequency of visits and length of stay are positively associated with total OOP, especially for transportation and spiritual expenses. Going to a public primary healthcare provider for the first outpatient visit, on the other hand, significantly decreases likelihood and amount of medical, transportation and spiritual OOP. These key results highlight the importance of understanding context-specific drivers of healthcare-related spending. In Bhutan, the financial burden particularly impacts respondents in rural areas and those with higher needs for healthcare services. A clear implication of the findings is that primary care and gatekeeping mechanisms need to be strengthened, especially considering that cost pressures have been growing which could lead to higher OOP in the future. Moreover, closer examination of the role of spiritual practices in the provision of health services is needed.
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Kannure M, Hegde A, Khungar-Pathni A, Sharma B, Scuteri A, Neupane D, Gandhi RK, Patel H, Surendran S, Jondhale V, Gupta S, Phalake A, Walkar V, George R, Mcguire H, Jain N, Vijayan S. Phone calls for improving blood pressure control among hypertensive patients attending private medical practitioners in India: Findings from Mumbai hypertension project. J Clin Hypertens (Greenwich) 2021; 23:730-737. [PMID: 33591624 PMCID: PMC8678825 DOI: 10.1111/jch.14221] [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: 10/22/2020] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 11/27/2022]
Abstract
Despite the availability of effective medication, blood pressure control rates are low, particularly in low‐ and middle‐income countries. Adherence to medication and follow‐up visits are important factors in blood pressure control. This study assessed the effectiveness of reminder telephone calls on follow‐up visits and blood pressure control among hypertensive patients as part of the Mumbai Hypertension Project. This project was initiated by PATH with the support from Resolve to Save Lives from January 2019 to February 2020. The study included hypertensive patients attending 164 private practices in Mumbai, India; practitioners screened all adults visiting their clinic during the project period. Among 13 184 hypertensive patients registered, the mean age was 53 years (SD = 12.38) and 52% were female. Among the 11 544 patients that provided phone numbers and gave consent for follow‐up calls, 9528 responded to phone calls at least once and 5250 patients followed up at least once. Of the 5250 patients, 82% visited the clinic for follow‐up visit within one month after receiving the phone call. The blood pressure control rate among those who answered phone calls and who did not answer phone calls increased from 23.6% to 48.8% (P <.001) and 21.0% to 44.3% (P <.001), respectively. The blood pressure control rate at follow‐up was significantly associated with phone calls (OR: 1.51, 95% CI: 1.34 ‐ 1.71). The study demonstrates that telephone call intervention and follow‐up visits can improve patient retention in care and, subsequently, blood pressure control among hypertensive patients attending urban private sector clinics in India.
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Affiliation(s)
| | | | | | | | - Angelo Scuteri
- Lancet Commission on Hypertension Group.,Department of Medical, Surgical, and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Dinesh Neupane
- Lancet Commission on Hypertension Group.,Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Epidemiology, Johns Hopkins University, Baltimore, USA
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López-López S, del Pozo-Rubio R, Ortega-Ortega M, Escribano-Sotos F. Catastrophic Household Expenditure Associated with Out-of-Pocket Healthcare Payments in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030932. [PMID: 33494518 PMCID: PMC7908509 DOI: 10.3390/ijerph18030932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/19/2021] [Indexed: 11/17/2022]
Abstract
Background. The financial effect of households’ out-of-pocket payments (OOP) on access and use of health systems has been extensively studied in the literature, especially in emerging or developing countries. However, it has been the subject of little research in European countries, and is almost nonexistent after the financial crisis of 2008. The aim of the work is to analyze the incidence and intensity of financial catastrophism derived from Spanish households’ out-of-pocket payments associated with health care during the period 2008–2015. Methods. The Household Budget Survey was used and catastrophic measures were estimated, classifying the households into those above the threshold of catastrophe versus below. Three ordered logistic regression models and margins effects were estimated. Results. The results reveal that, in 2008, 4.42% of Spanish households dedicated more than 40% of their income to financing out-of-pocket payments in health, with an average annual gap of EUR 259.84 (DE: EUR 2431.55), which in overall terms amounts to EUR 3939.44 million (0.36% of GDP). Conclusion. The findings of this study reveal the existence of catastrophic households resulting from OOP payments associated with health care in Spain and the need to design financial protection policies against the financial risk derived from facing these types of costs.
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Affiliation(s)
- Samuel López-López
- Castilla-La Mancha Health Services, SESCAM, Hospital of Cuenca, C/Hermandad de Donantes de Sangre, 1, 16002 Cuenca, Spain
- Correspondence:
| | - Raúl del Pozo-Rubio
- Department of Economic Analysis and Finance, University of Castilla-La Mancha, Avda. Los Alfares, 44, 16071 Cuenca, Spain;
- Research Group on Food, Economy and Society, University of Castilla-La Mancha, Avda. Los Alfares, 44, 16071 Cuenca, Spain;
| | - Marta Ortega-Ortega
- Department of Applied and Public Economics, and Political Economy, Complutense University of Madrid, Campus de Somosaguas s/n, Pozuelo de Alarcón, 28223 Madrid, Spain;
| | - Francisco Escribano-Sotos
- Research Group on Food, Economy and Society, University of Castilla-La Mancha, Avda. Los Alfares, 44, 16071 Cuenca, Spain;
- Department of Economic Analysis and Finance, University of Castilla-La Mancha, Plaza de la Universidad s/n, 02001 Albacete, Spain
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Hamiduzzaman M, De Bellis A, Abigail W, Kalaitzidis E, Harrington A. The World Is Not Mine - Barriers to Healthcare Access for Bangladeshi Rural Elderly Women. J Cross Cult Gerontol 2021; 36:69-89. [PMID: 33449242 DOI: 10.1007/s10823-020-09420-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 11/30/2022]
Abstract
Social determinants of health is a core cross-cutting approach of the World Health Organization to reduce health inequalities, and places an emphasis on aged care planning in rural areas of low- and lower-middle income countries including Bangladesh. The complex correlated health and social factors in Bangladesh interplay to shape the healthcare access of rural people. This impact is significant for rural elderly women in particular who have been shown to access healthcare in ways that are described as 'socially determined'. This study aimed to explore how this cohort related their healthcare access to their living circumstances and provided insight into how their healthcare access needs can be addressed. This study was a critical social theoretical exploration from conversational interviews held over three months with 25 elderly women in rural Bangladesh. Two critical social constructs, 'emancipation' of Habermas and 'recognition' of Honneth, were used in the exploration and explanation of the influence of personal circumstances, society and system on rural elderly women's healthcare access. The concept of 'social determinants of healthcare access' is defined from the physical, emotive, symbolic and imaginative experiences of these women. Interviewing the women provided information for exploration of the determinants that characterized their experiences into an overall construct of 'The World is Not Mine'. This construct represented four themes focusing on the exclusion from healthcare, oppressive socioeconomic condition, marginalization in social relationships and personal characteristics that led the women to avoid or delay access to modern healthcare. This study confirms that the rural elderly women require adequate policy responses from the government, and also need multiple support systems to secure adequate access to healthcare. As healthcare services are often a reflection of community values and human rights concerns for the elderly, there is a need of recognition and respect of their voice by the family members, society and the healthcare system in planning and implementation of a prudent aged care policy for rural elderly women in Bangladesh.
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Affiliation(s)
- Mohammad Hamiduzzaman
- College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia. .,College of Medicine & Public Health, Flinders University Rural Health SA, Flinders University, GPO BOX 852, Renmark, South Australia, 5341, Australia.
| | - Anita De Bellis
- College of Nursing & Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Wendy Abigail
- College of Nursing & Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Evdokia Kalaitzidis
- College of Nursing & Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Ann Harrington
- College of Nursing & Health Sciences, Flinders University, Bedford Park, South Australia, Australia
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Spatial Pattern of Population Ageing and Household Health Spending in India. AGEING INTERNATIONAL 2021. [DOI: 10.1007/s12126-020-09406-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Chauhan A, Campbell C. Risk, trust and patients' strategic choices of healthcare practitioners. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:82-98. [PMID: 33034906 DOI: 10.1111/1467-9566.13198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 08/04/2020] [Accepted: 09/07/2020] [Indexed: 06/11/2023]
Abstract
Research on patients' choice of healthcare practitioners has focussed on countries with regulated and controlled healthcare markets. In contrast, low- and middle-income countries have a pluralistic landscape where untrained, unqualified and unlicensed informal healthcare providers (IHPs) provide significant share of services. Using qualitative data from 58 interviews in an Indian village, this paper explores how patients choose between IHPs and qualified practitioners in the public and formal private sectors. The study found that patients' choices were structurally constrained by accessibility and affordability of care and choosing a practitioner from any sector presented some risk. Negotiation and engagement with risks depended on perceived severity of the health condition and trust in practitioners. Patients had low institutional trust in public and formal private sectors, whereas IHPs operated outside any institutional framework. Consequently, people relied on relational or competence-derived interpersonal trust. Care was sought from formal private practitioners for severe issues due to high-competence-based interpersonal trust in them, whereas for other issues IHPs were preferred due to high relationship-based interpersonal trust. The research shows that patients develop a strategic approach to practitioner choice by using trust to negotiate risks, and crucially, in low- and middle-income countries IHPs bridge a gap by providing accessible and affordable care imbued with relational-interpersonal trust.
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Affiliation(s)
- Apurv Chauhan
- School of Applied Social Science (SASS), University of Brighton, Brighton, UK
| | - Catherine Campbell
- Department of Psychological and Behavioural Science, London School of Economics & Political Science (LSE), London, UK
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Macinko J, Cristina Drumond Andrade F, Bof de Andrade F, Lima-Costa MF. Universal Health Coverage: Are Older Adults Being Left Behind? Evidence From Aging Cohorts In Twenty-Three Countries. Health Aff (Millwood) 2020; 39:1951-1960. [DOI: 10.1377/hlthaff.2019.01570] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- James Macinko
- James Macinko is a professor in the Fielding School of Public Health at the University of California Los Angeles, in Los Angeles, California
| | - Flavia Cristina Drumond Andrade
- Flavia Cristina Drumond Andrade is an associate professor in the School of Social Work at the University of Illinois at Urbana-Champaign, in Urbana, Illinois
| | - Fabiola Bof de Andrade
- Fabiola Bof de Andrade is an assistant professor in the Rene Rachou Research Institute at the Fundação Oswaldo Cruz, in Belo Horizonte, Minas Gerais, Brazil
| | - Maria Fernanda Lima-Costa
- Maria Fernanda Lima-Costa is a professor in the Rene Rachou Research Institute, Fundação Oswaldo Cruz, and the Public Health Postgraduate Program at the Federal University of Minas Gerais, in Belo Horizonte, Brazil
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Sinha P, Carwile M, Bhargava A, Cintron C, Acuna-Villaorduna C, Lakshminarayan S, Liu AF, Kulatilaka N, Locks L, Hochberg NS. How much do Indians pay for tuberculosis treatment? A cost analysis. Public Health Action 2020; 10:110-117. [PMID: 33134125 DOI: 10.5588/pha.20.0017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/25/2020] [Indexed: 11/10/2022] Open
Abstract
Setting India's National Tuberculosis Elimination Programme (NTEP) covers diagnostic and therapeutic costs of TB treatment. However, persons living with TB (PLWTB) continue to experience financial distress due to direct costs (payment for testing, treatment, travel, hospitalization, and nutritional supplements) and indirect costs (lost wages, loan interest, and cost of domestic helpers). Objective To analyze the magnitude and pattern of TB-related costs from the perspective of Indian PLWTB. Design We identified relevant articles using key search terms ('tuberculosis,' 'India,' 'cost,' 'expenditures,' 'financing,' 'catastrophic' and 'out of pocket') and calculated variance-weighted mean costs. Results Indian patients incur substantial direct costs (mean: US$46.8). Mean indirect costs (US$666.6) constitute 93.4% of the net costs. Mean direct costs before diagnosis can be up to four-fold that of costs during treatment. Treatment in the private sector can result in costs up to six-fold higher than in government facilities. As many as one in three PLWTB in India experience catastrophic costs. Conclusion PLWTB in India face high direct and indirect costs. Priority interventions to realize India's goal of eliminating catastrophic costs from TB include decreasing diagnostic delays through active case finding, reducing the need for travel, improving awareness and perception of NTEP services, and ensuring sufficient reimbursement for inpatient TB care.
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Affiliation(s)
- P Sinha
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, MA, USA
| | - M Carwile
- Department of Global Health, Boston University School of Public Health, MA, USA
| | - A Bhargava
- Department of Medicine, Yenepoya Medical College, Mangalore, India.,Department of Medicine, McGill University, Montreal, Quebec, Canada.,Center for Nutrition Studies, Yenepoya (Deemed to be University), Mangalore, India
| | - C Cintron
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, MA, USA
| | - C Acuna-Villaorduna
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, MA, USA
| | - S Lakshminarayan
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - A F Liu
- Department of Gastroenterology, Brigham and Women's Hospital, Boston, MA, USA
| | - N Kulatilaka
- Susilo Institute for Ethics in a Global Economy, Boston University Questrom School of Business, Boston, MA, USA
| | - L Locks
- Department of Health Sciences, Sargent College, Boston University College of Health & Rehabilitation Sciences, Boston, MA, USA
| | - N S Hochberg
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, MA, USA.,Department of Epidemiology, Boston University School of Public Health, MA, USA
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Biswas UN, Dellve L, Bhattacharjee A, Wolmesjӧ M. Ageing and Values in the Developments of Home-Based Eldercare: Perspectives from India and Sweden. PSYCHOLOGY AND DEVELOPING SOCIETIES 2020. [DOI: 10.1177/0971333620937373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ageing population is becoming a major concern because of its economic, political and social impact. Trusted eldercare service is an important issue for a matured nation. The paper addresses the preconditions of healthy ageing and sustainable value integrated eldercare in a developing and a developed society. In India, professional eldercare is about a decade old and is still emerging to get a foothold in the health care system. The aim is to explore understanding and values of home-based eldercare (HBEC) in India from a multiple stakeholder’s perspective and to understand the value related challenges and issues in developments with HBEC in Sweden which has a century old experience of professional and public organised eldercare. The study included 210 in-depth interviews, 105 each from India and Sweden. The in-depth interviews of various stakeholders including older individuals, their relatives, caregivers, managers and doctors. Interviews and focused group discussions were carried out across six cities in India and 10 municipalities in Sweden. The qualitative data were analysed to conceptualise the stakeholders understanding of HBEC, the values associated with care giving, perceived challenges and issues in the emerging HBEC sector in India. The findings highlight the changing values in the societies with relation to the needs and context of eldercare in both countries. These preconditions for compassion and work engagement in care giving as well as competence development in caregivers need to be strengthened in the contexts of care and in alignment with sociocultural values.
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Affiliation(s)
- Urmi Nanda Biswas
- Department of Psychology, The Maharaja Sayajirao University of Baroda, Gujarat, India
| | - Lotta Dellve
- Department of Sociology and Work Science, Gothenburg University, Gothenburg, Sweden
| | - Anindo Bhattacharjee
- Anil Surendra Modi School of Commerce (ASMSOC), NMIMS Mumbai, Maharashtra, India
| | - Maria Wolmesjӧ
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Wang N, Gao W, Ma M, Shan L, Fu X, Sun T, Xia Q, Tian W, Liu L, Yang H, Shi B, Li H, Ma Y, Jiao M, Wu Q, You D, Li Y. The medical insurance system's weakness to provide economic protection for vulnerable citizens in China: A five-year longitudinal study. Arch Gerontol Geriatr 2020; 92:104227. [PMID: 32979552 DOI: 10.1016/j.archger.2020.104227] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/14/2020] [Accepted: 08/06/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Little is known about the magnitude of catastrophic health expenditure (CHE) attributable to critical disease, especially in the middle-aged and elderly population. This research aimed to exploring the key aspects of how the health insurance fails to protect the middle-aged and elderly against CHE in the past five years. And propose corresponding measures to improve. METHODS Data were obtained from the 2011 to 2015 China Health and Retirement Longitudinal Study. The method was adapted from WHO to calculate the catastrophic health expenditure (CHE) and impoverishment by medical expense (IME), and use Generalized Linear Mixed Models (GLMMs) to comprehensively analyze the risk factors that cause middle-aged and elderly people to fall into CHE. RESULTS The incidence of CHE of China's middle-aged and elderly population has been rose in the five years from 2011 (10.5 %) to 2013 (17.5 %) to 2015 (19.7 %). The CHE of richest families was almost 6 times from 2011 to 2015. Urban Employee Medical Insurance Scheme, the incidence of CHE was up 10 percentage from 2011 to 2015. According to the GLMMs, families have inpatient cares as the most important factor to CHE. The incidence of CHE increased by 2.25 times compared with those who did not use inpatient services. CONCLUSIONS The health system needs to control the irrational growth of health expenses and reduce residents' overuse of health services. Government should take supplementary measures to comprehensively strengthen the advantages of health insurance. Raise residents' awareness of health care, enhance citizens' physical fitness, and avoid unnecessary waste of health resources.
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Affiliation(s)
- Nianshi Wang
- Harbin Medical University, Policy and Management Research Center, School of Health Management, Department of Social Medicine; School of Public Health, No. 157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150086, China
| | - Wei Gao
- Heilongjiang Provincial Hospital, Department of Infectious Diseases, No. 82, Zhongshan Road, Xiangfang District, Harbin, Heilongjiang, 150000, China
| | - Meiyan Ma
- Harbin Medical University, Policy and Management Research Center, School of Health Management, Department of Social Medicine; School of Public Health, No. 157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150086, China
| | - Linghan Shan
- Harbin Medical University, Policy and Management Research Center, School of Health Management, Department of Social Medicine; School of Public Health, No. 157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150086, China
| | - Xuelian Fu
- The Second Affiliated Hospital of Harbin Medical University, No. 246 Xuefu Road, Nangang District, Harbin, Heilongjiang, 150001, China
| | - Tao Sun
- Department of Health Service Management, School of Medicine, Hang Zhou Normal University, Zhejiang, China
| | - Qi Xia
- Harbin Medical University, Policy and Management Research Center, School of Health Management, Department of Social Medicine; School of Public Health, No. 157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150086, China
| | - Wanxin Tian
- Harbin Medical University, Policy and Management Research Center, School of Health Management, Department of Social Medicine; School of Public Health, No. 157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150086, China
| | - Limin Liu
- The Second Affiliated Hospital of Harbin Medical University, No. 246 Xuefu Road, Nangang District, Harbin, Heilongjiang, 150001, China
| | - Huiying Yang
- The Second Affiliated Hospital of Harbin Medical University, No. 246 Xuefu Road, Nangang District, Harbin, Heilongjiang, 150001, China
| | - Baoguo Shi
- Department of Economics, School of Economics, Minzu University of China, Beijing, China
| | - Heng Li
- Hospital Development Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Yanan Ma
- China Medical University, Liaoning, China
| | - Mingli Jiao
- Harbin Medical University, Policy and Management Research Center, School of Health Management, Department of Social Medicine; School of Public Health, No. 157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150086, China.
| | - Qunhong Wu
- Harbin Medical University, Policy and Management Research Center, School of Health Management, Department of Social Medicine; School of Public Health, No. 157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150086, China.
| | - Dingyun You
- School of Public Health, Kunming Medical University, Kunming, Yunnan, 650500, China.
| | - Ye Li
- Harbin Medical University, Policy and Management Research Center, School of Health Management, Department of Social Medicine; School of Public Health, No. 157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150086, China.
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Zhao SW, Zhang XY, Dai W, Ding YX, Chen JY, Fang PQ. Effect of the catastrophic medical insurance on household catastrophic health expenditure: evidence from China. GACETA SANITARIA 2020; 34:370-376. [DOI: 10.1016/j.gaceta.2018.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 10/03/2018] [Accepted: 10/22/2018] [Indexed: 10/27/2022]
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Fischer FB, Mengliboeva Z, Karimova G, Abdujabarov N, Prytherch H, Wyss K. Out of pocket expenditures of patients with a chronic condition consulting a primary care provider in Tajikistan: a cross-sectional household survey. BMC Health Serv Res 2020; 20:546. [PMID: 32546162 PMCID: PMC7298845 DOI: 10.1186/s12913-020-05392-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Within its reform efforts, the Government of Tajikistan is embracing the essential role of primary health care (PHC) in decreasing out of pocket (OOP) expenditures and increasing equity in access to health services. In the light of the increasing burden of disease relating to chronic conditions, we investigated OOP expenditures of patients with chronic conditions within a PHC setting; and if and how those expenditures are impacted by several interventions currently being implemented within Tajikistan. METHODS A cross-sectional survey among 1600 adult patients who had visited a PHC facility was conducted. The data obtained through interviews were descriptively analysed, and logistic regressions and gamma generalized linear models were performed. RESULTS The total OOP expenditures related to a patient's last visit to the PHC facility were 17.2 USD for those with chronic conditions and 13.9 USD for those visiting due to an acute condition. Adjustment for potential confounders reduced the discrepancy from 3.3 USD to 0.5 USD. This convergence of costs was only observed in districts covered by the Basic Benefit Package (BBP), a governmental pilot project, aiming to standardise exemptions for payment and formal co-payments for health care services. Hence, we found the BBP to have a protective impact for patients with chronic conditions. However, considering the demographics of these patients (older in age, with greater dependency on pensions and social aid, and lower socio-economic status) in combination with the 40% higher utilisation rate of PHC and the high rate of onward referrals to specialists; it is clear that patients with chronic conditions continue to face substantial long-term costs and disadvantages. CONCLUSIONS After accounting for confounders, patients with chronic and acute conditions faced similar costs related to a single visit to a PHC facility in districts covered by the BBP. However, greater efforts are required to ensure that citizens are well informed about their rights to health care, the BBP and the services that should be provided at no cost at the point of delivery. Moreover, the needs of patients with chronic conditions warrant a more integrative approach that takes long-term expenditures and services beyond the level of PHC into account.
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Affiliation(s)
- Fabienne B. Fischer
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Zulfira Mengliboeva
- Swiss Agency for Development and Cooperation’s Enhancing Primary Health Care Services Project (Project Sino), Dushanbe, Tajikistan
| | - Gulzira Karimova
- Swiss Agency for Development and Cooperation’s Enhancing Primary Health Care Services Project (Project Sino), Dushanbe, Tajikistan
| | - Nasrullo Abdujabarov
- Swiss Agency for Development and Cooperation’s Enhancing Primary Health Care Services Project (Project Sino), Dushanbe, Tajikistan
| | - Helen Prytherch
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kaspar Wyss
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Buyl R, Beogo I, Fobelets M, Deletroz C, Van Landuyt P, Dequanter S, Gorus E, Bourbonnais A, Giguère A, Lechasseur K, Gagnon MP. e-Health interventions for healthy aging: a systematic review. Syst Rev 2020; 9:128. [PMID: 32493515 PMCID: PMC7271471 DOI: 10.1186/s13643-020-01385-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/11/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Healthy aging (HA) is a contemporary challenge for population health worldwide. Electronic health (e-Health) interventions have the potential to support empowerment and education of adults aged 50 and over. OBJECTIVES To summarize evidence on the effectiveness of e-Health interventions on HA and explore how specific e-Health interventions and their characteristics effectively impact HA. METHODS A systematic review was conducted based on the Cochrane Collaboration methods including any experimental study design published in French, Dutch, Spanish, and English from 2000 to 2018. RESULTS Fourteen studies comparing various e-Health interventions to multiple components controls were included. The target population, type of interventions, and outcomes measured were very heterogeneous across studies; thus, a meta-analysis was not possible. However, effect estimates indicate that e-Health interventions could improve physical activity. Positive effects were also found for other healthy behaviors (e.g., healthy eating), psychological outcomes (e.g., memory), and clinical parameters (e.g., blood pressure). Given the low certainty of the evidence related to most outcomes, these results should be interpreted cautiously. CONCLUSIONS This systematic review found limited evidence supporting the effectiveness of e-Health interventions, although the majority of studies show positive effects of these interventions for improving physical activity in older adults. Thus, better quality evidence is needed regarding the effects of e-Health on the physiological, psychological, and social dimensions of HA. SYSTEMATIC REVIEW REGISTRATION The review protocol was registered in PROSPERO (registration number: CRD42016033163).
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Affiliation(s)
- Ronald Buyl
- Faculty of Medicine and Pharmacy, Department of Public Health Sciences, Biostatistics and Medical Informatics(BISI) Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Idrissa Beogo
- École des sciences infirmières et des études de la santé/School of Nursing and Health Studies, Université de Saint-Boniface, Winnipeg, Manitoba Canada
| | - Maaike Fobelets
- Faculty of Medicine and Pharmacy, Department of Public Health Sciences, Biostatistics and Medical Informatics(BISI) Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Carole Deletroz
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland, Avenue de Beaumont 21, CH-1011 Lausanne, Switzerland
| | - Philip Van Landuyt
- Faculty of Medicine and Pharmacy, Department of Public Health Sciences, Biostatistics and Medical Informatics(BISI) Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Samantha Dequanter
- Faculty of Medicine and Pharmacy, Department of Public Health Sciences, Biostatistics and Medical Informatics(BISI) Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ellen Gorus
- Faculty of Medicine and Pharmacy, Department of Gerontology, Frailty in Ageing (FRIA) Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Anne Bourbonnais
- Faculty of Nursing, Université de Montréal, Montreal, Quebec Canada
- Research Center of the Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Quebec Canada
| | - Anik Giguère
- Faculty of Medicine, Université Laval, Quebec, Canada
- Centre de recherche sur les soins et services de première ligne de l’Université Laval (CERSSPL-UL), Quebec, Canada
- Research Center of the Centre Hospitalier de Québec-Université Laval (CRCHUQ-UL), Quebec, Canada
| | - Kathleen Lechasseur
- Faculty of Nursing Sciences, Université Laval, Québec, 1050 avenue de la Médecine, Quebec, Canada
| | - Marie-Pierre Gagnon
- Centre de recherche sur les soins et services de première ligne de l’Université Laval (CERSSPL-UL), Quebec, Canada
- Research Center of the Centre Hospitalier de Québec-Université Laval (CRCHUQ-UL), Quebec, Canada
- Faculty of Nursing Sciences, Université Laval, Québec, 1050 avenue de la Médecine, Quebec, Canada
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Ma M, Li Y, Wang N, Wu Q, Shan L, Jiao M, Fu X, Li H, Sun T, Yi B, Tian W, Xia Q, Shi B, Hao Y, Yin H, Ning N, Gao L, Liang L, Wang J. Does the medical insurance system really achieved the effect of poverty alleviation for the middle-aged and elderly people in China? Characteristics of vulnerable groups and failure links. BMC Public Health 2020; 20:435. [PMID: 32245435 PMCID: PMC7118817 DOI: 10.1186/s12889-020-08554-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/19/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND We examined the physiological, household, and spatial agglomeration characteristics of the health poverty population in China. We identified weak links that affect the implementation of the medical insurance and further improve its effectiveness for health poverty alleviation. METHODS A national representative sample from the China Health and Retirement Longitudinal Study (CHARLS) was analyzed. The WHO recommended method was adopted to calculate catastrophic health expenditure (CHE) and impoverishment by medical expenses (IME). We created a binary indicator for IME as the outcome variable and applied the treatment-effect model to analyze the determinants of IME. RESULTS The incidence of IME was 7.2% of the overall population, compared to 20.3% of the sample households trapped in CHE. The incidence of IME enrolled in insurance schemes was 7.4% higher than that of uninsured families (4.8%). Economic level, living area, family size, age of household head, having hospitalized members, and participating in insurance were statistically significant for the occurrence of IME. CONCLUSIONS The original poverty-promoting policies has not reached the maximum point of convergence with China's current demand for health. The overlapped health vulnerabilities exacerbated the risk of poverty among the elderly and households with high health needs and utilization. In addition, the medical insurance schemes have proven to be insufficient for protection against economic burden of poor households. So, special health needs, age, and household capacity to pay should be comprehensively considered while strengthening the connection between the disease insurance scheme with supplementary insurance.
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Affiliation(s)
- Meiyan Ma
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Ye Li
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China.
| | - Nianshi Wang
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Qunhong Wu
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Linghan Shan
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Mingli Jiao
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Xuelian Fu
- The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Heng Li
- China Hospital Development institute of Shanghai Jiao Tong University, Shanghai, China
| | - Tao Sun
- Department of Health Service Management, School of Medicine, Hang Zhou Normal University, Zhejiang, China
| | - Bin Yi
- The First Specialized Hospital of Harbin, Harbin, Heilongjiang, China
| | - Wanxin Tian
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Qi Xia
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Baoguo Shi
- Department of Economics, School of Economics, Minzu University of China, Beijing, China
| | - Yanhua Hao
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Hui Yin
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Ning Ning
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Lijun Gao
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Libo Liang
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Jiahui Wang
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
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Srivastava S, Gill A. Untreated morbidity and treatment-seeking behaviour among the elderly in India: Analysis based on National Sample Survey 2004 and 2014. SSM Popul Health 2020; 10:100557. [PMID: 32258352 PMCID: PMC7109628 DOI: 10.1016/j.ssmph.2020.100557] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 12/17/2022] Open
Abstract
The changing demographic structure in India and worldwide accompanies with it a gamut of problems and opportunities. According to the Census of India, the proportion of elderly in the overall population rose from 5.6 per cent in 1961 to 8.6 per cent in 2011 and is expected to rise to 20 per cent in 2050. Considering the consequent growing challenges in healthcare the main aim of the study is to find essential determinants contributing to untreated morbidity among the elderly. Also, the paper examines treatment-seeking behaviour for infectious and chronic diseases among the elderly in India. Data from the 60th and 71st round of National Sample Survey Organization was used for the analysis. Relative differences were calculated along with logistic regression to study the objectives and the heckprobit model was used to carve out the treatment-seeking behaviour among the elderly in India. It was found that the overall decrease in relative decadal difference was 41% for untreated morbidity. In both the rounds, the elderly living below the poverty line had 42% and 50% more likelihood of untreated morbidities respectively in comparison to elderly not living below the poverty line. The study indicates that elderly who were living with a spouse in comparison to those living alone had less likelihood to have untreated morbidities. Also, elderly from rural areas and having lower levels of education had higher likelihood of untreated morbidity. Similar inequalities were observed in treatment-seeking behaviour as well, where it was found that elderly belonging to lower socio-economic status were less likely to seek treatment. Linking the results from the heckprobit model this study provides the evidence that social and economic factors play a significant role in affecting both untreated morbidity and treatment-seeking behaviour of elderly in India.
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Affiliation(s)
- Shobhit Srivastava
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088, India
| | - Anayat Gill
- Centre for Research in Rural and Industrial Development, Sector 19, Chandigarh, India
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Ren J, Ding D, Wu Q, Liu C, Hao Y, Cui Y, Sun H, Ning N, Li Y, Kang Z, Shan L, Zhao M, Liu B. Financial Affordability, Health Insurance, and Use of Health Care Services by the Elderly: Findings From the China Health and Retirement Longitudinal Study. Asia Pac J Public Health 2020; 31:510-521. [PMID: 31610715 DOI: 10.1177/1010539519877054] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The rapidly growing aging population has attracted global attention. This study explores the associations between 3 basic health insurances, and it identifies factors associated with health care services among the elderly populations. This study is based on multistage stratified cluster sampling method from the 2013 China Health and Retirement Longitudinal Study (CHARLS) resulting in 7589 participants. Medical Insurance for Urban Employees (MIUE) members were more likely to use inpatient health care services. Health insurance programs were associated with inpatient services usage but not outpatient services usage. There are significant disparities in medical costs and health care service usage among the 3 insurance programs. Health insurance program is only associated with inpatient care. These findings may provide some suggestions to support improvements to the Chinese health care system.
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Affiliation(s)
- Jiaojiao Ren
- Zhuhai Campus of Zunyi Medical University, Zhuhai, China
| | - Ding Ding
- Dalian Medical University, Dalian, China
| | - Qunhong Wu
- Harbin Medical University, Harbin, China
| | - Chaojie Liu
- La Trobe University, Melbourne, Victoria, Australia
| | - Yanhua Hao
- Harbin Medical University, Harbin, China
| | - Yu Cui
- Harbin Medical University, Harbin, China
| | - Hong Sun
- Harbin Medical University, Harbin, China
| | - Ning Ning
- Harbin Medical University, Harbin, China
| | - Ye Li
- Harbin Medical University, Harbin, China
| | - Zheng Kang
- Harbin Medical University, Harbin, China
| | | | | | - Baohua Liu
- Harbin Medical University, Harbin, China
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Zhao Y, Zhang L, Fu Y, Wang M, Zhang L. Socioeconomic Disparities in Cancer Treatment, Service Utilization and Catastrophic Health Expenditure in China: A Cross-Sectional Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1327. [PMID: 32092913 PMCID: PMC7068279 DOI: 10.3390/ijerph17041327] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 01/31/2020] [Accepted: 02/11/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND This study aims (1) to assess socioeconomic disparities in healthcare use and catastrophic health expenditure (CHE) among cancer patients in China, which is defined as the point at which annual household health payments exceeded 40% of non-food household consumption expenditure, and (2) to examine the association of different treatments for cancers with health service utilization and CHE. METHODS We used nationally representative data from the China Health and Retirement Longitudinal Study in 2015 with 17,018 participants in which 381 with doctor-diagnosed cancer. The main treatments for cancer included the Chinese traditional medicine (TCM), western modern medicine (refers to taking western modern medications excluding TCM and other treatments for cancers), surgery, and radiation/chemotherapy. Concentration curve was used to assess economic-related disparities in healthcare and CHE. Multivariate regression models were used to examine the impact of the cancer treatment on health service use and incidence of CHE. RESULTS The main cancer treatments and health service use were more concentrated among the rich patients than among the poor patients in 2015. There was a positive association between the treatment of cancer and outpatient visit (Adjusted Odds Ratio (AOR) = 2.492, 95% CI = 1.506, 4.125), inpatient visit (AOR = 1.817, 95% CI = 1.098, 3.007), as well as CHE (AOR = 2.744, 95% CI = 1.578, 4.772). All cancer therapies except for medication treatments were associated with a higher incidence of CHE, particularly the surgery therapy (AOR = 6.05, 95% CI = 3.393, 27.866) in urban areas. CONCLUSION Disparities in treatment and health service utilization among Chinese cancer patients was largely determined by financial capability. The current insurance schemes are insufficient to address these disparities. A comprehensive health insurance policy of expanding the current benefits packages and strengthening the Public Medical Assistance System, are essential for Chinese adults with cancer.
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Affiliation(s)
- Yang Zhao
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria 3010, Australia; (Y.Z.); (Y.F.)
- WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, Melbourne, Victoria 3010, Australia
| | - Lin Zhang
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria 3010, Australia;
- The University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Melbourne, Victoria 3000, Australia
| | - Yu Fu
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria 3010, Australia; (Y.Z.); (Y.F.)
| | - Minyu Wang
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000 Australia;
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria 3052, Australia
- Centre for Cancer Immunotherapy, Peter Mac and VCCC Alliance, Melbourne, Victoria 3000, Australia
| | - Luwen Zhang
- School of Health Services Management, Southern Medical University, Guangzhou 500000, Guangdong, China
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Out-of-pocket health-care spending and its determinants among households in Nigeria: a national study. J Public Health (Oxf) 2020. [DOI: 10.1007/s10389-020-01199-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Badulescu D, Simut R, Badulescu A, Badulescu AV. The Relative Effects of Economic Growth, Environmental Pollution and Non-Communicable Diseases on Health Expenditures in European Union Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16245115. [PMID: 31847367 PMCID: PMC6949912 DOI: 10.3390/ijerph16245115] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 11/06/2019] [Accepted: 12/12/2019] [Indexed: 02/07/2023]
Abstract
National and global health policies are increasingly recognizing the key role of the environment in human health development, which is related to its economic and social determinants, such as income level, technical progress, education, quality of jobs, inequality, education or lifestyle. Research has shown that the increase of GDP (Gross Domestic Product) per capita can provide additional funds for health but also for environmental protection. However, often, economic growth is associated with the accelerated degradation of the environment, and this in turn will result in an exponential increase in harmful emissions and will implicitly determine the increasing occurrence of non-communicable diseases (NCDs), mainly cardiovascular diseases, cancers and respiratory diseases. In this paper, we investigate the role and effects of economic growth, environmental pollution and non-communicable diseases on health expenditures, for the case of EU (European Union) countries during 2000–2014. In order to investigate the long-term and the short-term relationship between them, we have employed the Panel Autoregressive Distributed Lag (ARDL) method. Using the Pedroni-Johansen cointegration methods, we found that the variables are cointegrated. The findings of this study show that economic growth is one of the most important factors influencing the health expenditures both in the long- and short-run in all the 28 EU countries. With regards to the influence of CO2 emissions on health expenditure, we have found a negative impact in the short-run and a positive impact on the long-run. We have also introduced an interaction between NCDs and environmental expenditure as independent variable, a product variable. Finally, we have found that in all the three estimated models, the variation in environmental expenditure produces changes in NCDs’ effect on health expenditure.
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Affiliation(s)
- Daniel Badulescu
- Department of Economics and Business, Faculty of Economic Sciences, University of Oradea, 410087 Oradea, Romania; (D.B.); (R.S.); (A.B.)
| | - Ramona Simut
- Department of Economics and Business, Faculty of Economic Sciences, University of Oradea, 410087 Oradea, Romania; (D.B.); (R.S.); (A.B.)
| | - Alina Badulescu
- Department of Economics and Business, Faculty of Economic Sciences, University of Oradea, 410087 Oradea, Romania; (D.B.); (R.S.); (A.B.)
| | - Andrei-Vlad Badulescu
- Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Correspondence: ; Tel.: +40-752-304056
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Lartey ST, de Graaff B, Magnussen CG, Boateng GO, Aikins M, Minicuci N, Kowal P, Si L, Palmer AJ. Health service utilization and direct healthcare costs associated with obesity in older adult population in Ghana. Health Policy Plan 2019; 35:199-209. [DOI: 10.1093/heapol/czz147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 12/23/2022] Open
Abstract
Abstract
Obesity is a major risk factor for many chronic diseases and disabilities, with severe implications on morbidity and mortality among older adults. With an increasing prevalence of obesity among older adults in Ghana, it has become necessary to develop cost-effective strategies for its management and prevention. However, developing such strategies is challenging as body mass index (BMI)-specific utilization and costs required for cost-effectiveness analysis are not available in this population. Therefore, this study examines the associations between health services utilization as well as direct healthcare costs and overweight (BMI ≥25.00 and <30.00 kg/m2) and obesity (BMI ≥30.00 kg/m2) among older adults in Ghana. Data were used from a nationally representative, multistage sample of 3350 people aged 50+ years from the World Health Organization’s Study on global AGEing and adult health (WHO-SAGE; 2014/15). Health service utilization was measured by the number of health facility visits over a 12-month period. Direct costs (2017 US dollars) included out-of-pocket payments and the National Health Insurance Scheme (NHIS) claims. Associations between utilization and BMI were examined using multivariable zero-inflated negative binomial regressions; and between costs and BMI using multivariable two-part regressions. Twenty-three percent were overweight and 13% were obese. Compared with normal-weight participants, overweight and obesity were associated with 75% and 159% more inpatient admissions, respectively. Obesity was also associated with 53% additional outpatient visits. One in five of the overweight and obese population had at least one chronic disease, and having chronic disease was associated with increased outpatient utilization. The average per person total costs for overweight was $78 and obesity was $132 compared with $35 for normal weight. The NHIS bore approximately 60% of the average total costs per person expended in 2014/15. Overweight and obese groups had significantly higher total direct healthcare costs burden of $121 million compared with $64 million for normal weight in the entire older adult Ghanaian population. Compared with normal weight, the total costs per person associated with overweight increased by 73% and more than doubled for obesity. Even though the total prevalence of overweight and obesity was about half of that of normal weight, the sum of their cost burden was almost doubled. Implementing weight reduction measures could reduce health service utilization and costs in this population.
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Affiliation(s)
- Stella T Lartey
- Menzies Institute for Medical Research, University of Tasmania, Medical Sciences 2 Building, 17 Liverpool Street, Hobart 7000, Tasmania, Australia
| | - Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Medical Sciences 2 Building, 17 Liverpool Street, Hobart 7000, Tasmania, Australia
| | - Costan G Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Medical Sciences 2 Building, 17 Liverpool Street, Hobart 7000, Tasmania, Australia
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku FI-20014, Finland
| | - Godfred O Boateng
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Moses Aikins
- School of Public Health, University of Ghana, Accra LG 13, Ghana
| | - Nadia Minicuci
- National Research Council, Neuroscience Institute, Via Giustiniani, 2 35128 Padova, Italy
| | - Paul Kowal
- World Health Organization (WHO), Avenue Appia 20, 1211 Genève, Switzerland
- University of Newcastle Research Centre for Generational Health and Ageing, Newcastle, New South Wales 2305, Australia
| | - Lei Si
- The George Institute for Global Health, University of New South Wales, Kensington, NSW 2042, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Medical Sciences 2 Building, 17 Liverpool Street, Hobart 7000, Tasmania, Australia
- Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria 3053, Australia
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Prinja S, Jagnoor J, Sharma D, Aggarwal S, Katoch S, Lakshmi PVM, Ivers R. Out-of-pocket expenditure and catastrophic health expenditure for hospitalization due to injuries in public sector hospitals in North India. PLoS One 2019; 14:e0224721. [PMID: 31697781 PMCID: PMC6837486 DOI: 10.1371/journal.pone.0224721] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 10/21/2019] [Indexed: 11/18/2022] Open
Abstract
Background Injuries are a major public health problem, resulting in high health care demand and economic burden. They result in loss of disability adjusted life years (DALYs) and high out-of-pocket expenditure. However, there is little evidence on the economic burden of injuries in India. We undertook this study to report out-of-pocket expenditure and the prevalence of catastrophic health expenditure for injuries related hospitalizations in public sector hospitals in North India. Further, we also evaluate the determinants of catastrophic health expenditure. Methods and analysis A prospective observational study was conducted. Participants were recruited from three hospitals for all injury cases. Data were collected via face-to-face baseline interviews and follow-up interviews over the phone at 1, 2, 4 and 12 months post-injury. Prevalence of catastrophic health expenditure (more than 30% of consumption expenditure) and impoverishment (International dollar 1.90) were estimated. Results Road traffic injuries (57%) were the leading cause of injury. Direct out-of-pocket expenditure for hospitalizations was INR 16,768 (USD 263) while indirect productivity loss was INR 8,164 (USD 128). The prevalence of catastrophic expenditure was 22.2% with 12.2% slipping below poverty line. Prevalence of catastrophic health expenditure and impoverishment was higher and significantly associated with poorest quintile, tertiary care hospital and increased duration of hospitalization (p< 0.001). Conclusion The economic impact of injuries is notably high both in terms of out-of-pocket expenditure and productivity loss. A high proportion of households experienced catastrophic expenditure and impoverishment following an injury, highlighting need for programs to prevent injuries.
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Affiliation(s)
- Shankar Prinja
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
- * E-mail:
| | - Jagnoor Jagnoor
- The George Institute for Global Health, New Delhi, India
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Deepshikha Sharma
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Aggarwal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Swati Katoch
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P. V. M. Lakshmi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rebecca Ivers
- The George Institute for Global Health, University of Sydney, Sydney, Australia
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