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Oyando R, Were V, Koros H, Mugo R, Kamano J, Etyang A, Murphy A, Hanson K, Perel P, Barasa E. Evaluating the effectiveness of the National Health Insurance Fund in providing financial protection to households with hypertension and diabetes patients in Kenya. Int J Equity Health 2023; 22:107. [PMID: 37264458 PMCID: PMC10234077 DOI: 10.1186/s12939-023-01923-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) can impose a substantial financial burden to households in the absence of an effective financial risk protection mechanism. The national health insurance fund (NHIF) has included NCD services in its national scheme. We evaluated the effectiveness of NHIF in providing financial risk protection to households with persons living with hypertension and/or diabetes in Kenya. METHODS We carried out a prospective cohort study, following 888 households with at least one individual living with hypertension and/or diabetes for 12 months. The exposure arm comprised households that are enrolled in the NHIF national scheme, while the control arm comprised households that were not enrolled in the NHIF. Study participants were drawn from two counties in Kenya. We used the incidence of catastrophic health expenditure (CHE) as the outcome of interest. We used coarsened exact matching and a conditional logistic regression model to analyse the odds of CHE among households enrolled in the NHIF compared with unenrolled households. Socioeconomic inequality in CHE was examined using concentration curves and indices. RESULTS We found strong evidence that NHIF-enrolled households spent a lower share (12.4%) of their household budget on healthcare compared with unenrolled households (23.2%) (p = 0.004). While households that were enrolled in NHIF were less likely to incur CHE, we did not find strong evidence that they are better protected from CHE compared with households without NHIF (OR = 0.67; p = 0.47). The concentration index (CI) for CHE showed a pro-poor distribution (CI: -0.190, p < 0.001). Almost half (46.9%) of households reported active NHIF enrolment at baseline but this reduced to 10.9% after one year, indicating an NHIF attrition rate of 76.7%. The depth of NHIF cover (i.e., the share of out-of-pocket healthcare costs paid by NHIF) among households with active NHIF was 29.6%. CONCLUSION We did not find strong evidence that the NHIF national scheme is effective in providing financial risk protection to households with individuals living with hypertension and/diabetes in Kenya. This could partly be explained by the low depth of cover of the NHIF national scheme, and the high attrition rate. To enhance NHIF effectiveness, there is a need to revise the NHIF benefit package to include essential hypertension and/diabetes services, review existing provider payment mechanisms to explicitly reimburse these services, and extend the existing insurance subsidy programme to include individuals in the informal labour market.
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Affiliation(s)
- Robinson Oyando
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, P.O.BOX 43640-00100, Nairobi, Kenya.
| | - Vincent Were
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, P.O.BOX 43640-00100, Nairobi, Kenya
| | - Hillary Koros
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, P.O.BOX 43640-00100, Nairobi, Kenya
| | | | - Jemima Kamano
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Anthony Etyang
- Department of Epidemiology and Demography, KEMRI-Wellcome Trust Research Program, Kilifi, Kenya
| | - Adrianna Murphy
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Kara Hanson
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Pablo Perel
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, P.O.BOX 43640-00100, Nairobi, Kenya
- Center for Tropical Medicine and Global Health, Oxford University, Oxford, 01540, UK
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Karan A, Farooqui HH, Hussain S, Hussain MA, Selvaraj S, Mathur MR. Multimorbidity, healthcare use and catastrophic health expenditure by households in India: a cross-section analysis of self-reported morbidity from national sample survey data 2017-18. BMC Health Serv Res 2022; 22:1151. [PMID: 36096819 PMCID: PMC9469515 DOI: 10.1186/s12913-022-08509-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this research is to generate new evidence on the economic consequences of multimorbidity on households in terms of out-of-pocket (OOP) expenditures and their implications for catastrophic OOP expenditure. METHODS We analyzed Social Consumption Health data from National Sample Survey Organization (NSSO) 75th round conducted in the year 2017-2018 in India. The sample included 1,13,823 households (64,552 rural and 49,271 urban) through a multistage stratified random sampling process. Prevalence of multimorbidity and related OOP expenditure were estimated. Using Coarsened Exact Matching (CEM) we estimated the mean OOP expenditure for individuals reporting multimorbidity and single morbidity for each episode of outpatient visits and hospital admission. We also estimated implications in terms of catastrophic OOP expenditure for households. RESULTS Results suggest that outpatient OOP expenditure is invariably lower in the presence of multimorbidity as compared with single conditions of the selected Non-Communicable Diseases(NCDs) (overall, INR 720 [USD 11.3] for multimorbidity vs. INR 880 [USD 14.8] for single). In the case of hospitalization, the OOP expenditures were mostly higher for the same NCD conditions in the presence of multimorbidity as compared with single conditions, except for cancers and cardiovascular diseases. For cancers and cardiovascular, OOP expenditures in the presence of multimorbidity were lower by 39% and 14% respectively). Furthermore, around 46.7% (46.674-46.676) households reported incurring catastrophic spending (10% threshold) because of any NCD in the standalone disease scenario which rose to 63.3% (63.359-63.361) under the multimorbidity scenario. The catastrophic implications of cancer among individual diseases was the highest. CONCLUSIONS Multimorbidity leads to high and catastrophic OOP payments by households and treatment of high expenditure diseases like cancers and cardiovascular are under-financed by households in the presence of competing multimorbidity conditions. Multimorbidity should be considered as an integrated treatment strategy under the existing financial risk protection measures (Ayushman Bharat) to reduce the burden of household OOP expenditure at the country level.
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Affiliation(s)
- Anup Karan
- Indian Institute of Public Health Delhi, Public Health Foundation of India, Gurugram, 122002, India
| | | | - Suhaib Hussain
- Indian Institute of Public Health Delhi, Public Health Foundation of India, Gurugram, 122002, India
| | | | - Sakthivel Selvaraj
- Health Economics, Financing and Policy, Public Health Foundation of India, Gurugram, 122002, India
| | - Manu Raj Mathur
- Indian Institute of Public Health Delhi, Public Health Foundation of India, Gurugram, 122002, India. .,Institute of Dentistry, Bart's and The London School of Medicine and Dentistry, New Road, London, E1 2AT, UK.
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Welten VM, Wanis KN, Semeniv S, Shabat G, Dabekaussen KFAA, Davids JS, Beznosenko A, Suprun U, Soeteman DI, Melnitchouk N. Colonoscopy Needs for Implementation of a Colorectal Cancer Screening Program in Ukraine. World J Surg 2022; 46:2476-2486. [PMID: 35835863 DOI: 10.1007/s00268-022-06656-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND In Ukraine, there is no established colorectal cancer screening program. We aimed to project the number of screening colonoscopies needed for implementation of various CRC screening strategies in Ukraine. METHODS We modified a previously developed Markov microsimulation model to reflect the natural history of adenoma and CRC progression among average-risk 50-74-year-olds. We simulated colonoscopies needed for the following screening strategies: no screening, fecal occult blood test yearly, FOBT yearly with flexible sigmoidoscopy every 5 years, FS every 5 years, fecal immunohistochemistry test (FIT) yearly, or colonoscopy every 10 years. Assuming 80% screening adherence, we estimated colonoscopies required at 1 and 5 years depending on the implementation rate. In one-way sensitivity analyses, we varied implementation rate, screening adherence, sensitivity, and specificity. RESULTS Assuming an 80% screening adherence and complete implementation (100%), besides a no screening strategy, the fewest screening colonoscopies are needed with an FOBT program, requiring on average 6,600 and 26,800 colonoscopies per 100,000 persons at 1 and 5 years post-implementation, respectively. The most screening colonoscopies are required with a colonoscopy program, requiring on average 76,600 and 101,000 colonoscopies per 100,000 persons at 1 and 5 years post-implementation, respectively. In sensitivity analyses, the biggest driver of number of colonoscopies needed was screening adherence. CONCLUSIONS The number of colonoscopies needed and therefore the potential strain on the healthcare system vary substantially by screening test. These findings can provide valuable information for stakeholders on equipment needs when implementing a national screening program in Ukraine.
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Affiliation(s)
- Vanessa M Welten
- Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Kerollos Nashat Wanis
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Galyna Shabat
- Department of Surgery, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Kirsten F A A Dabekaussen
- Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jennifer S Davids
- Department of Surgery, University of Massachusetts Memorial Medical Center, Worcester, MA, USA
| | | | | | - Djøra I Soeteman
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Nelya Melnitchouk
- Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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De Guzman KR, Snoswell CL, Taylor ML, Gray LC, Caffery LJ. Economic Evaluations of Remote Patient Monitoring for Chronic Disease: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:897-913. [PMID: 35667780 DOI: 10.1016/j.jval.2021.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aimed to systematically review and summarize economic evaluations of noninvasive remote patient monitoring (RPM) for chronic diseases compared with usual care. METHODS A systematic literature search identified economic evaluations of RPM for chronic diseases, compared with usual care. Searches of PubMed, Embase, CINAHL, and EconLit using keyword synonyms for RPM and economics identified articles published from up until September 2021. Title, abstract, and full-text reviews were conducted. Data extraction of study characteristics and health economic findings was performed. Article reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist. RESULTS This review demonstrated that the cost-effectiveness of RPM was dependent on clinical context, capital investment, organizational processes, and willingness to pay in each specific setting. RPM was found to be highly cost-effective for hypertension and may be cost-effective for heart failure and chronic obstructive pulmonary disease. There were few studies that investigated RPM for diabetes or other chronic diseases. Studies were of high reporting quality, with an average Consolidated Health Economic Evaluation Reporting Standards score of 81%. Of the final 34 included studies, most were conducted from the healthcare system perspective. Eighteen studies used cost-utility analysis, 4 used cost-effectiveness analysis, 2 combined cost-utility analysis and a cost-effectiveness analysis, 1 used cost-consequence analysis, 1 used cost-benefit analysis, and 8 used cost-minimization analysis. CONCLUSIONS RPM was highly cost-effective for hypertension and may achieve greater long-term cost savings from the prevention of high-cost health events. For chronic obstructive pulmonary disease and heart failure, cost-effectiveness findings differed according to disease severity and there was limited economic evidence for diabetes interventions.
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Affiliation(s)
- Keshia R De Guzman
- Centre for Online Health, The University of Queensland, Brisbane, Australia; Centre for Health Services Research, The University of Queensland, Brisbane, Australia.
| | - Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Brisbane, Australia; Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Monica L Taylor
- Centre for Online Health, The University of Queensland, Brisbane, Australia; Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Leonard C Gray
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Australia; Centre for Health Services Research, The University of Queensland, Brisbane, Australia
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Lui M, Safiri S, Mereke A, Davletov K, Mebonia N, Myrkassymova A, Aripov T, Mirrakhimov E, Aghayan SA, Gamkrelidze A, Naghavi M, Kopec JA, Sarrafzadegan N. Burden of Ischemic Heart Disease in Central Asian Countries, 1990-2017. IJC HEART & VASCULATURE 2021; 33:100726. [PMID: 33604451 PMCID: PMC7876559 DOI: 10.1016/j.ijcha.2021.100726] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/04/2021] [Accepted: 01/19/2021] [Indexed: 11/27/2022]
Abstract
Background The burden of ischemic heart disease (IHD) is high. There is limited information on the burden of IHD in identified high risk areas like Central Asia (CA) which is comprised of Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Turkmenistan, Mongolia, Uzbekistan and Tajikistan. This study addresses the burden of IHD in CA at the regional and country levels. Methods Using data from the latest iteration of the Global Burden of Disease Study (GBD), this study provides age-adjusted mortality, prevalence, and Disability Adjusted Life Years (DALYs) of IHD by sex in the CA region, and national levels for countries in this region from 1990 to 2017. Results The CA region has a higher IHD burden than the rest of the world over the studied period. Amongst the countries within this region, age-standardized mortality and DALY rates in Uzbekistan are the highest not only in CA but worldwide, while Armenia consistently has the lowest IHD burden in CA. Unhealthy diet, high systolic blood pressure and LDL-cholesterol are the risk factors with the highest attributable IHD DALYs. Conclusion Increasing burden of IHD over time in CA can be partially explained by the economic crisis in the 1990s. There is considerable variation in IHD DALY rates among countries in the CA region. The reasons for such differences are likely multifactorial such as differences in risk factors distribution, health care effectiveness, political, social and economic factors.
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Affiliation(s)
- Michelle Lui
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
| | - Saeid Safiri
- Tuberculosis and Lung Disease Research Center, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.,Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.,Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alibek Mereke
- Health Research Institute, The Faculty of Medicine, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| | - Kairat Davletov
- Health Research Institute, The Faculty of Medicine, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| | - Nana Mebonia
- Department of Epidemiology and Biostatistics, Tbilisi State Medical University, Tbilisi, Georgia
| | - Akbope Myrkassymova
- School of Public Health, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Timur Aripov
- Department of Public Health and Healthcare Management, Tashkent Institute of Postgraduate Medical Education, Tashkent, Uzbekistan
| | - Erkin Mirrakhimov
- Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan.,National Center of Cardiology and Internal Disease, Bishkek, Kyrgyzstan
| | | | | | - Mohsen Naghavi
- Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation, School of Medicine, University of Washington, Washington, USA
| | - Jacek A Kopec
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
| | - Nizal Sarrafzadegan
- School of Population & Public Health, University of British Columbia, Vancouver, Canada.,Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Jayathilaka R, Joachim S, Mallikarachchi V, Perera N, Ranawaka D. Chronic diseases: An added burden to income and expenses of chronically-ill people in Sri Lanka. PLoS One 2020; 15:e0239576. [PMID: 33113548 PMCID: PMC7592793 DOI: 10.1371/journal.pone.0239576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 09/10/2020] [Indexed: 01/16/2023] Open
Abstract
In the global context, health and the quality of life of people are adversely affected by either one or more types of chronic diseases. This paper investigates the differences in the level of income and expenditure between chronically-ill people and non-chronic population. Data were gathered from a national level survey conducted namely, the Household Income and Expenditure Survey (HIES) by the Department of Census and Statistics (DCS) of Sri Lanka. These data were statistically analysed with one-way and two-way ANOVA, to identify the factors that cause the differences among different groups. For the first time, this study makes an attempt using survey data, to examine the differences in the level of income and expenditure among chronically-ill people in Sri Lanka. Accordingly, the study discovered that married females who do not engage in any type of economic activity (being unemployed due to the disability associated with the respective chronic illness), in the age category of 40-65, having an educational level of tertiary education or below and living in the urban sector have a higher likelihood of suffering from chronic diseases. If workforce population is compelled to lose jobs, it can lead to income insecurity and impair their quality of lives. Under above findings, it is reasonable to assume that most health care expenses are out of pocket. Furthermore, the study infers that chronic illnesses have a statistically proven significant differences towards the income and expenditure level. This has caused due to the interaction of demographic and socio-economic characteristics associated with chronic illnesses. Considering private-public sector partnerships that enable affordable access to health care services for all as well as implementation of commercial insurance and community-based mutual services that help ease burden to the public, are vital when formulating effective policies and strategies related to the healthcare sector. Sri Lanka is making strong efforts to support its healthcare sector and public, which was affected by the coronavirus (COVID-19) in early 2020. Therefore, findings of this paper will be useful to gain insights on the differences of chronic illnesses towards the income and expenditure of chronically-ill patients in Sri Lanka.
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Affiliation(s)
- Ruwan Jayathilaka
- Department of Business Management, SLIIT Business School, Sri Lanka Institute of Information Technology, Malabe, Sri Lanka
| | - Sheron Joachim
- Department of Business Management, SLIIT Business School, Sri Lanka Institute of Information Technology, Malabe, Sri Lanka
| | - Venuri Mallikarachchi
- Department of Business Management, SLIIT Business School, Sri Lanka Institute of Information Technology, Malabe, Sri Lanka
| | - Nishali Perera
- Department of Business Management, SLIIT Business School, Sri Lanka Institute of Information Technology, Malabe, Sri Lanka
| | - Dhanushika Ranawaka
- Department of Business Management, SLIIT Business School, Sri Lanka Institute of Information Technology, Malabe, Sri Lanka
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Jayathilaka R, Joachim S, Mallikarachchi V, Perera N, Ranawaka D. Do chronic illnesses and poverty go hand in hand? PLoS One 2020; 15:e0241232. [PMID: 33095818 PMCID: PMC7584216 DOI: 10.1371/journal.pone.0241232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/11/2020] [Indexed: 01/28/2023] Open
Abstract
In the global context, the health and quality of life of people are adversely affected by either one or more types of chronic diseases. The chronic pain associated with diagnosed patients may include heavy medical expenditure along with the physical and mental suffering they undergo. Usually, unbearable amounts of medical expenses are incurred, to improve or sustain the health condition of the patient. Consequently, the heavy financial burden tends to push households from a comfortable or secure life, or even from bad to worse, towards the probability of becoming poor. Hence, this study is conducted to identify the impact chronic illnesses have on poverty using data from a national survey referred as the Household Income and Expenditure Survey (HIES), with data gathered by the Department of Census and Statistics (DCS) of Sri Lanka in 2016. As such, this study is the first of its kind in Sri Lanka, declaring the originality of the study based on data collected from the local arena. Accordingly, the study discovered that married females who do not engage in any type of economic activity, in the age category of 40-65, having an educational level of tertiary level or below and living in the urban sector have a higher likelihood of suffering from chronic diseases. Moreover, it was inferred that, if a person is deprived from access to basic education in the level of education, lives in the rural or estate sector, or suffers from a brain disease, cancer, heart disease or kidney disease, he is highly likely to be poor. Some insights concluded from this Sri Lankan case study can also be applied in the context of other developing countries, to minimise chronic illnesses and thereby the probability of falling into poverty.
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Affiliation(s)
- Ruwan Jayathilaka
- Department of Business Management, SLIIT Business School, Sri Lanka Institute of Information Technology, Malabe, Sri Lanka
| | - Sheron Joachim
- Department of Business Management, SLIIT Business School, Sri Lanka Institute of Information Technology, Malabe, Sri Lanka
| | - Venuri Mallikarachchi
- Department of Business Management, SLIIT Business School, Sri Lanka Institute of Information Technology, Malabe, Sri Lanka
| | - Nishali Perera
- Department of Business Management, SLIIT Business School, Sri Lanka Institute of Information Technology, Malabe, Sri Lanka
| | - Dhanushika Ranawaka
- Department of Business Management, SLIIT Business School, Sri Lanka Institute of Information Technology, Malabe, Sri Lanka
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Dwivedi R, Pradhan J. Does affordability matter? Examining the trends and patterns in health care expenditure in India. Health Serv Manage Res 2020; 33:207-218. [PMID: 32447992 DOI: 10.1177/0951484820923921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Absence of better financing mechanism results in higher out of pocket expenditure and catastrophe, which leads to impoverishment and poverty especially among low- and middle-income countries like India. This paper examines the major characteristics associated with the higher out of pocket expenditure and provides an insight from Andersen's behavioural model that how predisposing, enabling and need factors influence the level and pattern of out of pocket expenditure in India. METHODS Data has been extracted from three rounds of nationally representative consumer expenditure surveys, i.e. 1993-1994, 2004-2005 and 2011-2012 conducted by the Government of India. States were categorized based on regional classification, and adult equivalent scale was used to adjust the household size. Multiple Generalized-Linear-Regression-Model was employed to explore the relative effect of various socio-economic covariates on the level of out of pocket expenditure. RESULTS The gap has widened between advantaged and disadvantaged segment of the population along with noticeable regional disparities among Indian states. Generalized-Linear-Regression-Model indicates that the most influential predisposing and enabling factor determining the level of out of pocket expenditure were age composition, religion, social-group, household type, residence, economic status, sources of cooking and lighting arrangements among the households. CONCLUSIONS Present study suggests the need for strengthening the affordability mechanism of the households to cope with the excessive burden of health care payments. Furthermore, special consideration is required to accommodate the needs of the elderly, rural, backward states and impoverishment segment of population to reduce the unjust burden of out of pocket expenditure in India.
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Affiliation(s)
- Rinshu Dwivedi
- Department of Humanities and Social Sciences, Indian Institute of Information Technology, Tiruchirappalli, Tamil Nadu, India
| | - Jalandhar Pradhan
- Department of Humanities and Social Sciences, National Institute of Technology Rourkela, Rourkela, India
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Murphy A, Palafox B, Walli-Attaei M, Powell-Jackson T, Rangarajan S, Alhabib KF, Avezum AJ, Calik KBT, Chifamba J, Choudhury T, Dagenais G, Dans AL, Gupta R, Iqbal R, Kaur M, Kelishadi R, Khatib R, Kruger IM, Kutty VR, Lear SA, Li W, Lopez-Jaramillo P, Mohan V, Mony PK, Orlandini A, Rosengren A, Rosnah I, Seron P, Teo K, Tse LA, Tsolekile L, Wang Y, Wielgosz A, Yan R, Yeates KE, Yusoff K, Zatonska K, Hanson K, Yusuf S, McKee M. The household economic burden of non-communicable diseases in 18 countries. BMJ Glob Health 2020; 5:e002040. [PMID: 32133191 PMCID: PMC7042605 DOI: 10.1136/bmjgh-2019-002040] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 11/29/2022] Open
Abstract
Background Non-communicable diseases (NCDs) are the leading cause of death globally. In 2014, the United Nations committed to reducing premature mortality from NCDs, including by reducing the burden of healthcare costs. Since 2014, the Prospective Urban and Rural Epidemiology (PURE) Study has been collecting health expenditure data from households with NCDs in 18 countries. Methods Using data from the PURE Study, we estimated risk of catastrophic health spending and impoverishment among households with at least one person with NCDs (cardiovascular disease, diabetes, kidney disease, cancer and respiratory diseases; n=17 435), with hypertension only (a leading risk factor for NCDs; n=11 831) or with neither (n=22 654) by country income group: high-income countries (Canada and Sweden), upper middle income countries (UMICs: Brazil, Chile, Malaysia, Poland, South Africa and Turkey), lower middle income countries (LMICs: the Philippines, Colombia, India, Iran and the Occupied Palestinian Territory) and low-income countries (LICs: Bangladesh, Pakistan, Zimbabwe and Tanzania) and China. Results The prevalence of catastrophic spending and impoverishment is highest among households with NCDs in LMICs and China. After adjusting for covariates that might drive health expenditure, the absolute risk of catastrophic spending is higher in households with NCDs compared with no NCDs in LMICs (risk difference=1.71%; 95% CI 0.75 to 2.67), UMICs (0.82%; 95% CI 0.37 to 1.27) and China (7.52%; 95% CI 5.88 to 9.16). A similar pattern is observed in UMICs and China for impoverishment. A high proportion of those with NCDs in LICs, especially women (38.7% compared with 12.6% in men), reported not taking medication due to costs. Conclusions Our findings show that financial protection from healthcare costs for people with NCDs is inadequate, particularly in LMICs and China. While the burden of NCD care may appear greatest in LMICs and China, the burden in LICs may be masked by care foregone due to costs. The high proportion of women reporting foregone care due to cost may in part explain gender inequality in treatment of NCDs.
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Affiliation(s)
- Adrianna Murphy
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Benjamin Palafox
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Marjan Walli-Attaei
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Timothy Powell-Jackson
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Jephat Chifamba
- Department of Physiology, University of Zimbabwe, Harare, Zimbabwe
| | | | - Gilles Dagenais
- Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Ontario, Canada
| | - Antonio L Dans
- Department of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, Jaipur, India
| | - Romaina Iqbal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Manmeet Kaur
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Roya Kelishadi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, the Islamic Republic of Iran
| | - Rasha Khatib
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Iolanthe Marike Kruger
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
| | | | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Wei Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, University Teknologi MARA, Beijing, China
| | | | - Viswanathan Mohan
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai, India
| | - Prem K Mony
- St John's Medical College and Research Institute, Bangalore, India
| | | | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University, Gothenburg, Sweden
| | - Ismail Rosnah
- Community Health Department, Faculty of Medicine, UKM Medical Centre, Kuala Lumpur, Malaysia
| | - Pamela Seron
- Facultad de Medicina, Universidad de La Frontera, Temucu, Chile
| | - Koon Teo
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Lap Ah Tse
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Lungiswa Tsolekile
- School of Public Health, University of the Western Cape, Bellville, Western Cape, South Africa
| | - Yang Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Andreas Wielgosz
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ruohua Yan
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Karen E Yeates
- Department of Medicine, Queen's University, Kingston, New Hampshire, Canada
| | - Khalid Yusoff
- UiTM, Selayang, Selangor and UCSI University, Cheras, Kuala Lumpur, Malaysia
| | - Katarzyna Zatonska
- Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Kara Hanson
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Martin McKee
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
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Financial Catastrophism Inherent with Out-of-Pocket Payments in Long Term Care for Households: A Latent Impoverishment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17010295. [PMID: 31906289 PMCID: PMC6981754 DOI: 10.3390/ijerph17010295] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/21/2019] [Accepted: 12/29/2019] [Indexed: 11/17/2022]
Abstract
Background: Out-of-pocket (OOP) payments are configured as an important source of financing long-term care (LTC). However, very few studies have analyzed the risk of impoverishment and catastrophic effects of OOP in LTC. To estimate the contribution of users to the financing of LTC and to analyze the economic consequences for households in terms of impoverishment and catastrophism after financial crisis in Spain. METHODS The database that was used is the 2008 Spanish Disability and Dependency Survey, projected to 2012. We analyze the OOP payments effect associated to the impoverishment of households comparing volume and financial situation before and after OOP payment. At the same time, the extent to which OOP payment had led to catastrophism was analyzed using different thresholds. RESULTS The results show that contribution of dependent people to the financing of the services they receive exceeds by 50% the costs of these services. This expenditure entails an increase in the number of households that live below the poverty. In terms of catastrophism, more than 80% of households dedicate more than 10% of their income to dependency OOP payments. In annual terms, the catastrophe gap generated by devoting more than 10% of the household income to dependent care OOP payment reached €3955, 1 million (0.38% of GDP). CONCLUSION This article informs about consequences of OOP in LCT and supplements previous research that focus on health. Our results should serve to develop strategic for protection against the financial risk resulting from facing the costs of a situation of dependence.
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Murphy A, McGowan C, McKee M, Suhrcke M, Hanson K. Coping with healthcare costs for chronic illness in low-income and middle-income countries: a systematic literature review. BMJ Glob Health 2019; 4:e001475. [PMID: 31543984 PMCID: PMC6730576 DOI: 10.1136/bmjgh-2019-001475] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/25/2019] [Accepted: 06/29/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Experiencing illness in low-income and middle-income countries (LMICs) can incur very high out-of-pocket (OOP) payments for healthcare and, while the existing literature typically focuses on levels of expenditure, it rarely examines what happens when households do not have the necessary money. Some will adopt one or more 'coping strategies', such as borrowing money, perhaps at exorbitant interest rates, or selling assets, some necessary for their future income, with detrimental long-term effects. This is particularly relevant for chronic illnesses that require consistent, long-term OOP payments. We systematically review the literature on strategies for financing OOP costs of chronic illnesses in LMICs, their correlates and their impacts on households. METHODS We searched MEDLINE, EconLit, EMBASE, Global Health and Scopus on 22 October 2018 for literature published on or after 1 January 2000. We included qualitative or quantitative studies describing at least one coping strategy for chronic illness OOP payments in a LMIC context. Our narrative review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. RESULTS Forty-seven papers were included. Studies identified coping strategies for chronic illness costs that are not traditionally addressed in financial risk protection research (eg, taking children out of school, sending them to work, reducing expenditure on food or education, quitting work to give care). Twenty studies reported socioeconomic or other correlates of coping strategies, with poorer households and those with more advanced disease more vulnerable to detrimental strategies. Only six studies (three cross-sectional and three qualitative) included evidence of impacts of coping strategies on households, including increased labour to repay debts and discontinuing treatment. CONCLUSIONS Monitoring of financial risk protection provides an incomplete picture if it fails to capture the effect of coping strategies. This will require qualitative and longitudinal research to understand the long-term effects, especially those associated with chronic illness in LMICs.
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Affiliation(s)
- Adrianna Murphy
- Centre for Global Chronic Conditions, Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Catherine McGowan
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Humanitarian Public Health Technical Unit, Save the Children UK, London, United Kingdom
| | - Martin McKee
- Centre for Global Chronic Conditions, Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Marc Suhrcke
- Centre for Health Economics, University of York, York, UK
- Luxembourg Institute of Socio-economic Research (LISER), Belval, Luxembourg
| | - Kara Hanson
- Department of Global Health Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Loopstra R, Reeves A, Tarasuk V. The rise of hunger among low-income households: an analysis of the risks of food insecurity between 2004 and 2016 in a population-based study of UK adults. J Epidemiol Community Health 2019; 73:668-673. [DOI: 10.1136/jech-2018-211194] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 03/09/2019] [Accepted: 03/13/2019] [Indexed: 11/03/2022]
Abstract
BackgroundRising food bank use in the past decade in the UK raises questions about whether food insecurity has increased. Using the 2016 Food and You survey, we describe the magnitude and severity of the problem, examine characteristics associated with severity of food insecurity, and examine how vulnerability has changed among low-income households by comparing 2016 data to the 2004 Low Income Diet and Nutrition Survey.MethodsThe Food and You survey is a representative survey of adults living in England, Wales, and Northern Ireland (n=3118). Generalised ordered logistic regression models were used to examine how socioeconomic characteristics related to severity of food insecurity. Coarsened exact matching was used to match respondents to respondents in the 2004 survey. Logistic regression models were used to examine if food insecurity rose between survey years.Results20.7% (95% CI 18.7% to 22.8%) of adults experienced food insecurity in 2016, and 2.72% (95% CI 2.07% to 3.58%) were severely food insecure. Younger age, non-white ethnicity, low education, disability, unemployment, and low income were all associated with food insecurity, but only the latter three characteristics were associated with severe food insecurity. Controlling for socioeconomic variables, the probability of low-income adults being food insecure rose from 27.7% (95% CI 24.8% to 30.6 %) in 2004 to 45.8% (95% CI 41.6% to 49.9%) in 2016. The rise was most pronounced for people with disabilities.ConclusionsFood insecurity affects economically deprived groups in the UK, but unemployment, disability and low income are characteristics specifically associated with severe food insecurity. Vulnerability to food insecurity has worsened among low-income adults since 2004, particularly among those with disabilities.
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Ortega-Ortega M, Del Pozo-Rubio R. Catastrophic financial effect of replacing informal care with formal care: a study based on haematological neoplasms. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:303-316. [PMID: 30121870 DOI: 10.1007/s10198-018-0998-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 08/10/2018] [Indexed: 06/08/2023]
Abstract
Informal care is a substantial source of support for people with cancer. However, various studies have predicted its disappearance in the near future. The aim of this study is to analyse the catastrophic effect resulting from the substitution of informal care with formal care in patients with blood cancer throughout the different stages of treatment. A total of 139 haematological neoplasm patients who underwent stem cell transplantation in Spain, completed a longitudinal questionnaire according to the three phases of treatment between 2012 and 2013. The economic value of informal care was estimated using proxy good, opportunity cost, and contingent valuation methods. Catastrophic health expenditure measures with thresholds ranging from 5 to 100% were used to value the financial burden derived from substitution. A total of 88.5% of patients reported having received informal care. In 85.37%, 80.49%, and 33.33% of households, more than 40% of their monthly income would have to be devoted to the replacement with formal care, with monthly amounts of €2105.22, €1790.86, and €1221.94 added to the 40% in the short, medium, and long-term, respectively (proxy good method, value = 9 €/h). Informal caregivers are a structural support for patients with blood cancer, assuming significant care time and societal costs. The substitution of informal care with formal care would be financially unaffordable by the families of people with blood cancer.
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Affiliation(s)
- Marta Ortega-Ortega
- Department of Applied Economics, Public Economics and Political Economy. School of Economics and Business, Complutense University of Madrid, Campus de Somosaguas s/n. 28.023, Pozuelo de Alarcón, Madrid, Spain
| | - Raúl Del Pozo-Rubio
- Department of Economic Analysis and Finance, Faculty of Social Sciences, University of Castilla-La Mancha, Avenida de los Alfares, 44, 16.071, Cuenca, Spain.
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Roberts B, Makhashvili N, Javakhishvili J, Karachevskyy A, Kharchenko N, Shpiker M, Richardson E. Mental health care utilisation among internally displaced persons in Ukraine: results from a nation-wide survey. Epidemiol Psychiatr Sci 2019; 28:100-111. [PMID: 28747237 PMCID: PMC6998949 DOI: 10.1017/s2045796017000385] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 07/03/2017] [Indexed: 10/19/2022] Open
Abstract
AimsThere are an estimated 1.5 million internally displaced persons (IDPs) in Ukraine because of the armed conflict in the east of the country. The aim of this paper is to examine utilisation patterns of mental health and psychosocial support (MHPSS) care among IDPs in Ukraine. METHODS A cross-sectional survey design was used. Data were collected from 2203 adult IDPs throughout Ukraine between March and May 2016. Data on mental health care utilisation were collected, along with outcomes including post-traumatic stress disorder (PTSD), depression and anxiety. Descriptive and multivariate regression analyses were used. RESULTS PTSD prevalence was 32%, depression prevalence was 22%, and anxiety prevalence was 17%. Among those that likely required care (screened positive with one of the three disorders, and also self-reporting a problem) there was a large treatment gap, with 74% of respondents who likely required MHPSS care over the past 12 months not receiving it. For the 26% (N = 180) that had sought care, the most common sources of services/support were pharmacies, family or district doctor/paramedic (feldsher), neurologist at a polyclinic, internist/neurologist at a general hospital, psychologists visiting communities, and non-governmental organisations/volunteer mental health/psychosocial centres. Of the 180 respondents who did seek care, 163 could recall whether they had to pay for their care. Of these 163 respondents, 72 (44%) recalled paying for the care they received despite government care officially being free in Ukraine. The average costs they paid for care was US$107 over the previous 12 months. All 180 respondents reported having to pay for medicines and the average costs for medicines was US$109 over the previous 12 months. Among the 74% had not sought care despite likely needing it; the principal reasons for not seeking care were: thought that they would get better by using their own medications, could not afford to pay for health services or medications, no awareness of where to receive help, poor understanding by health care providers, poor quality of services, and stigma/embarrassment. The findings from multivariate regression analysis show the significant influence of a poor household economic situation on not accessing care. CONCLUSIONS The study highlights a high burden of mental disorders and large MHPSS treatment gap among IDPs in Ukraine. The findings support the need for a scaled-up, comprehensive and trauma-informed response to provision of MHPSS care of IDPs in Ukraine alongside broader health system strengthening.
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Affiliation(s)
- B. Roberts
- London School of Hygiene and Tropical Medicine, UK
| | - N. Makhashvili
- Global Initiative on Psychiatry – Tbilisi, Georgia
- Ilia State University, Tbilisi, Georgia
| | - J. Javakhishvili
- Global Initiative on Psychiatry – Tbilisi, Georgia
- Ilia State University, Tbilisi, Georgia
| | | | - N. Kharchenko
- Kiev International Institute of Sociology (KIIS), Kiev, Ukraine
| | - M. Shpiker
- Kiev International Institute of Sociology (KIIS), Kiev, Ukraine
| | - E. Richardson
- European Observatory on Health Systems and Policies, London, UK
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15
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Murphy A, Kowal P, Albertini M, Rechel B, Chatterji S, Hanson K. Family transfers and long-term care: An analysis of the WHO Study on global AGEing and adult health (SAGE). JOURNAL OF THE ECONOMICS OF AGEING 2018; 12:195-201. [PMID: 30555777 PMCID: PMC6282503 DOI: 10.1016/j.jeoa.2017.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Populations globally are ageing, resulting in increased need for long-term care. Where social welfare systems are insufficient, these costs may fall to other family members. We set out to estimate the association between long-term care needs and family transfers in selected low- and middle- income countries. METHODS We used data from the World Health Organization's Study on global AGEing and adult health (SAGE). Using regression, we analysed the relationship between long-term care needs in older households and i) odds of receiving net positive transfers from family outside the household and ii) the amount of transfer received, controlling for relevant socio-demographic characteristics. RESULTS The proportion of household members requiring long-term care was significantly associated with receiving net positive transfers in China (OR: 1.76; p = 0.023), Ghana (OR: 2.79; p = 0.073), Russia (OR: 3.50; p < 0.001). There was a statistically significant association with amount of transfer received only in Mexico (B: 541.62; p = 0.010). CONCLUSION In selected LMICs, receiving family transfers is common among older households, and associated with requiring long-term care. Further research is needed to better understand drivers of observed associations and identify ways in which financial protection of older adults' long-term care needs can be improved.
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Affiliation(s)
| | - Paul Kowal
- World Health Organization, United States
- University of Newcastle, Australia
| | | | - Bernd Rechel
- European Observatory on Health Systems and Policies, UK
| | | | - Kara Hanson
- London School of Hygiene and Tropical Medicine, UK
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16
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Melnitchouk N, Shabat G, Lu P, Lyu H, Scully R, Leung K, Jarman M, Lukashenko A, Kolesnik OO, Goldberg J, Davids JS, Bleday R. Colorectal Cancer in Ukraine: Regional Disparities and National Trends in Incidence, Management, and Mortality. J Glob Oncol 2018; 4:JGO.18.00145. [PMID: 30354936 PMCID: PMC6657623 DOI: 10.1200/jgo.18.00145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose The incidence of colorectal cancer (CRC) is increasing worldwide, and the greatest increase is in low- to middle-income countries, such as Ukraine. Better knowledge of epidemiology of CRC in Ukraine is needed to understand how best to decrease the burden of disease. Methods The National Cancer Registry of Ukraine (NCRU) was queried for CRC incidence, mortality, stage, and treatment in Ukraine and assessed for regional variation from 1999 to 2015. Joinpoint analysis was used to analyze the trends. Results The incidence of colon cancer increased from 10.6 to 13.3 occurrences per 100,000, which provided an average annual percent change (AAPC) of 1.48 (95% CI, 1.3 to 1.7; P < .05). The incidence of rectal and anal cancers also increased from 9.9 to 11.5 occurrences per 100,000, which provided an AAPC of 1.0 (95% CI, 0.8 to 1.3; P < .05). Mortality remained the same (AAPC, 0.1; 95% CI, -0.3 to 0.2; P = .4). The proportion of patients who received cancer-specific treatment increased from 54.6% to 68.5% for colon cancer and from 61% to 74.4% for rectal and anal cancers. Overall, 34.5% of patients with colon cancer and 27.5% of patients with rectal cancer died within a year of diagnosis in 2015. Great regional variations in 1-year mortality and treatment received were identified. Conclusion The incidence of CRC in Ukraine is increasing. Despite stable mortality rates, many do not receive cancer-specific treatment, and a large proportion of patients die within a year of diagnosis. These findings illustrate the need to promote establishment of a screening program and to improve access to cancer-specific therapy in Ukraine.
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Affiliation(s)
- Nelya Melnitchouk
- Nelya Melnitchouk, Galyna Shabat,
Pamela Lu, Heather Lyu, Rebecca
Scully, Krystle Leung, Joel Goldberg, and
Ronald Bleday, Brigham and Women’s Hospital, Harvard
Medical School; Nelya Melnitchouk, Rebecca Scully, and
Molly Jarman, Center for Surgery and Public Health, Boston;
Jennifer S. Davids, University of Massachusetts Medical School,
Worcester, MA; and Andrey Lukashenko and Olena O.
Kolesnik, National Cancer Institute, National Cancer Registry of
Ukraine, Kyiv, Ukraine
| | - Galyna Shabat
- Nelya Melnitchouk, Galyna Shabat,
Pamela Lu, Heather Lyu, Rebecca
Scully, Krystle Leung, Joel Goldberg, and
Ronald Bleday, Brigham and Women’s Hospital, Harvard
Medical School; Nelya Melnitchouk, Rebecca Scully, and
Molly Jarman, Center for Surgery and Public Health, Boston;
Jennifer S. Davids, University of Massachusetts Medical School,
Worcester, MA; and Andrey Lukashenko and Olena O.
Kolesnik, National Cancer Institute, National Cancer Registry of
Ukraine, Kyiv, Ukraine
| | - Pamela Lu
- Nelya Melnitchouk, Galyna Shabat,
Pamela Lu, Heather Lyu, Rebecca
Scully, Krystle Leung, Joel Goldberg, and
Ronald Bleday, Brigham and Women’s Hospital, Harvard
Medical School; Nelya Melnitchouk, Rebecca Scully, and
Molly Jarman, Center for Surgery and Public Health, Boston;
Jennifer S. Davids, University of Massachusetts Medical School,
Worcester, MA; and Andrey Lukashenko and Olena O.
Kolesnik, National Cancer Institute, National Cancer Registry of
Ukraine, Kyiv, Ukraine
| | - Heather Lyu
- Nelya Melnitchouk, Galyna Shabat,
Pamela Lu, Heather Lyu, Rebecca
Scully, Krystle Leung, Joel Goldberg, and
Ronald Bleday, Brigham and Women’s Hospital, Harvard
Medical School; Nelya Melnitchouk, Rebecca Scully, and
Molly Jarman, Center for Surgery and Public Health, Boston;
Jennifer S. Davids, University of Massachusetts Medical School,
Worcester, MA; and Andrey Lukashenko and Olena O.
Kolesnik, National Cancer Institute, National Cancer Registry of
Ukraine, Kyiv, Ukraine
| | - Rebecca Scully
- Nelya Melnitchouk, Galyna Shabat,
Pamela Lu, Heather Lyu, Rebecca
Scully, Krystle Leung, Joel Goldberg, and
Ronald Bleday, Brigham and Women’s Hospital, Harvard
Medical School; Nelya Melnitchouk, Rebecca Scully, and
Molly Jarman, Center for Surgery and Public Health, Boston;
Jennifer S. Davids, University of Massachusetts Medical School,
Worcester, MA; and Andrey Lukashenko and Olena O.
Kolesnik, National Cancer Institute, National Cancer Registry of
Ukraine, Kyiv, Ukraine
| | - Krystle Leung
- Nelya Melnitchouk, Galyna Shabat,
Pamela Lu, Heather Lyu, Rebecca
Scully, Krystle Leung, Joel Goldberg, and
Ronald Bleday, Brigham and Women’s Hospital, Harvard
Medical School; Nelya Melnitchouk, Rebecca Scully, and
Molly Jarman, Center for Surgery and Public Health, Boston;
Jennifer S. Davids, University of Massachusetts Medical School,
Worcester, MA; and Andrey Lukashenko and Olena O.
Kolesnik, National Cancer Institute, National Cancer Registry of
Ukraine, Kyiv, Ukraine
| | - Molly Jarman
- Nelya Melnitchouk, Galyna Shabat,
Pamela Lu, Heather Lyu, Rebecca
Scully, Krystle Leung, Joel Goldberg, and
Ronald Bleday, Brigham and Women’s Hospital, Harvard
Medical School; Nelya Melnitchouk, Rebecca Scully, and
Molly Jarman, Center for Surgery and Public Health, Boston;
Jennifer S. Davids, University of Massachusetts Medical School,
Worcester, MA; and Andrey Lukashenko and Olena O.
Kolesnik, National Cancer Institute, National Cancer Registry of
Ukraine, Kyiv, Ukraine
| | - Andrey Lukashenko
- Nelya Melnitchouk, Galyna Shabat,
Pamela Lu, Heather Lyu, Rebecca
Scully, Krystle Leung, Joel Goldberg, and
Ronald Bleday, Brigham and Women’s Hospital, Harvard
Medical School; Nelya Melnitchouk, Rebecca Scully, and
Molly Jarman, Center for Surgery and Public Health, Boston;
Jennifer S. Davids, University of Massachusetts Medical School,
Worcester, MA; and Andrey Lukashenko and Olena O.
Kolesnik, National Cancer Institute, National Cancer Registry of
Ukraine, Kyiv, Ukraine
| | - Olena O. Kolesnik
- Nelya Melnitchouk, Galyna Shabat,
Pamela Lu, Heather Lyu, Rebecca
Scully, Krystle Leung, Joel Goldberg, and
Ronald Bleday, Brigham and Women’s Hospital, Harvard
Medical School; Nelya Melnitchouk, Rebecca Scully, and
Molly Jarman, Center for Surgery and Public Health, Boston;
Jennifer S. Davids, University of Massachusetts Medical School,
Worcester, MA; and Andrey Lukashenko and Olena O.
Kolesnik, National Cancer Institute, National Cancer Registry of
Ukraine, Kyiv, Ukraine
| | - Joel Goldberg
- Nelya Melnitchouk, Galyna Shabat,
Pamela Lu, Heather Lyu, Rebecca
Scully, Krystle Leung, Joel Goldberg, and
Ronald Bleday, Brigham and Women’s Hospital, Harvard
Medical School; Nelya Melnitchouk, Rebecca Scully, and
Molly Jarman, Center for Surgery and Public Health, Boston;
Jennifer S. Davids, University of Massachusetts Medical School,
Worcester, MA; and Andrey Lukashenko and Olena O.
Kolesnik, National Cancer Institute, National Cancer Registry of
Ukraine, Kyiv, Ukraine
| | - Jennifer S. Davids
- Nelya Melnitchouk, Galyna Shabat,
Pamela Lu, Heather Lyu, Rebecca
Scully, Krystle Leung, Joel Goldberg, and
Ronald Bleday, Brigham and Women’s Hospital, Harvard
Medical School; Nelya Melnitchouk, Rebecca Scully, and
Molly Jarman, Center for Surgery and Public Health, Boston;
Jennifer S. Davids, University of Massachusetts Medical School,
Worcester, MA; and Andrey Lukashenko and Olena O.
Kolesnik, National Cancer Institute, National Cancer Registry of
Ukraine, Kyiv, Ukraine
| | - Ronald Bleday
- Nelya Melnitchouk, Galyna Shabat,
Pamela Lu, Heather Lyu, Rebecca
Scully, Krystle Leung, Joel Goldberg, and
Ronald Bleday, Brigham and Women’s Hospital, Harvard
Medical School; Nelya Melnitchouk, Rebecca Scully, and
Molly Jarman, Center for Surgery and Public Health, Boston;
Jennifer S. Davids, University of Massachusetts Medical School,
Worcester, MA; and Andrey Lukashenko and Olena O.
Kolesnik, National Cancer Institute, National Cancer Registry of
Ukraine, Kyiv, Ukraine
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17
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Pallegedara A. Impacts of chronic non-communicable diseases on households' out-of-pocket healthcare expenditures in Sri Lanka. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2018; 18:301-319. [PMID: 29322278 DOI: 10.1007/s10754-018-9235-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/03/2018] [Indexed: 06/07/2023]
Abstract
This article examines the effects of chronic non-communicable diseases (NCDs) on households' out-of-pocket health expenditures in Sri Lanka. We explore the disease specific impacts on out-of-pocket health care expenses from chronic NCDs such as heart diseases, hypertension, cancer, diabetics and asthma. We use nationwide cross-sectional household income and expenditure survey 2012/2013 data compiled by the department of census and statistics of Sri Lanka. Employing propensity score matching method to account for selectivity bias, we find that chronic NCD affected households appear to spend significantly higher out-of-pocket health care expenditures and encounter grater economic burden than matched control group despite having universal public health care policy in Sri Lanka. The results also suggest that out-of-pocket expenses on medicines and other pharmaceutical products as well as expenses on medical laboratory tests and other ancillary services are particularly higher for households with chronic NCD patients. The findings underline the importance of protecting households against the financial burden due to NCDs.
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Affiliation(s)
- Asankha Pallegedara
- Department of Industrial Management, Faculty of Applied Sciences, Wayamba University of Sri Lanka, Kuliyapitiya, 60200, Sri Lanka.
- Chair of Development Economics, Faculty of Business Administration and Economics, University of Passau, Innstrasse 29, 94032, Passau, Germany.
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Alam K, Renzaho A, Mahal A. Impacts of adult illness on employment outcomes of rural households in India. J Glob Health 2018; 8:020408. [PMID: 30140434 PMCID: PMC6083015 DOI: 10.7189/jogh.08.020408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Existing literature on the impacts of adult illness on household labour supply and income in low- and middle-income countries shows that adverse health conditions significantly affect household labour supply, work participation and earnings. Most of the studies, however, are not equipped to distinguish between short- and long-term consequences of adult illness. We measured the impact of adult illness on household employment outcomes both in the short- and the long-run, using a unique longitudinal data set from rural India. Methods We used two waves of India Human Development Survey (1993-94 and 2004-05) with a balanced panel of 10 726 households to assess short-run (in the year of the occurrence of adult illness) and long-run (after 11 years of the occurrence of adult illness) effects of major illness of adult household members aged 15-64 years on household employment outcomes, using multiple matching methods: nearest-neighbor matching and inverse probability weighting following propensity score matching, and coarsened exact matching to compare employment outcomes to a set of matched control households. Results Rural households affected by adult illness experienced declines in workforce participation rate by 1-3%, wage employment by 4-15 days, and wage-earnings by Indian Rupee (INR) 374 to INR 837 compared to the matched control households in the short-run. In response, adult non-sick members of the affected households increased their workforce participation sharply by 14-16% to compensate for shortfalls in the short-run. In the long-run, workforce participation rate of the affected households also declined by nearly 1-3%. The long-run declines in wage-days and wage-earnings were small and not always statistically significant across the methods. However, long-run workforce participation rate of non-sick adults were smaller (4-6%) compared to short-run, but still statistically significant. Conclusions The long-term effects were smaller in absolute magnitude than those of the short-run. This suggests coping and adjustments by the affected households using this 11-year longer time-span in a manner that helps to ameliorate the immediate impacts of adult illness. Our study also reiterates the importance of improving financial access to health services as well as access to social security benefits for the illness-affected households in rural India both in the short- and long-run.
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Affiliation(s)
- Khurshid Alam
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Andre Renzaho
- Humanitarian and Development Research Initiative, School of Social Sciences and Psychology, Western Sydney University, Sydney, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ajay Mahal
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
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Jan S, Laba TL, Essue BM, Gheorghe A, Muhunthan J, Engelgau M, Mahal A, Griffiths U, McIntyre D, Meng Q, Nugent R, Atun R. Action to address the household economic burden of non-communicable diseases. Lancet 2018; 391:2047-2058. [PMID: 29627161 DOI: 10.1016/s0140-6736(18)30323-4] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 09/04/2017] [Accepted: 01/19/2018] [Indexed: 01/05/2023]
Abstract
The economic burden on households of non-communicable diseases (NCDs), including cardiovascular diseases, cancer, respiratory diseases, and diabetes, poses major challenges to global poverty alleviation efforts. For patients with NCDs, being uninsured is associated with 2-7-fold higher odds of catastrophic levels of out-of-pocket costs; however, the protection offered by health insurance is often incomplete. To enable coverage of the predictable and long-term costs of treatment, national programmes to extend financial protection should be based on schemes that entail compulsory enrolment or be financed through taxation. Priority should be given to eliminating financial barriers to the uptake of and adherence to interventions that are cost-effective and are designed to help the poor. In concert with programmes to strengthen national health systems and governance arrangements, comprehensive financial protection against the growing burden of NCDs is crucial in meeting the UN's Sustainable Development Goals.
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Affiliation(s)
- Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia.
| | - Tracey-Lea Laba
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Beverley M Essue
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Adrian Gheorghe
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Janani Muhunthan
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Michael Engelgau
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ajay Mahal
- Nossal Institute for Global Health, University of Melbourne, VIC, Australia
| | - Ulla Griffiths
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Diane McIntyre
- Health Economics Unit, University of Cape Town, Cape Town, South Africa
| | - Qingyue Meng
- China Center for Health Development Studies, Peking University, China
| | - Rachel Nugent
- Research Triangle Institute International, Seattle, WA, USA
| | - Rifat Atun
- Department of Global Health and Population, Harvard School of Public Health, Harvard University, Cambridge, MA, USA
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20
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Yerramilli P, Fernández Ó, Thomson S. Financial protection in Europe: a systematic review of the literature and mapping of data availability. Health Policy 2018; 122:493-508. [DOI: 10.1016/j.healthpol.2018.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/09/2018] [Accepted: 02/10/2018] [Indexed: 10/18/2022]
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21
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Su M, Zhou Z, Si Y, Wei X, Xu Y, Fan X, Chen G. Comparing the effects of China's three basic health insurance schemes on the equity of health-related quality of life: using the method of coarsened exact matching. Health Qual Life Outcomes 2018. [PMID: 29514714 PMCID: PMC5842629 DOI: 10.1186/s12955-018-0868-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China has three basic health insurance schemes: Urban Employee Basic Medical Insurance (UEBMI), Urban Resident Basic Medical Insurance (URBMI) and New Rural Cooperative Medical Scheme (NRCMS). This study aimed to compare the equity of health-related quality of life (HRQoL) of residents under any two of the schemes. METHODS Using data from the 5th National Health Services Survey of Shaanxi Province, China, coarsened exact matching method was employed to control confounding factors. We included a matched sample of 6802 respondents between UEBMI and URBMI, 34,169 respondents between UEBMI and NRCMS, and 36,928 respondents between URBMI and NRCMS. HRQoL was measured by EQ-5D-3L based on the Chinese-specific value set. Concentration index was adopted to assess health inequality and was decomposed into its contributing factors to explain health inequality. RESULTS After matching, the horizontal inequity indexes were 0.0036 and 0.0045 in UEBMI and URBMI, 0.0035 and 0.0058 in UEBMI and NRCMS, and 0.0053 and 0.0052 in URBMI and NRCMS respectively, which were mainly explained by age, educational and economic statuses. The findings demonstrated the pro-rich health inequity was much higher for the rural scheme than that for the urban ones. CONCLUSION This study highlights the need to consolidate all three schemes by administrating uniformly, merging funds pooling and benefit packages. Based on the contributing factors, strategies aim to facilitate health conditions of the elderly, narrow economic gap, and reduce educational inequity, are essential. This study will provide evidence-based strategies on consolidating the fragmented health schemes towards reducing health inequity in both China and other developing countries.
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Affiliation(s)
- Min Su
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China.
| | - Yafei Si
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Xiaolin Wei
- Division of Clinical Public Health, and Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Yongjian Xu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Xiaojing Fan
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Gang Chen
- Monash Business School, Monash University, Clayton, Australia
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Murphy A, Palafox B, O'Donnell O, Stuckler D, Perel P, AlHabib KF, Avezum A, Bai X, Chifamba J, Chow CK, Corsi DJ, Dagenais GR, Dans AL, Diaz R, Erbakan AN, Ismail N, Iqbal R, Kelishadi R, Khatib R, Lanas F, Lear SA, Li W, Liu J, Lopez-Jaramillo P, Mohan V, Monsef N, Mony PK, Puoane T, Rangarajan S, Rosengren A, Schutte AE, Sintaha M, Teo KK, Wielgosz A, Yeates K, Yin L, Yusoff K, Zatońska K, Yusuf S, McKee M. Inequalities in the use of secondary prevention of cardiovascular disease by socioeconomic status: evidence from the PURE observational study. Lancet Glob Health 2018; 6:e292-e301. [PMID: 29433667 PMCID: PMC5905400 DOI: 10.1016/s2214-109x(18)30031-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 11/30/2017] [Accepted: 01/16/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND There is little evidence on the use of secondary prevention medicines for cardiovascular disease by socioeconomic groups in countries at different levels of economic development. METHODS We assessed use of antiplatelet, cholesterol, and blood-pressure-lowering drugs in 8492 individuals with self-reported cardiovascular disease from 21 countries enrolled in the Prospective Urban Rural Epidemiology (PURE) study. Defining one or more drugs as a minimal level of secondary prevention, wealth-related inequality was measured using the Wagstaff concentration index, scaled from -1 (pro-poor) to 1 (pro-rich), standardised by age and sex. Correlations between inequalities and national health-related indicators were estimated. FINDINGS The proportion of patients with cardiovascular disease on three medications ranged from 0% in South Africa (95% CI 0-1·7), Tanzania (0-3·6), and Zimbabwe (0-5·1), to 49·3% in Canada (44·4-54·3). Proportions receiving at least one drug varied from 2·0% (95% CI 0·5-6·9) in Tanzania to 91·4% (86·6-94·6) in Sweden. There was significant (p<0·05) pro-rich inequality in Saudi Arabia, China, Colombia, India, Pakistan, and Zimbabwe. Pro-poor distributions were observed in Sweden, Brazil, Chile, Poland, and the occupied Palestinian territory. The strongest predictors of inequality were public expenditure on health and overall use of secondary prevention medicines. INTERPRETATION Use of medication for secondary prevention of cardiovascular disease is alarmingly low. In many countries with the lowest use, pro-rich inequality is greatest. Policies associated with an equal or pro-poor distribution include free medications and community health programmes to support adherence to medications. FUNDING Full funding sources listed at the end of the paper (see Acknowledgments).
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Affiliation(s)
- Adrianna Murphy
- Centre for Global Chronic Conditions, London School of Tropical Medicine, London, UK.
| | - Benjamin Palafox
- Centre for Global Chronic Conditions, London School of Tropical Medicine, London, UK
| | - Owen O'Donnell
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, Netherlands; Faculty of Economics and Business, University of Lausanne, Lausanne, Switzerland
| | - David Stuckler
- Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
| | - Pablo Perel
- Centre for Global Chronic Conditions, London School of Tropical Medicine, London, UK
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alvaro Avezum
- Institute of Cardiology, University of Santo Amaro, Sao Paulo, Brazil
| | - Xiulin Bai
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jephat Chifamba
- Department of Physiology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Clara K Chow
- The University of Sydney and The George Institute for Global Health, Camperdown, NSW, Australia
| | - Daniel J Corsi
- Ottawa Hospital Research Institute, OMNI Research Group, Clinical Epidemiology Program, Ottawa, ON, Canada
| | - Gilles R Dagenais
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Québec City, QC, Canada
| | - Antonio L Dans
- University of the Philippines-Manila, Manila, Philippines
| | - Rafael Diaz
- Estudios Clínicos Latinoamérica (ECLA) International, Rosario, Santa Fe, Argentina
| | | | - Noorhassim Ismail
- Department of Community Health, UKM Medical Centre, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Romaina Iqbal
- Departments of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
| | - Roya Kelishadi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Chamran Hospital, Isfahan, Iran
| | - Rasha Khatib
- Department of Public Health Sciences, Loyola Medical Center, Maywood, IL, USA
| | | | | | - Wei Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jia Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Patricio Lopez-Jaramillo
- Fundación Oftalmológica de Santander-FOSCAL-FOSCAL Internacional, Floridablanca, Santander, Colombia
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and DrMohan's Diabetes Specialities Centre, Gopalapuram, Chennai, India
| | - Nahed Monsef
- Dubai Health Authority, Dubai, United Arab Emirates
| | - Prem K Mony
- St John's Medical College and Research Insitute, Bangalore, India
| | - Thandi Puoane
- School of Public Health, University of the Western Cape, Cape Town, Western Cape Province, South Africa
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, C2-106 DBCVSRI Hamilton General Hospital, Hamilton, ON, Canada
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital/Östra, Göteborg, Sweden
| | - Aletta E Schutte
- South African Medical Research Council Unit for Hypertension and Cardiovascular Disease, Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Mariz Sintaha
- Independent University, Bangladesh, Dhaka, Bangladesh
| | - Koon K Teo
- Population Health Research Institute, McMaster University, C2-106 DBCVSRI Hamilton General Hospital, Hamilton, ON, Canada
| | | | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Lu Yin
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Khalid Yusoff
- Universiti Teknologi MARA, Selyang Campus, Selayang, Selangor and UCSI University, Cheras, Malaysia
| | | | - Salim Yusuf
- Population Health Research Institute, McMaster University, C2-106 DBCVSRI Hamilton General Hospital, Hamilton, ON, Canada
| | - Martin McKee
- Centre for Global Chronic Conditions, London School of Tropical Medicine, London, UK
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Murphy A, Banerjee A, Breithardt G, Camm AJ, Commerford P, Freedman B, Gonzalez-Hermosillo JA, Halperin JL, Lau CP, Perel P, Xavier D, Wood D, Jouven X, Morillo CA. The World Heart Federation Roadmap for Nonvalvular Atrial
Fibrillation. Glob Heart 2017; 12:273-284. [DOI: 10.1016/j.gheart.2017.01.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Murphy A, Johnson CO, Roth GA, Forouzanfar MH, Naghavi M, Ng M, Pogosova N, Vos T, Murray CJL, Moran AE. Ischaemic heart disease in the former Soviet Union 1990-2015 according to the Global Burden of Disease 2015 Study. Heart 2017; 104:58-66. [PMID: 28883037 PMCID: PMC5749345 DOI: 10.1136/heartjnl-2016-311142] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 05/22/2017] [Accepted: 05/30/2017] [Indexed: 12/16/2022] Open
Abstract
Objective The objective of this study was to compare ischaemic heart disease (IHD) mortality and risk factor burden across former Soviet Union (fSU) and satellite countries and regions in 1990 and 2015. Methods The fSU and satellite countries were grouped into Central Asian, Central European and Eastern European regions. IHD mortality data for men and women of any age were gathered from national vital registration, and age, sex, country, year-specific IHD mortality rates were estimated in an ensemble model. IHD morbidity and mortality burden attributable to risk factors was estimated by comparative risk assessment using population attributable fractions. Results In 2015, age-standardised IHD death rates in Eastern European and Central Asian fSU countries were almost two times that of satellite states of Central Europe. Between 1990 and 2015, rates decreased substantially in Central Europe (men −43.5% (95% uncertainty interval −45.0%, −42.0%); women −42.9% (−44.0%, −41.0%)) but less in Eastern Europe (men −5.6% (−9.0, –3.0); women −12.2% (−15.5%, −9.0%)). Age-standardised IHD death rates also varied within regions: within Eastern Europe, rates decreased −51.7% in Estonian men (−54.0, −47.0) but increased +19.4% in Belarusian men (+12.0, +27.0). High blood pressure and cholesterol were leading risk factors for IHD burden, with smoking, body mass index, dietary factors and ambient air pollution also ranking high. Conclusions Some fSU countries continue to experience a high IHD burden, while others have achieved remarkable reductions in IHD mortality. Control of blood pressure, cholesterol and smoking are IHD prevention priorities.
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Affiliation(s)
- Adrianna Murphy
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Catherine O Johnson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Gregory A Roth
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.,Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Mohammad H Forouzanfar
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Mohsen Naghavi
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Marie Ng
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Nana Pogosova
- National Research Centre for Preventive Medicine, Moscow, Russia
| | - Theo Vos
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Christopher J L Murray
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Andrew E Moran
- Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, New York, USA
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Sultana M, Mahumud RA, Sarker AR. Burden of chronic illness and associated disabilities in Bangladesh: Evidence from the Household Income and Expenditure Survey. Chronic Dis Transl Med 2017; 3:112-122. [PMID: 29063064 PMCID: PMC5627690 DOI: 10.1016/j.cdtm.2017.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the distribution of chronic illness and associated disability, out-of-pocket payment (OOPP), and other related factors using survey data from Bangladesh. METHODS This study analyzed Bangladesh Household Income and Expenditure Survey data that include socio-economic and demographic data, such as consumption, expenditures, and assets, along with information regarding chronic illness and disability. Multiple linear regression models were used to identify factors significantly associated with OOPP. Furthermore, a binary Logistic regression model was employed to assess the association of the explanatory variables with disability status. RESULTS A higher prevalence of chronic illness was found for those with chronic gastritis (18.70%), and 41.92% of the population had at least one side disability. The average OOPP healthcare expenditure for chronic illness was estimated to be US$7.59. Higher OOPP was found among the upper 2 wealth quintiles. Overall OOPP health expenditure was significantly higher among individuals with an associated disability (P < 0.001). The likelihood of having an associated disability was higher among those individuals with a lower education level (OR = 2.36, 95% CI: 1.95-4.06), those who not earning an income (OR = 2.85, 95% CI: 2.53-3.21), those who did not seek care (OR = 1.73, 95% CI: 1.57-1.90), those who sought care from a pharmacy (OR = 8.91, 95% CI: 7.38-10.74), and those in the lowest wealth quintile (OR = 7.21, 95% CI: 6.41-8.12). CONCLUSIONS The high OOPP illustrates the necessity of financial risk protection for the population at low socio-economic status. Therefore, we recommend that the government strengthen the healthcare system with appropriate support directed to the rural and elderly populations.
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Affiliation(s)
- Marufa Sultana
- Health Economics and Financing Research, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr'b), Dhaka, Bangladesh
| | - Rashidul Alam Mahumud
- Health Economics and Financing Research, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr'b), Dhaka, Bangladesh
| | - Abdur Razzaque Sarker
- Health Economics and Financing Research, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr'b), Dhaka, Bangladesh
- University of Strathclyde, Glasgow, United Kingdom
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Sukeri S, Mirzaei M, Jan S. Does tax-based health financing offer protection from financial catastrophe? Findings from a household economic impact survey of ischaemic heart disease in Malaysia. Int Health 2016; 9:29-35. [DOI: 10.1093/inthealth/ihw054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/23/2016] [Accepted: 11/16/2016] [Indexed: 11/14/2022] Open
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Arsenijevic J, Pavlova M, Rechel B, Groot W. Catastrophic Health Care Expenditure among Older People with Chronic Diseases in 15 European Countries. PLoS One 2016; 11:e0157765. [PMID: 27379926 PMCID: PMC4933384 DOI: 10.1371/journal.pone.0157765] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 06/03/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction It is well-known that the prevalence of chronic diseases is high among older people, especially those who are poor. Moreover, chronic diseases can result in catastrophic health expenditure. The relationship between chronic diseases and their financial burden on households is thus double-sided, as financial difficulties can give rise to, and result from, chronic diseases. Our aim was to examine the levels of catastrophic health expenditure imposed by private out-of-pocket payments among older people diagnosed with diabetes mellitus, cardiovascular diseases and cancer in 15 European countries. Methods The SHARE dataset for individuals aged 50+ and their households, collected in 2010–2012 was used. The total number of participants included in this study was N = 51,661. The sample consisted of 43.8% male and 56.2% female participants. The average age was 67 years. We applied an instrumental variable approach for binary instrumented variables known as a treatment-effect model. Results We found that being diagnosed with diabetes mellitus and cardiovascular diseases was associated with catastrophic health expenditure among older people even in comparatively wealthy countries with developed risk-pooling mechanisms. When compared to the Netherlands (the country with the lowest share of out-of-pocket payments as a percentage of total health expenditure in our study), older people diagnosed with diabetes mellitus in Portugal, Poland, Denmark, Italy, Switzerland, Belgium, the Czech Republic and Hungary were more likely to experience catastrophic health expenditure. Similar results were observed for diagnosed cardiovascular diseases. In contrast, cancer was not associated with catastrophic health expenditure. Discussion Our study shows that older people with diagnosed chronic diseases face catastrophic health expenditure even in some of the wealthiest countries in Europe. The effect differs across chronic diseases and countries. This may be due to different socio-economic contexts, but also due to the specific characteristics of the different health systems. In view of the ageing of European populations, it will be crucial to strengthen the mechanisms for financial protection for older people with chronic diseases.
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Affiliation(s)
- Jelena Arsenijevic
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- * E-mail:
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Bernd Rechel
- European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Wim Groot
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Top Institute Evidence-Based Education Research (TIER), Maastricht University, Maastricht, The Netherlands
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Murphy A, Jakab M, McKee M, Richardson E. Persistent low adherence to hypertension treatment in Kyrgyzstan: How can we understand the role of drug affordability? Health Policy Plan 2016; 31:1384-1390. [PMID: 27315830 DOI: 10.1093/heapol/czw080] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2016] [Indexed: 11/13/2022] Open
Abstract
It is well known that cardiovascular diseases (CVD) are a growing cause of mortality and morbidity in low-and middle-income countries (LMIC). While hypertension (HTN), a leading risk factor for CVD, can be easily managed with widely available medicines, there is a huge gap in treatment for HTN in many LMIC. One such country is Kyrgyzstan, where HTN is a major public health concern and adherence to medication is low. The reasons for low adherence in Kyrgyzstan are not well understood, but some evidence suggests that HTN medicines may be unaffordable for low-income families, resulting in inequitable access to HTN treatment. With data from the 2010 Kyrgyzstan Integrated Household Survey, we estimate the prevalence and factors associated with adherence to HTN medication in Kyrgyzstan. We then investigate the hypothesis that affordability may be an important factor in adherence to HTN medication. Using the coarsened exact matching approach, we estimate the economic burden faced by households with at least one member with elevated blood pressure (EBP) in Kyrgyzstan and their risk of catastrophic spending on health care. We find that EBP households have significantly higher total expenditure on health, as well as on medicines, and are more likely to experience catastrophic health spending, suggesting that out-of-pocket expenditure for EBP may be prohibitively expensive for the poorest in Kyrgyzstan. Our findings also reveal a high prevalence of self-medication (i.e. purchasing and using medication without a doctor's prescription), and increased expenditure due to self-medication, among those with EBP. Our research suggests that affordability of HTN medicines may be an important factor in low adherence to treatment in Kyrgyzstan. Low affordability may be due partly to the prescription of medicines that are not reimbursable under the national drug benefit plan, but more research is needed to identify solutions to the affordability problem.
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Affiliation(s)
- Adrianna Murphy
- Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, UK
| | - Melitta Jakab
- World Health Organization Office for Europe, Regional Office for Health Systems Strengthening, Barcelona, Spain
| | - Martin McKee
- Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, UK
| | - Erica Richardson
- European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK
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Arnold M, Beran D, Haghparast-Bidgoli H, Batura N, Akkazieva B, Abdraimova A, Skordis-Worrall J. Coping with the economic burden of Diabetes, TB and co-prevalence: evidence from Bishkek, Kyrgyzstan. BMC Health Serv Res 2016; 16:118. [PMID: 27048370 PMCID: PMC4822315 DOI: 10.1186/s12913-016-1369-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 04/01/2016] [Indexed: 11/18/2022] Open
Abstract
Background The increasing number of patients co-affected with Diabetes and TB may place individuals with low socio-economic status at particular risk of persistent poverty. Kyrgyz health sector reforms aim at reducing this burden, with the provision of essential health services free at the point of use through a State-Guaranteed Benefit Package (SGBP). However, despite a declining trend in out-of-pocket expenditure, there is still a considerable funding gap in the SGBP. Using data from Bishkek, Kyrgyzstan, this study aims to explore how households cope with the economic burden of Diabetes, TB and co-prevalence. Methods This study uses cross-sectional data collected in 2010 from Diabetes and TB patients in Bishkek, Kyrgyzstan. Quantitative questionnaires were administered to 309 individuals capturing information on patients’ socioeconomic status and a range of coping strategies. Coarsened exact matching (CEM) is used to generate socio-economically balanced patient groups. Descriptive statistics and logistic regression are used for data analysis. Results TB patients are much younger than Diabetes and co-affected patients. Old age affects not only the health of the patients, but also the patient’s socio-economic context. TB patients are more likely to be employed and to have higher incomes while Diabetes patients are more likely to be retired. Co-affected patients, despite being in the same age group as Diabetes patients, are less likely to receive pensions but often earn income in informal arrangements. Out-of-pocket (OOP) payments are higher for Diabetes care than for TB care. Diabetes patients cope with the economic burden by using social welfare support. TB patients are most often in a position to draw on income or savings. Co-affected patients are less likely to receive social welfare support than Diabetes patients. Catastrophic health spending is more likely in Diabetes and co-affected patients than in TB patients. Conclusions This study shows that while OOP are moderate for TB affected patients, there are severe consequences for Diabetes affected patients. As a result of the underfunding of the SGBP, Diabetes and co-affected patients are challenged by OOP. Especially those who belong to lower socio-economic groups are challenged in coping with the economic burden. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1369-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthias Arnold
- Munich Center of Health Sciences, Ludwig-Maximilians-Universität, Munich, Germany. .,Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany.
| | - David Beran
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | | | - Neha Batura
- Institute for Global Health, UCL, London, UK
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Maracy MR, Isfahani MT, Kelishadi R, Ghasemian A, Sharifi F, Shabani R, Djalalinia S, Majidi S, Ansari H, Asayesh H, Qorbani M. Burden of ischemic heart diseases in Iran, 1990-2010: Findings from the Global Burden of Disease study 2010. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2016; 20:1077-83. [PMID: 26941812 PMCID: PMC4755095 DOI: 10.4103/1735-1995.172832] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: Cardiovascular diseases are viewed worldwide as one of the main causes of death. This study aims to report the burden of ischemic heart diseases (IHDs) in Iran by using data of the global burden of disease (GBD) study, 1990-2010. Materials and Methods: The GBD study 2010 was a systematic effort to provide comprehensive data to calculate disability-adjusted life years (DALYs) for diseases and injuries in the world. Years of life lost (YLLs) due to premature mortality were computed on the basis of cause-of-death estimates, using Cause of Death Ensemble model (CODEm). Years lived with disability (YLDs) were assessed by the multiplication of prevalence, the disability weight for a sequel, and the duration of symptoms. A systematic review of published and unpublished data was performed to evaluate the distribution of diseases, and consequently prevalence estimates were calculated with a Bayesian meta-regression method (DisMod-MR). Data from population-based surveys were used for producing disability weights. Uncertainty from all inputs into the calculations of DALYs was disseminated by Monte Carlo simulation techniques. Results: The age-standardized IHDs DALY specified rate decreased 31.25% over 20 years from 1990 to 2010 [from 4720 (95% uncertainty interval (UI): 4,341-5,099) to 3,245 (95% UI: 2,810-3,529) person-years per 100,000]. The decrease were 38.14% among women and 26.87% among men. The age-standardized IHDs death specefied rate decreased by 21.17% [from 222) 95% UI: 207-243 (to 175 (95% UI:152-190) person-years per 100,000] in both the sexes. The age-standardized YLL and YLD rates decreased 32.05% and 4.28%, respectively, in the above period. Conclusion: Despite decreasing age-standardized IHD of mortality, YLL, YLD, and DALY rates from 1990 to 2010, population growth and aging increased the global burden of IHD. YLL has decreased more than IHD deaths and YLD since 1990 but IHD mortality remains the greatest contributor to disease burden.
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Affiliation(s)
- Mohammad Reza Maracy
- Department of Biostatistics and Epidemiology, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Motahareh Tabar Isfahani
- Department of Biostatistics and Epidemiology, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Kelishadi
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Anoosheh Ghasemian
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Sharifi
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Reihaneh Shabani
- Department of Cardiology, Shahid Rajaei Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shirin Djalalinia
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Development of Research and Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Somayye Majidi
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Ansari
- Department of Epidemiology and Biostatistics, Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Hamid Asayesh
- Department of Medical Emergencies, Qom University of Medical Sciences, Qom, Iran
| | - Mostafa Qorbani
- Department of Community Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran; Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Gotsadze G, Murphy A, Shengelia N, Zoidze A. Healthcare utilization and expenditures for chronic and acute conditions in Georgia: does benefit package design matter? BMC Health Serv Res 2015; 15:88. [PMID: 25889249 PMCID: PMC4352571 DOI: 10.1186/s12913-015-0755-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 02/19/2015] [Indexed: 11/24/2022] Open
Abstract
Background In 2007 the Georgian government introduced a full state-subsidized Medical Insurance Program for the Poor (MIP) to provide better financial protection and improved access for socially and financially disadvantaged citizens. Studies evaluating MIP have noted its positive impact on financial protection, but find only a marginal impact on improved access. To better assess whether the effect of MIP varies according to different conditions, and to identify areas for improvement, we explored whether MIP differently affects utilization and costs among chronic patients compared to those with acute health needs. Methods Data were collected from two cross-sectional nationally representative household surveys conducted in 2007 and in 2010 that examined health care utilization rates and expenditures. Approximately 3,200 households were interviewed from each wave of both studies using a standardized survey questionnaire. Differences in health care utilization and expenditures between chronic and acute patients with and without MIP insurance were evaluated, using coarsened exact matching techniques. Results Among patients with chronic illnesses, MIP did not affect either health service utilization or expenditures for outpatient drugs and reduction in provider fees. For patients with acute illnesses MIP increased the odds (OR = 1.47) that they would use health services. MIP was also associated with a 20.16 Gel reduction in provider fees for those with acute illnesses (p = 0.003) and a 15.14 Gel reduction in outpatient drug expenditure (p = 0.013). Among those reporting a chronic illness with acute episode during the 30 days prior to the interview, MIP reduced expenditures on provider fees (B = -20.02 GEL) with marginal statistical significance. Conclusions Our findings suggest that the MIP may have improved utilization and reduce costs incurred by patients with acute health needs, while chronic patients marginally benefit only during exacerbation of their illnesses. This suggests that the MIP did not adequately address the needs of the aging Georgian population where chronic illnesses are prevalent. Increasing MIP benefits, particularly for patients with chronic illnesses, should receive priority attention if universal coverage objectives are to be achieved.
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Affiliation(s)
- George Gotsadze
- Curatio International Foundation, 37 Chavchavadze Ave., 0162, Tbilisi, Georgia.
| | - Adrianna Murphy
- London School of Hygiene and Tropical Medicine, Department of Health Services Research and Policy, Keppel Street, London, WC1E 7HT, UK.
| | - Natia Shengelia
- Curatio International Foundation, 37 Chavchavadze Ave., 0162, Tbilisi, Georgia.
| | - Akaki Zoidze
- Curatio International Foundation, 37 Chavchavadze Ave., 0162, Tbilisi, Georgia.
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MOUSAVI SM, ANJOMSHOA M. Prevention and Control of Non-Communicable Diseases in Iran: A Window of Opportunity for Policymakers. IRANIAN JOURNAL OF PUBLIC HEALTH 2014; 43:1720-1. [PMID: 26171369 PMCID: PMC4499098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 10/27/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Seyyed Meysam MOUSAVI
- Dept. of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mina ANJOMSHOA
- Research Center for Health Services Management, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Htet S, Alam K, Mahal A. Economic burden of chronic conditions among households in Myanmar: the case of angina and asthma. Health Policy Plan 2014; 30:1173-83. [PMID: 25468454 DOI: 10.1093/heapol/czu125] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are becoming a major source of the national disease burden in Myanmar with potentially serious economic implications. METHODS Using data on 5484 households from the World Health Survey (WHS), this study assessed the household-level economic burden of two chronic conditions, angina and asthma, in Myanmar. Propensity score matching (PSM) and coarsened exact matching (CEM) methods were used to compare household out-of-pocket (OOP) spending, catastrophic and impoverishment effects, reliance on borrowing or asset sales to finance OOP healthcare payments and employment among households reporting a member with angina (asthma) to matched households, with and without adjusting for comorbidities. Sensitivity analyses were carried out to assess the impacts of alternative assumptions on common support and potential violations of the assumption of independence of households being angina (asthma) affected and household economic outcomes, conditional on the variables used for matching (conditional independence). RESULTS Households with angina (asthma) reported greater OOP spending (angina: range I$1.94-I$4.31; asthma: range I$1.53-I$2.01) (I$1 = 125.09 Myanmar Kyats; I$=International Dollar) almost half of which was spending on medicines; higher rates of catastrophic spending based on a 20% threshold ratio of OOP to total household spending (angina: range 6-7%; asthma: range 3-5%); greater reliance on borrowing and sale of assets to finance healthcare (angina: range 12-14%; asthma: range 40-49%); increased medical impoverishment and lower employment rates than matched controls. There were no statistically differences in OOP expenses for inpatient care between angina-affected (asthma-affected) households and matched controls. Our results were generally robust to multiple methods of matching. However, conclusions for medical impoverishment impacts were not robust to potential violations of the conditional independence assumption. CONCLUSIONS Myanmar is expanding public spending on health and has recently launched an innovative programme for supporting hospital-based care for poor households. Our findings suggest the need for interventions to address OOP expenses associated with outpatient care (including drugs) for chronic conditions in Myanmar's population.
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Affiliation(s)
- Soe Htet
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, 99 Commercial Road, The Alfred Centre, Melbourne, Victoria 3004, Australia, Department of Health, Ministry of Health, Government of Myanmar, 4 Zeya Htani Rd, Nay Pyi Taw, Myanmar 10528 and
| | - Khurshid Alam
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, 99 Commercial Road, The Alfred Centre, Melbourne, Victoria 3004, Australia, Equity and Health Systems, International Centre for Diarrhoeal Disease Research (ICDDR,B), Dhaka 1212, Bangladesh
| | - Ajay Mahal
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, 99 Commercial Road, The Alfred Centre, Melbourne, Victoria 3004, Australia,
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Alam K, Mahal A. Economic impacts of health shocks on households in low and middle income countries: a review of the literature. Global Health 2014; 10:21. [PMID: 24708831 PMCID: PMC4108100 DOI: 10.1186/1744-8603-10-21] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 03/24/2014] [Indexed: 12/04/2022] Open
Abstract
Poor health is a source of impoverishment among households in low -and middle- income countries (LMICs) and a subject of voluminous literature in recent years. This paper reviews recent empirical literature on measuring the economic impacts of health shocks on households. Key inclusion criteria were studies that explored household level economic outcomes (burden of out-of-pocket (OOP) health spending, labour supply responses and non-medical consumption) of health shocks and sought to correct for the likely endogeneity of health shocks, in addition to studies that measured catastrophic and impoverishment effects of ill health. The review only considered literature in the English language and excluded studies published before 2000 since these have been included in previous reviews. We identified 105 relevant articles, reports, and books. Our review confirmed the major conclusion of earlier reviews based on the pre-2000 literature--that households in LMICs bear a high but variable burden of OOP health expenditure. Households use a range of sources such as income, savings, borrowing, using loans or mortgages, and selling assets and livestock to meet OOP health spending. Health shocks also cause significant reductions in labour supply among households in LMICs, and households (particularly low-income ones) are unable to fully smooth income losses from moderate and severe health shocks. Available evidence rejects the hypothesis of full consumption insurance in the face of major health shocks. Our review suggests additional research on measuring and harmonizing indicators of health shocks and economic outcomes, measuring economic implications of non-communicable diseases for households and analyses based on longitudinal data. Policymakers need to include non-health system interventions, including access to credit and disability insurance in addition to support formal insurance programs to ameliorate the economic impacts of health shocks.
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Affiliation(s)
- Khurshid Alam
- Monash School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Level 5, Melbourne, VIC 3004, Australia
- Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Mohakhali, Dhaka 1212, Bangladesh
| | - Ajay Mahal
- Monash School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Level 5, Melbourne, VIC 3004, Australia
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Affiliation(s)
- Johan P Mackenbach
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, 3000 CA Rotterdam, Netherlands.
| | - Adrianna Murphy
- European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK
| | - Martin McKee
- European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK
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Alam K, Mahal A. The economic burden of angina on households in South Asia. BMC Public Health 2014; 14:179. [PMID: 24548585 PMCID: PMC3930925 DOI: 10.1186/1471-2458-14-179] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 02/17/2014] [Indexed: 11/27/2022] Open
Abstract
Background Globally, an estimated 54 million people have angina, 16 million of whom are from the WHO South-East Asia region. Despite the increasing burden of cardiovascular disease (CVD) in South Asia, there is no evidence of an economic burden of angina on households in this region. We investigated the economic burden of angina on households in South Asia. Methods We applied a novel propensity score matching approach to assess the economic burden of angina on household out-of-pocket (OOP) health spending, borrowing or selling assets, non-medical consumption expenditure, and employment status of angina-affected individual using nationally representative World Health Survey data from Bangladesh, India, Nepal and Sri Lanka collected during 2002-2003. We used multiple matching methods to match households where the respondent reported symptomatic or diagnosed angina with control households with similar propensity scores. Results Angina-affected households had significantly higher OOP health spending per person in the four weeks preceding the survey than matched controls, in Bangladesh (I$1.94, p = 0.04), in Nepal (I$4.68, p = 0.03) and in Sri Lanka (I$1.99, p < 0.01). Nearly half of this difference was accounted for by drug expenditures. Catastrophic spending, defined as the ratio of OOP health spending to total household expenditure in excess of 20%, was significantly higher in angina-affected households relative to matched controls in India (9.60%, p < 0.01), Nepal (4.90%, p = 0.02) and Sri Lanka (9.10%, p < 0.01). Angina-affected households significantly relied on borrowing or selling assets to finance OOP health expenses in Bangladesh (6%, p = 0.03), India (8.20%, p < 0.01) and Sri Lanka (7.80%, p = 0.01). However, impoverishment, non-medical consumption expenditure and employment status of the angina-affected individual remained mostly unaffected. We adjusted our estimates for comorbidities, but limitations on comorbidity data in the WHS mean that our results may be upwardly biased. Conclusions Households that had the respondent reporting angina in South Asia face an economic burden of OOP health expenses (primarily on drugs and other outpatient expenses), and tend to rely on borrowing or selling assets. Our analysis underscores the need to protect South Asian households from the financial burden of CVD.
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Affiliation(s)
- Khurshid Alam
- Monash School of Public Health & Preventive Medicine, Monash University, 99 Commercial Road, The Alfred Centre, Melbourne, Vic, 3004, Australia.
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