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Klazura G, Wong LY, Ribeiro LLPA, Kojo Anyomih TT, Ooi RYK, Berhane Fissha A, Alam SF, Daudu D, Nyalundja AD, Beltrano J, Patil PP, Wafford QE, Rapolti DI, Sullivan GA, Graf A, Veras P, Nico E, Sheth M, Shing SR, Mathur P, Langer M. Measurements of Impoverishing and Catastrophic Surgical Health Expenditures in Low- and Middle-Income Countries and Reduction Interventions in the Last 30 Years: A Systematic Review. J Surg Res 2024; 299:163-171. [PMID: 38759332 DOI: 10.1016/j.jss.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/14/2024] [Accepted: 04/18/2024] [Indexed: 05/19/2024]
Abstract
INTRODUCTION Approximately 33 million people suffer catastrophic health expenditure (CHE) from surgery and/or anesthesia costs. The aim of this systematic review is to evaluate catastrophic and impoverishing expenditure associated with surgery and anesthesia in low- and middle-income countries (LMICs). METHODS We performed a systematic review of all studies from 1990 to 2021 that reported CHE in LMICs for treatment of a condition requiring surgical intervention, including cesarean section, trauma care, and other surgery. RESULTS 77 studies met inclusion criteria. Tertiary facilities (23.4%) were the most frequently studied facility type. Only 11.7% of studies were conducted in exclusively rural health-care settings. Almost 60% of studies were retrospective in nature. The cost of procedures ranged widely, from $26 USD for a cesarean section in Mauritania in 2020 to $74,420 for a pancreaticoduodenectomy in India in 2018. GDP per capita had a narrower range from $315 USD in Malawi in 2019 to $9955 USD in Malaysia in 2015 (Median = $1605.50, interquartile range = $1208.74). 35 studies discussed interventions to reduce cost and catastrophic expenditure. Four of those studies stated that their intervention was not successful, 18 had an unknown or equivocal effect on cost and CHE, and 13 concluded that their intervention did help reduce cost and CHE. CONCLUSIONS CHE from surgery is a worldwide problem that most acutely affects vulnerable patients in LMICs. Existing efforts are insufficient to meet the true need for affordable surgical care unless assistance for ancillary costs is given to patients and families most at risk from CHE.
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Affiliation(s)
- Greg Klazura
- University of Illinois at Chicago, Chicago, Illinois
| | - Lye-Yeng Wong
- Department of Cardiothoracic Surgery, Stanford Hospital, Stanford, California.
| | | | | | | | - Aemon Berhane Fissha
- Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - Syeda Fatema Alam
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Davina Daudu
- Faculty of Surgery, University of Western Australia, Nedlands, Western Australia, Australia
| | - Arsene Daniel Nyalundja
- Faculty of Medicine, Université Catholique de Bukavu, Bukavu, South Kivu, Democratic Republic of Congo
| | | | - Poorvaprabha P Patil
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | | | - Gwyneth A Sullivan
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Akua Graf
- University of Illinois at Chicago, Chicago, Illinois
| | - Perry Veras
- Loyola Stritch School of Medicine, Maywood, Illinois
| | - Elsa Nico
- University of Illinois at Chicago, Chicago, Illinois
| | - Monica Sheth
- Loyola Stritch School of Medicine, Oak Park, Illinois
| | - Samuel R Shing
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Priyanka Mathur
- Northwestern University Feinberg School of Medicine, Chicago Illinois
| | - Monica Langer
- Lurie Children's Hospital of Chicago, Chicago, Illinois
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Lyu J, Lin Q, Fang Z, Xu Z, Liu Z. Complex impacts of gallstone disease on metabolic syndrome and nonalcoholic fatty liver disease. Front Endocrinol (Lausanne) 2022; 13:1032557. [PMID: 36506064 PMCID: PMC9727379 DOI: 10.3389/fendo.2022.1032557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/25/2022] [Indexed: 11/24/2022] Open
Abstract
Background Patients with gallstone disease (GSD) often have highly co-occurrence with metabolic syndrome (MetS) and Nonalcoholic fatty liver disease (NAFLD) both associated with insulin resistance (IR). Meanwhile, highly prevalence of NAFLD was found in patients who received cholecystectomy. However, the associations of GSD with MetS, NAFLD is inconsistent in the published literature. And risk of cholecystectomy on NAFLD is unclear. Methods We searched the Medline EMBASE and WOS databases for literature that met our study topic. To be specific, studies with focus on associations between GSD and MetS/NAFLD, and risk evaluation on cholecystectomy and NAFLD incidence were enrolled for further analysis. The random effect model was used to calculate the combined relative ratio (RR) and odds ratio (OR)and 95% confidence interval (CI). Results Seven and six papers with focus on connections between GSD and NAFLD/MetS prevalence. Correspondingly, seven papers with focus on risk of cholecystectomy on NAFLD occurrence were also enrolled into meta-analysis. After pooling the results from individual study, patients with GSD had higher risk of MetS (OR:1.45, 95%CI: 1.23-1.67, I2 = 41.1%, P=0.165). Risk of GSD was increased by 52% in NAFLD patients (pooled OR:1.52, 95%CI:1.24-1.80). And about 32% of increment on NAFLD prevalence was observed in patients with GSD (pooled OR: 1.32, 95%CI:1.14-1.50). With regard to individual MetS components, patients with higher systolic blood pressure were more prone to develop GSD, with combined SMD of 0.29 (96%CI: 0.24-0.34, P<0.05). Dose-response analysis found the GSD incidence was significantly associated with increased body mass index (BMI) (pooled OR: 1.02, 95%CI:1.01-1.03) in linear trends. Patients who received cholecystectomy had a higher risk of post-operative NAFLD (OR:2.14, 95%CI: 1.43-2.85), P<0.05). And this impact was amplified in obese patients (OR: 2.51, 95%CI: 1.95-3.06, P<0.05). Conclusion Our results confirmed that controls on weight and blood pressure might be candidate therapeutic strategy for GSD prevention. And concerns should be raised on de-novo NAFLD after cholecystectomy.
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Affiliation(s)
- Jingting Lyu
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, Zhejiang, China
| | - Qinghong Lin
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, Zhejiang, China
| | - Zhongbiao Fang
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, Zhejiang, China
| | - Zeling Xu
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, Zhejiang, China
| | - Zhengtao Liu
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, Zhejiang, China
- NHC Key Laboratory of Combined Multi-Organ Transplantation, Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, CAMS, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Organ Transplantation, Zhejiang Province, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Shulan (Hangzhou) Hospital, Hangzhou, China
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Vuong QH, La VP, Nguyen MH, Nguyen THT, Ho MT. Good budget or good care: The dilemma of social health insurance in Vietnam. SAGE Open Med 2021; 9:20503121211042512. [PMID: 34504705 PMCID: PMC8422827 DOI: 10.1177/20503121211042512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/10/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: 2014 marked a rising public commitment to universal health coverage in Vietnam to eliminate the financial burden for patients, but there are lots of hindrances. It is evident that patients met difficulties to validate their insurances, so health insurance does not significantly address out-of-pocket payments issues. Furthermore, the unequal geographical distribution of hospitals in Vietnam has created an inequality between non-residing patients and residing patients; the former usually pay more. This calls into question how the validity of healthcare insurance and patient’s residence could be related to patient’s financial status and their satisfaction with health insurance. Methods: Bayesian regression models are employed to analyze a data set of 1042 inpatients in hospitals of all levels in Northern Vietnam. Result: The results show that living in the same region as the hospital and having valid insurance is negatively correlated with the impoverishing risk. Regarding patients’ satisfaction with health insurance, it is negatively correlated with having a residence in the same region as the hospital but positively correlated with higher socioeconomic status and insurance validity. Finally, on average, the satisfaction of patients who have already recovered from the illness and those who quit early is lower than that of patients who needed follow-up in medical care or stop in the middle. Conclusion: This article suggests that policymakers consider addressing the unequal geographical distribution of hospitals and healthcare quality to help patients avoid going to hospitals outside their regions, which may generate a financial burden for patients and lower their satisfaction with health insurance.
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Affiliation(s)
- Quan-Hoang Vuong
- Centre for Interdisciplinary Social Research, Phenikaa University, Hanoi, Vietnam
| | - Viet-Phuong La
- Centre for Interdisciplinary Social Research, Phenikaa University, Hanoi, Vietnam
| | - Minh-Hoang Nguyen
- Centre for Interdisciplinary Social Research, Phenikaa University, Hanoi, Vietnam
| | - Thanh-Huyen T Nguyen
- Centre for Interdisciplinary Social Research, Phenikaa University, Hanoi, Vietnam
| | - Manh-Toan Ho
- Centre for Interdisciplinary Social Research, Phenikaa University, Hanoi, Vietnam
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Thu Thuong NT, Van Den Berg Y, Huy TQ, Tai DA, Anh BNH. Determinants of catastrophic health expenditure in Vietnam. Int J Health Plann Manage 2020; 36:316-333. [PMID: 33022102 DOI: 10.1002/hpm.3076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/17/2020] [Accepted: 09/13/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The Government of Vietnam has set the goal of achieving universal health coverage (UHC) by 2025. Health insurance (HI) is being considered a tool to achieve this goal. However, out-of-pocket spending and catastrophic health expenditure (CHE) remain high. Research evidence on how to reduce these expenditures to achieve UHC is essential. Therefore, this study examines the determinants of CHE, especially the HI factor. METHOD To identify HI participation status and other factors associated with CHE, we use logistic regression on a dataset from the 2016 Vietnam Household Living Standards Survey. RESULTS The study finds that HI is a protective factor against CHE, although this result is not always statistically significant across different subsamples. Moreover, the household head's age and employment status, household size, share of the elderly above 60 years, income, illness status, healthcare utilisation, availability of hospitals, commune health stations with medical doctors and place of residence all correlate with household CHE. CONCLUSION Although there has been a rise in HI coverage, the financial protection capacity of HI schemes in Vietnam remains inadequate, particularly for households living in rural areas. Further investigations of the causal effect of HI, other health system factors and CHE in rural settings are necessary to reduce the incidence of CHE. Additionally, policies aimed at groups vulnerable to CHE, such as those with higher incidences of severe illness or inpatient admissions, low income, and higher age, should be considered.
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Affiliation(s)
- Nguyen Thi Thu Thuong
- Faculty of Economics, TNU-University of Economics and Business Administration, Thai Nguyen, Vietnam
| | - Yme Van Den Berg
- Royal Tropical Institute, KIT Health, Amsterdam, The Netherlands
| | - Tran Quang Huy
- Department of Academic Affairs, TNU-University of Economics and Business Administration, Thai Nguyen, Vietnam
| | - Do Anh Tai
- Department of Science, Technology and International Cooperation, TNU-University of Economics and Business Administration, Thai Nguyen, Vietnam
| | - Bui Nu Hoang Anh
- Faculty of Economics, TNU-University of Economics and Business Administration, Thai Nguyen, Vietnam
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Anser MK, Yousaf Z, Khan MA, Nassani AA, Alotaibi SM, Qazi Abro MM, Vo XV, Zaman K. Does communicable diseases (including COVID-19) may increase global poverty risk? A cloud on the horizon. ENVIRONMENTAL RESEARCH 2020; 187:109668. [PMID: 32422482 PMCID: PMC7228701 DOI: 10.1016/j.envres.2020.109668] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/01/2020] [Accepted: 05/08/2020] [Indexed: 05/11/2023]
Abstract
Coronavirus epidemic can push millions of people in poverty. The shortage of healthcare resources, lack of sanitation, and population compactness leads to an increase in communicable diseases, which may increase millions of people add in a vicious cycle of poverty. The study used the number of factors that affect poverty incidence in a panel of 76 countries for a period of 2010-2019. The dynamic panel GMM estimates show that the causes of death by communicable diseases, chemical-induced carbon and fossil fuel combustion, and lack of access to basic hand washing facilities menace to increase poverty headcounts, whereas, an increase in healthcare expenditures substantially decreases poverty headcounts across countries. Further, the results show the U-shaped relationship between economic growth and poverty headcounts, as economic growth first decreases and later increase poverty headcount due to rising healthcare disparities among nations. The causality estimates show that lack of access to basic amenities lead to increase of communicable diseases including COVID-19 whereas chemical-induced carbon and fossil fuel emissions continue to increase healthcare expenditures and economic growth in a panel of selected countries. The rising healthcare disparities, regional conflicts, and public debt burden further 'hold in the hand' of communicable diseases that push millions of people in the poverty trap.
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Affiliation(s)
- Muhammad Khalid Anser
- Department of Public Administration, Xi'an University of Architecture and Technology, Xi'an, 710000, China
| | - Zahid Yousaf
- Higher Education Department Khyber Pakhtunkhwa, Government College of Management Sciences, Abbottabad, 22060, Pakistan
| | - Muhammad Azhar Khan
- Department of Economics, University of Haripur, Khyber Pakhtunkhwa, Haripur, Pakistan
| | - Abdelmohsen A Nassani
- Department of Management, College of Business Administration, King Saud University, P.O. Box 71115, Riyadh, 11587, Saudi Arabia
| | - Saad M Alotaibi
- Department of Management, College of Business Administration, King Saud University, P.O. Box 71115, Riyadh, 11587, Saudi Arabia
| | - Muhammad Moinuddin Qazi Abro
- Department of Management, College of Business Administration, King Saud University, P.O. Box 71115, Riyadh, 11587, Saudi Arabia
| | - Xuan Vinh Vo
- Institute of Business Research and CFVG Ho Chi Minh City, University of Economics Ho Chi Minh City, 59C Nguyen Dinh Chieu Street, District 3, Ho Chi Minh City, Viet Nam
| | - Khalid Zaman
- Institute of Business Research, University of Economics Ho Chi Minh City, 59C Nguyen Dinh Chieu Street, District 3, Ho Chi Minh City, Viet Nam; Department of Economics, University of Wah, Quaid Avenue, Wah Cantt, Pakistan.
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