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Naz L, Sriram S. Out-of-pocket expenditures associated with double disease burden in Pakistan: a quantile regression analysis. BMC Public Health 2024; 24:801. [PMID: 38486277 PMCID: PMC10938732 DOI: 10.1186/s12889-024-18320-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 03/10/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Pakistan is currently experiencing a double burden of disease. Families with members having both communicable and noncommunicable diseases are at a greater risk of impoverishment due to enormous out-of-pocket payments. This study examines the percentile distribution of the determinants of the out-of-pocket expenditure on the double disease burden. METHOD The study extracted a sample of 6,775 households with at least one member experiencing both communicable and noncommunicable diseases from the Household Integrated Economic Survey 2018-19. The dataset is cross-sectional and nationally representative. Quantile regression was used to analyze the association of various socioeconomic factors with the OOP expenditure associated with double disease burden. RESULTS Overall, 28.5% of households had double disease in 2018-19. The households with uneducated heads, male heads, outpatient healthcare, patients availing public sector healthcare services, and rural and older members showed a significant association with the prevalence of double disease. The out-of-pocket expenditure was higher for depression, liver and kidney disease, hepatitis, and pneumonia in the upper percentiles. The quantile regression results showed that an increased number of communicable and noncommunicable diseases was associated with higher monthly OOP expenditure in the lower percentiles (10th percentile, coefficient 312, 95% CI: 92-532), and OOP expenditure was less pronounced among the higher percentiles (75th percentile, coefficient 155, 95% CI: 30-270). The households with older members were associated with higher OOP expenditure at higher tails (50th and 75th percentiles) compared to lower (10th and 25th percentiles). Family size was associated with higher OOPE at lower percentiles than higher ones. CONCLUSION The coexistence of communicable and noncommunicable diseases is associated with excessive private healthcare costs in Pakistan. The results call for addressing the variations in financial costs associated with double diseases.
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Affiliation(s)
- Lubna Naz
- Department of Economics, School of Economics and Social Sciences, Institute of Business Administration, 75270, Karachi, Pakistan
| | - Shyamkumar Sriram
- Department of Social and Public Health, Ohio University, 45701, Athens, OH, USA.
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Kim BR, Cho HA, Shin H. The effects of orthodontic treatment on personal dental expenditures in South Korea: a follow-up study using Korean health panel survey. BMC Health Serv Res 2022; 22:1598. [PMID: 36585698 PMCID: PMC9805093 DOI: 10.1186/s12913-022-09009-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND This study aimed to investigate the effects of orthodontic treatment on cumulative out-of-pocket (OOP) expenditures for up to 8 years and the factors contributing to changes in individual OOP dental expenses. METHODS The data of adults aged ≥19 years, 218 with experience of orthodontic treatment (OT group) and 654 without experience of orthodontic treatment (non-OT group) were extracted from the Korea Health Panel Survey between 2009 and 2017 using the propensity score matching method. The total personal OOP expenditure for dental care incurred after orthodontic treatment in the OT group and that incurred in the matched non-OT group were calculated. Since dependent variables, cumulative dental expenditures, were continuous with excess zeros, Tweedie compound Poisson linear models were used to explore the influence of orthodontic treatment experience and demographic and socioeconomic factors, including private insurance, on per capita OOP dental expenditures. RESULTS The OT group had socioeconomic characteristics distinct from those of general dental patients. The Box-Cox transformed per capita OOP expenditures for dental care in the OT group were lower than those in the non-OT group (P < 0.05). When all covariates were held constant, the non-OT group spent 1.4-times more on OOP dental expenditures, but this was not statistically significant (P > 0.1). The data from those with higher incomes revealed the opposite trend (P < 0.05), while the other covariates were not statistically significant. CONCLUSIONS Orthodontic treatment had no positive or negative effect on future oral care use. This finding is similar to the inconsistent results of previous clinical studies on oral health and orthodontic treatment.
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Affiliation(s)
- Bo-Ra Kim
- grid.443736.10000 0004 0647 1428Department of Dental Hygiene, Namseoul University, Cheonan-si, South Korea
| | - Han-A Cho
- grid.496515.a0000 0004 0371 6987Department of Dental Hygiene, Shinhan University, Uijeongbu-si, South Korea
| | - Hosung Shin
- grid.410899.d0000 0004 0533 4755Department of Social and Humanity in Dentistry, Wonkwang University School of Dentistry, 460 Iksan-daero, Iksan-si, 54538 South Korea
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Keane C, Regan M, Walsh B. Failure to take-up public healthcare entitlements: Evidence from the Medical Card system in Ireland. Soc Sci Med 2021; 281:114069. [PMID: 34120084 DOI: 10.1016/j.socscimed.2021.114069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/11/2021] [Accepted: 05/19/2021] [Indexed: 11/26/2022]
Abstract
While population health and welfare can be improved through the provision of non-cash benefits, such as free healthcare, many welfare improving schemes have low rates of take up amongst those eligible for such a benefit. One interesting example of this is the Medical Card scheme in Ireland. Medical Cards are a non-cash benefit that provide free primary, community, and hospital care, as well as heavily subsidised prescriptions drugs, for those below specific income means-test threshold. However, despite the significant benefits afforded by a Medical Card, many people forego entitlement. While this has been of concern to policymakers, the prevalence of, and reason for, non-take up, have to date not been examined in-depth. Using detailed household demographic, healthcare, income and expenditure data, this paper estimates the Medical Card take-up rate, examines the reasons for non-take, and estimates the additional healthcare cost burden to individuals due to non-take-up. The paper estimates that 31% of eligible individuals do not take up a Medical Card. Private health insurance coverage, receipt of social welfare, employment status and health status are all strongly correlated with take up. Results suggest that of a lack of information about eligibility status and social stigma are key factors driving non take up. The paper estimates that families who forego their entitled Medical Card typically spend an additional €202 annually on healthcare. Furthermore, as a consequence of higher purchase rates of, perhaps unnecessary, private health insurance, families not taking up their entitlement spend an additional €489 per annum on PHI premia. Welfare losses are likely to be even higher if forgoing medical care due to cost results in future negative health outcomes.
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Affiliation(s)
- Claire Keane
- Affiliated to the Economic and Social Research Institute and Trinity College Dublin, Ireland.
| | - Mark Regan
- Affiliated to the Economic and Social Research Institute and Trinity College Dublin, Ireland
| | - Brendan Walsh
- Affiliated to the Economic and Social Research Institute and Trinity College Dublin, Ireland
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Zhou Y, Wushouer H, Vuillermin D, Guan X, Shi L. Does the universal medical insurance system reduce catastrophic health expenditure among middle-aged and elderly households in China? A longitudinal analysis. Eur J Health Econ 2021; 22:463-471. [PMID: 33582893 DOI: 10.1007/s10198-021-01267-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 01/13/2021] [Indexed: 05/11/2023]
Abstract
BACKGROUND The Chinese government has made great progress in establishing the universal medical insurance system. This study aimed to analyze whether the universal medical insurance system protected middle-aged and elderly households from catastrophic health expenditure (CHE). METHODS The data were obtained from the China Health and Retirement Longitudinal Study. We used household as our unit of analysis and CHE was measured as out-of-pocket expenditures ≥ 40% of nonfood household expenditures. Univariate analysis was deployed to examine the impacts of different medical insurance schemes on CHE, and the factors associated with CHE were estimated using a random-effects logit regression model. RESULTS We identified 10,005, 10,370, and 11,567 households in 2011, 2013, and 2015, respectively, and found 12.9% (2011), 26.6% (2013) and 27.9% (2015) of the households experienced CHE. When compared with no insurance, households enrolled in New Rural Cooperative Medical Insurance Scheme (P = 0.023) were associated with a lower incidence of CHE, but other insurance schemes were not significant. Households with members older than 65 years (P < 0.001), members with chronic diseases (P < 0.001), members with poor self-reported health conditions (P < 0.001), and members receiving health care (P < 0.001) had a higher risk of CHE. Large household size (P < 0.001) and high household income per capita (P < 0.001) were major protective factors to CHE incidence. CONCLUSIONS Despite China's great stride in the medical insurance coverage, it fell short to provide financial protection against medical expenditure burden. To reduce the risk of CHE, an integrated poverty and elderly-oriented medical insurance system could be put in place to address these problems.
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Affiliation(s)
- Yue Zhou
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Haishaerjiang Wushouer
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | | | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.
- International Research Center for Medicinal Administration, Peking University, Beijing, China.
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
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Kiros M, Dessie E, Jbaily A, Tolla MT, Johansson KA, Norheim OF, Memirie ST, Verguet S. The burden of household out-of-pocket health expenditures in Ethiopia: estimates from a nationally representative survey (2015-16). Health Policy Plan 2020; 35:1003-1010. [PMID: 32772112 PMCID: PMC7553759 DOI: 10.1093/heapol/czaa044] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2020] [Indexed: 11/13/2022] Open
Abstract
In Ethiopia, little is known about the extent of out-of-pocket health expenditures and the associated financial hardships at national and regional levels. We estimated the incidence of both catastrophic and impoverishing health expenditures using data from the 2015/16 Ethiopian household consumption and expenditure and welfare monitoring surveys. We computed incidence of catastrophic health expenditures (CHE) at 10% and 25% thresholds of total household consumption and 40% threshold of household capacity to pay, and impoverishing health expenditures (IHE) using Ethiopia's national poverty line (ETB 7184 per adult per year). Around 2.1% (SE: 0.2, P < 0.001) of households would face CHE with a 10% threshold of total consumption, and 0.9% (SE: 0.1, P < 0.001) of households would encounter IHE, annually in Ethiopia. CHE rates were high in the regions of Afar (5.8%, SE: 1.0, P < 0.001) and Benshangul-Gumuz (4.0%, SE: 0.8, P < 0.001). Oromia (n = 902 000), Amhara (n = 275 000) and Southern Nations Nationalities and Peoples (SNNP) (n = 268 000) regions would have the largest numbers of affected households, due to large population size. The IHE rates would also show similar patterns: high rates in Afar (5.0%, SE: 0.96, P < 0.001), Oromia (1.1%, SE: 0.22, P < 0.001) and Benshangul-Gumuz (0.9%, SE: 0.4, P = 0.02); a large number of households would be impoverished in Oromia (n = 356 000) and Amhara (n = 202 000) regions. In summary, a large number of households is facing financial hardship in Ethiopia, particularly in Afar, Benshangul-Gumuz, Oromia, Amhara and SNNP regions and this number would likely increase with greater health services utilization. We recommend regional-level analyses on services coverage to be conducted as some of the estimated low CHE/IHE regional values might be due to low services coverage. Periodic analyses on the financial hardship status of households could also be monitored to infer progress towards universal health coverage.
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Affiliation(s)
- Mizan Kiros
- Ethiopia Health Insurance Agency, Addis Ababa, Ethiopia
| | - Ermias Dessie
- Federal Ministry of Health, Addis Ababa, Ethiopia
- World Health Organization, Addis Ababa, Ethiopia
| | - Abdulrahman Jbaily
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mieraf Taddesse Tolla
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kjell Arne Johansson
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ole F Norheim
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Solomon Tessema Memirie
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Rajan S, Rathod SD, Luitel NP, Murphy A, Roberts T, Jordans MJD. Healthcare utilization and out-of-pocket expenditures associated with depression in adults: a cross-sectional analysis in Nepal. BMC Health Serv Res 2020; 20:250. [PMID: 32213188 PMCID: PMC7093962 DOI: 10.1186/s12913-020-05094-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 03/09/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Despite attempts to improve universal health coverage (UHC) in low income countries like Nepal, most healthcare utilization is still financed by out-of-pocket (OOP) payments, with detrimental effects on the poorest and most in need. Evidence from high income countries shows that depression is associated with increased healthcare utilization, which may lead to increased OOP expenditures, placing greater stress on families. To inform policies for integrating mental healthcare into UHC in LMIC, we must understand healthcare utilization and OOP expenditure patterns in people with depression. We examined associations between symptoms of depression and frequency and type of healthcare utilization and OOP expenditure among adults in Chitwan District, Nepal. METHODS We analysed data from a population-based survey of 2040 adults in 2013, who completed the PHQ-9 screening tool for depression and answered questions about healthcare utilization. We examined associations between increasing PHQ-9 score and healthcare utilization frequency and OOP expenditure using negative binomial regression. We also compared utilization of specific outpatient service providers and their related costs among adults with and without probable depression, determined by a PHQ-9 score of 10 or more. RESULTS We classified 80 (3.6%) participants with probable depression, 70.9% of whom used some form of healthcare in the past year compared to 43.9% of people without probable depression. Mean annual OOP healthcare expenditures were $118 USD in people with probable depression, compared to $110 USD in people without. With each unit increase in PHQ-9 score, there was a 14% increase in total healthcare visits (95% CI 7-22%, p < 0.0001) and $9 USD increase in OOP expenditures (95% CI $2-$17; p < 0.0001). People with depression sought most healthcare from pharmacists (30.1%) but reported the greatest expenditure on specialist doctors ($36 USD). CONCLUSIONS In this population-based sample from Central Nepal, we identified dose-dependent increases in healthcare utilization and OOP expenditure with increasing PHQ-9 scores. Future studies should evaluate whether provision of mental health services as an integrated component of UHC can improve overall health and reduce healthcare utilisation and expenditure, thereby alleviating financial pressures on families.
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Affiliation(s)
- Selina Rajan
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sujit D. Rathod
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Nagendra P. Luitel
- Research Department, Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Adrianna Murphy
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, London, UK
| | - Tessa Roberts
- Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, Camberwell, London, SE5 8AF UK
| | - Mark J. D. Jordans
- Research Department, Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, Camberwell, London, SE5 8AF UK
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Gu H, Kou Y, Yan Z, Ding Y, Shieh J, Sun J, Cui N, Wang Q, You H. Income related inequality and influencing factors: a study for the incidence of catastrophic health expenditure in rural China. BMC Public Health 2017; 17:727. [PMID: 28931392 PMCID: PMC5607576 DOI: 10.1186/s12889-017-4713-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 09/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Catastrophic health expenditure (CHE) puts a heavy disease burden on patients' families, aggravating income-related inequality. In an attempt to reduce the financial risks of rural families incurring CHE, China began the New Rural Cooperative Medical System (NCMS) on a trial basis in 2003 and has raised the reimbursement rates continuously since then. Based on statistical data about rural families in sample area of Jiangsu province, this study measures the incidence of CHE, analyzes socioeconomic inequality related to CHE, and explores the influences of the NCMS on the incidence of CHE. METHODS Statistical data were acquired from two surveys about rural health care, one conducted in 2009 and one conducted in 2010. In 2009, 1424 rural families were analyzed; in 2010, 1796 rural families were analyzed. An index of CHE is created to enable the evaluation of the associated financial risks. The concentration index and concentration curve are used to measure the income-related inequality involved in CHE. Multiple logistic regression is utilized to explore the factors that influence the incidence of CHE. RESULTS The incidence of CHE decreased from 13.62% in 2009 to 7.74% in 2010. The concentration index of CHE was changed from -0.298 (2009) to -0.323 (2010). Compared with rural families in which all members were covered by the NCMS, rural families in which some members were not covered by the NCMS had a lower incidence of CHE: The odds ratio is 0.65 with a 95% confidence interval of 0.43 to 1.00. For rural families in which all members were covered by the NCMS, the increase in reimbursement rates is correlated to the decline in the incidence of CHE if other influencing factors were controlled: The odds ratio is 0.48 with a 95% confidence interval of 0.36 to 0.64. CONCLUSIONS Between 2009 and 2010, the incidence rate of CHE in the sampled area decreased sharply, CHE was more concentrated among least wealthy and inequality increased during study period. As of 2010, the poorest rural families still had high risk of experiencing CHE. For rural families in which all members are covered by the NCMS, the rise in reimbursement rates reduces the probability of experiencing CHE.
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Affiliation(s)
- Hai Gu
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, 210093, China.
| | - Yun Kou
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, 210093, China
| | - Zhiwen Yan
- School of Basic Medical Sciences, Nanjing Medical University, Nanjing, 211166, China
| | - Yilei Ding
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, 210093, China.,Division of Cooperative Medical Scheme, Department of Primary Health, National Health and Family Planning Commission of People's Republic of China, Beijing, 100044, China
| | - Jusheng Shieh
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, 210093, China
| | - Jun Sun
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, 210093, China
| | - Nan Cui
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, 210093, China
| | - Qianjing Wang
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, 210093, China
| | - Hua You
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, 210093, China. .,Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
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Abstract
This study assesses the impact of children's health insurance programs on health care utilization and health care expenditures of children from 6 to 14 years old in Vietnam using four rounds of the Vietnam Household Living Standard Surveys from 2006 to 2012. We find a positive effect of both student and free health insurance programs on the number of health care visits. This positive impact tends to increase over time, and the impact of the free health insurance program is larger than the impact of the student health insurance program. Regarding out-of-pocket health expenditures per visit, we find a reducing effect on this outcome of the free health insurance program but not the student health insurance program.
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