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Hasan MZ, Ahmed S, Mehdi GG, Ahmed MW, Arifeen SE, Chowdhury ME. The effectiveness of a government-sponsored health protection scheme in reducing financial risks for the below-poverty-line population in Bangladesh. Health Policy Plan 2024; 39:281-298. [PMID: 38164712 DOI: 10.1093/heapol/czad115] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 11/09/2023] [Indexed: 01/03/2024] Open
Abstract
The Government of Bangladesh is piloting a non-contributory health protection scheme called Shasthyo Surokhsha Karmasuchi (SSK) to increase access to quality essential healthcare services for the below-poverty-line (BPL) population. This paper assesses the effect of the SSK scheme on out-of-pocket expenditure (OOPE) for healthcare, catastrophic health expenditure (CHE) and economic impoverishment of the enrolled population. A comparative cross-sectional study was conducted in Tangail District, where the SSK was implemented. From August 2019 to March 2020, a total of 2315 BPL households (HHs) (1170 intervention and 1145 comparison) that had at least one individual with inpatient care experience in the last 12 months were surveyed. A household is said to have incurred CHE if their OOPE for healthcare exceeds the total (or non-food) HH's expenditure threshold. Multiple regression analysis was performed using OOPE, incidence of CHE and impoverishment as dependent variables and SSK membership status, actual BPL status and benefits use status as the main explanatory variables. Overall, the OOPE was significantly lower (P < 0.01) in the intervention areas (Bangladeshi Taka (BDT) 23 366) compared with the comparison areas (BDT 24 757). Regression analysis revealed that the OOPE, CHE incidence at threshold of 10% of total expenditure and 40% of non-food expenditure and impoverishment were 33% (P < 0.01), 46% (P < 0.01), 42% (P < 0.01) and 30% (P < 0.01) lower, respectively, in the intervention areas than in the comparison areas. Additionally, HHs that utilized SSK benefits experienced even lower OOPE by 92% (P < 0.01), CHE incidence at 10% and 40% threshold levels by 72% (P < 0.01) and 59% (P < 0.01), respectively, and impoverishment by 27% at 10% level of significance. These findings demonstrated the significant positive effect of the SSK in reducing financial burdens associated with healthcare utilization among the enrolled HHs. This illustrates the importance of the nationwide scaling up of the scheme in Bangladesh to reduce the undue financial risk of healthcare utilization for those in poverty.
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Affiliation(s)
- Md Zahid Hasan
- Health Systems and Population Studies Division, icddr,b, Dhaka 1212, Bangladesh
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Clarendon Way, Leeds LS2 9NL, UK
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Clarendon Way, Leeds LS2 9NL, UK
| | - Sayem Ahmed
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, 90 Byres Road, Glasgow G12 8TB, UK
- Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy, Normal Site, Holyhead Road, Gwynedd, Wales LL57 2PZ, UK
| | - Gazi Golam Mehdi
- Health Systems and Population Studies Division, icddr,b, Dhaka 1212, Bangladesh
| | | | - Shams El Arifeen
- Maternal and Child Health Division, icddr,b, Dhaka 1212, Bangladesh
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Wahdi AE, Sutanto E, Setyawan A, Astrini YP, Adani N, Mardani H, Maulana N, Pattnaik A, Trihono T, Wilopo SA. National health insurance contribution to family planning program funding in Indonesia: A fund flow analysis. Gates Open Res 2024; 7:105. [PMID: 38605912 PMCID: PMC11006955 DOI: 10.12688/gatesopenres.14642.2] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 04/13/2024] Open
Abstract
Background Launched in 2014, Indonesia's national health insurance system (JKN) aimed to provide universal health coverage, including contraceptive services, to its population. We aim to evaluate the contribution of JKN to the overall spending for the family planning program in Indonesia. Methods Data from the Indonesian Demographic Health Survey, Survey on Financial Flows for Family Planning, Indonesia Motion Tracker Matrix, World Population Prospect, and Indonesian ministries' budget accountability reports were entered into the CastCost Contraceptive Projection Tool to define budgetary allocation and spending for the family planning program at the national level in 2019. Results Indonesia's family planning program in 2019 was financed mostly by the national budget (64.0%) and out-of-pocket payments (34.6%). There were three main ministries responsible for family planning financing: the National Population and Family Planning Board (BKKBN) (35.8%), the Ministry of Finance (26.2%), and the Ministry of Health (2.0%). Overall, JKN contributed less than 0.4% of the funding for family planning services in Indonesia in 2019. The majority of family planning spending was by public facilities (57.3%) as opposed to private facilities (28.6%). Conclusion JKN's contribution to funding Indonesia's family planning programs in 2019 was low and highlights a huge opportunity to expand these contributions. A coordinated effort should be conducted to identify possible opportunities to realign BKKBN and JKN roles in the family planning programs and lift barriers to accessing family planning services in public and private facilities. This includes a concerted effort to improve integration of private family planning providers into the JKN program.
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Affiliation(s)
- Amirah Ellyza Wahdi
- Department of Biostatistics, Epidemiology, and Population Health, Faculty of Medicine, Public Health & Nursing, Universitas Gadjah Mada, Sleman, Special Region of Yogyakarta, 55281, Indonesia
- Center for Reproductive Health, Universitas Gadjah Mada, Sleman, Special Region of Yogyakarta, 55281, Indonesia
| | - Edward Sutanto
- ThinkWell, Central Jakarta, Jakarta Special Capital District, 10350, Indonesia
| | - Althaf Setyawan
- Center for Reproductive Health, Universitas Gadjah Mada, Sleman, Special Region of Yogyakarta, 55281, Indonesia
| | - Yufan Putri Astrini
- Center for Reproductive Health, Universitas Gadjah Mada, Sleman, Special Region of Yogyakarta, 55281, Indonesia
| | - Nadhila Adani
- ThinkWell, Central Jakarta, Jakarta Special Capital District, 10350, Indonesia
| | - Halimah Mardani
- ThinkWell, Central Jakarta, Jakarta Special Capital District, 10350, Indonesia
| | - Nirwan Maulana
- ThinkWell, Central Jakarta, Jakarta Special Capital District, 10350, Indonesia
| | - Anooj Pattnaik
- ThinkWell, 1519 York Road, Lutherville, Maryland, 21093, USA
| | - Trihono Trihono
- ThinkWell, Central Jakarta, Jakarta Special Capital District, 10350, Indonesia
| | - Siswanto Agus Wilopo
- Department of Biostatistics, Epidemiology, and Population Health, Faculty of Medicine, Public Health & Nursing, Universitas Gadjah Mada, Sleman, Special Region of Yogyakarta, 55281, Indonesia
- Center for Reproductive Health, Universitas Gadjah Mada, Sleman, Special Region of Yogyakarta, 55281, Indonesia
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Li J, Bancroft H, Harrison KL, Fox J, Tyler AM, Arias JJ. Out-of-Pocket Expenses for Long-Term Care by Dementia Status and Residential Setting among US Older Adults. J Am Med Dir Assoc 2024; 25:47-52. [PMID: 37863109 PMCID: PMC10872450 DOI: 10.1016/j.jamda.2023.09.010] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE To examine long-term care out-of-pocket payments by dementia status and residential setting. DESIGN Compare monthly out-of-pocket long-term care expenses paid to facilities and helpers, total monthly out-of-pocket long-term expenses and as a percentage of monthly income by dementia status and residential status (community, residential facility, and nursing home). SETTING AND PARTICIPANTS US Nationwide, 2019 National Health and Aging Trends Study (NHATS) respondents aged ≥70 years. METHODS We analyzed respondent-level data from the nationally representative 2019 NHATS. Weighted descriptive statistics were calculated for long-term care payments by source and summarized by dementia status and the respondent's residential status. RESULTS Among 4505 respondents aged ≥70 years, 1750 (38.8%) had possible or probable dementia and 2755 (61.2%) had no dementia. The median monthly out-of-pocket long-term care expenses for persons with dementia was $1465 for those living in nursing homes, and $2925 for those living in other residential facilities, much higher than those with dementia living in the community ($260). Although these are similar to the median out-of-pocket payments for persons without dementia by setting, those with dementia were at greater risk of facing catastrophic out-of-pocket expenses for long-term care than those without dementia, with the 75th percentile value of out-of-pocket payment at $4566 among dementia adults living in non-nursing home residential care facilities, and $7500 for those in nursing homes, compared to $3694 and $3100 among those without dementia. At median, these expenses accounted for 100% of monthly income of respondents with dementia living in facilities. CONCLUSIONS AND IMPLICATIONS Persons with dementia living in facilities often face substantial financial burdens from high out-of-pocket long-term care expenses. Policies that provide sufficient financial assistance are needed to address long-term care-related financial burdens experienced by older adults and their families, especially for those with dementia.
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Affiliation(s)
- Jing Li
- Department of Pharmacy, The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA, USA.
| | | | - Krista L Harrison
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA; Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
| | - Julia Fox
- Department of Pharmacy, The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Ana M Tyler
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Jalayne J Arias
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
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Matsubara C, Dalaba MA, Danchaka LL, Welaga P. Situation Analysis of a New Effort of Community-Based Health Planning and Services (CHPS) for Maternal Health in Upper West Region in Rural Ghana. Int J Environ Res Public Health 2023; 20:6595. [PMID: 37623178 PMCID: PMC10454043 DOI: 10.3390/ijerph20166595] [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] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 07/23/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023]
Abstract
A free maternal health policy started in Ghana in 2008, however, health facility utilization is still low, and out-of-pocket payments (OOPPs) are putting households at risk of catastrophic expenditure. To improve this situation, some rural communities have assigned a midwife to a health post called community-based health planning and services (CHPS), where only assistant nurses are allocated. This study explored the effectiveness of the new approach in Upper West Region, Ghana. We conducted a cross-sectional study and interviewed women who gave birth in the last year. We systematically selected communities matched into four criteria: communities near CHPS (functional CHPS), communities near CHPS with a midwife (advanced CHPS), communities near a health centre, and communities without a health facility in their neighbourhood. In total, 534 women were interviewed: functional CHPS 104, advanced CHPS 131, near health centre 173, and no facility 126. About 78% of the women were 20 to 34 years old. About half of the women incurred OOPP, however, catastrophic payment (household spending > 5% of annual income) was significantly lower in advanced CHPS communities for normal delivery compared with the other three communities. The new local approach of assigning a midwife to CHPS functioned well, improving access to healthcare facilities for childbirth.
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Affiliation(s)
- Chieko Matsubara
- Bureau of International Medical Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Maxwell Ayindenaba Dalaba
- Centre for Non-Communicable Diseases Research, Institute of Health Research, University of Health and Allied Sciences, P.O. Box 31, Ho, Volta Region, Ghana;
- Navrongo Health Research Centre, P.O. Box 114, Navrongo, Upper East Region, Ghana
| | | | - Paul Welaga
- Navrongo Health Research Centre, P.O. Box 114, Navrongo, Upper East Region, Ghana
- Department of Biostatistics and Epidemiology, School of Public Health, C.K. Tedam University of Technology and Applied Sciences, P.O. Box 24, Navrongo, Upper East Region, Ghana
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Dahal PK, Rawal L, Ademi Z, Mahumud RA, Paudel G, Vandelanotte C. Estimating the Health Care Expenditure to Manage and Care for Type 2 Diabetes in Nepal: A Patient Perspective. MDM Policy Pract 2023; 8:23814683231216938. [PMID: 38107033 PMCID: PMC10725113 DOI: 10.1177/23814683231216938] [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: 07/16/2023] [Accepted: 10/05/2023] [Indexed: 12/19/2023] Open
Abstract
Background. This study aimed to estimate the health care expenditure for managing type 2 diabetes (T2D) in the community setting of Nepal. Methods. This is a baseline cross-sectional study of a heath behavior intervention that was conducted between September 2021 and February 2022 among patients with T2D (N = 481) in the Kavrepalanchok and Nuwakot districts of Nepal. Bottom-up and micro-costing approaches were used to estimate the health care costs and were stratified according to residential status and the presence of comorbid conditions. A generalized linear model with a log-link and gamma distribution was applied for modeling the continuous right-skewed costs, and 95% confidence intervals were obtained from 10,000 bootstrapping resampling techniques. Results. Over 6 months the mean health care resource cost to manage T2D was US $22.87 per patient: 61% included the direct medical cost (US $14.01), 15% included the direct nonmedical cost (US $3.43), and 24% was associated with productivity losses (US $5.44). The mean health care resource cost per patient living in an urban community (US $24.65) was about US $4.95 higher than patients living in the rural community (US $19.69). The health care costs per patient with comorbid conditions was US $22.93 and was US $22.81 for those without comorbidities. Patients living in rural areas had 16% lower health care expenses compared with their urban counterparts. Conclusion. T2D imposes a substantial financial burden on both the health care system and individuals. There is a need to establish high-value care treatment strategies for the management of T2D to reduce the high health care expenses. Highlights More than 60% of health care expenses comprise the direct medical cost, 15% direct nonmedical cost, and 24% patient productivity losses. The costs of diagnosis, hospitalization, and recommended foods were the main drivers of health care costs for managing type 2 diabetes.Health care expenses among patients living in urban communities and patients with comorbid conditions was higher compared with those in rural communities and those with without comorbidities.The results of this study are expected to help integrate diabetes care within the existing primary health care systems, thereby reducing health care expenses and improving the quality of diabetes care in Nepal.
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Affiliation(s)
- Padam Kanta Dahal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney Campus, Sydney, NSW, Australia
- Appleton Institute, Physical Activity Research Group, Central Queensland University, Queensland, Australia
| | - Lal Rawal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney Campus, Sydney, NSW, Australia
- Appleton Institute, Physical Activity Research Group, Central Queensland University, Queensland, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, NSW, Australia
| | - Zanfina Ademi
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rashidul Alam Mahumud
- NHRMC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Grish Paudel
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney Campus, Sydney, NSW, Australia
- Appleton Institute, Physical Activity Research Group, Central Queensland University, Queensland, Australia
| | - Corneel Vandelanotte
- Appleton Institute, Physical Activity Research Group, Central Queensland University, Queensland, Australia
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Ramsay ZJA, Bartlett RE, Clarke CA, Asnani MR, Knight-Madden JM, Gordon-Strachan GM. How Free Is Free Health Care? An Assessment of Universal Health Coverage Among Jamaicans with Sickle Cell Disease. Health Equity 2021; 5:210-217. [PMID: 33937607 PMCID: PMC8080932 DOI: 10.1089/heq.2021.0002] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 11/12/2022] Open
Abstract
Purpose: In an effort to transition toward universal health coverage (UHC), Jamaica abolished user fees at all public health facilities in 2008. We aimed to determine the extent of out-of-pocket payments (OPPs) and the other cost barriers to UHC among patients with sickle cell disease (SCD). Methods: Patients presenting to the Sickle Cell Unit in Kingston, Jamaica, for routine care between October 2019 and August 2020 were consecutively recruited and interviewed about their latest hospitalization within the previous 4 weeks. Parents or guardians completed the questionnaire on behalf of pediatric patients. The questionnaire included the Patient Satisfaction Questionnaire Short Form (PSQ)-18 and the health module of the Jamaica Survey of Living Conditions. Results: There were 103 patients with ages ranging from 7 months to 56 years (51.5% female, 60.2% public hospitalizations, and 54.4% pediatric). The modal income (J$6200-$11,999 per week) was similar to the minimum wage and 48.5% lived in overcrowded households. Government drug-subsidy cards were owned by 39.8%. OPPs were made by 19.4% of persons for items and tests that were unavailable at public facilities. There were no costs reported by 69.6%, who visited public pharmacies. Similarly, the cost of admission to public hospitals was free for 95.4% of subjects. Using public transportation, private hospitalization, and having more disease complications were predictive of a perception that health care is unaffordable. Conclusion: Most SCD subjects reported no expense with public hospitalizations; however, approximately one in five reported OPPs. Efforts are needed to increase the availability of subsidized items, and the use of drug-subsidy cards, to improve UHC.
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Affiliation(s)
- Zachary J A Ramsay
- Caribbean Institute for Health Research-Sickle Cell Unit, The University of the West Indies Mona Campus, Kingston, Jamaica
| | - Rachel E Bartlett
- Caribbean Institute for Health Research-Sickle Cell Unit, The University of the West Indies Mona Campus, Kingston, Jamaica
| | - Christine A Clarke
- The Department of Economics, The University of the West Indies Mona Campus, Kingston, Jamaica
| | - Monika R Asnani
- Caribbean Institute for Health Research-Sickle Cell Unit, The University of the West Indies Mona Campus, Kingston, Jamaica
| | - Jennifer M Knight-Madden
- Caribbean Institute for Health Research-Sickle Cell Unit, The University of the West Indies Mona Campus, Kingston, Jamaica
| | - Georgiana M Gordon-Strachan
- Caribbean Institute for Health Research-Sickle Cell Unit, The University of the West Indies Mona Campus, Kingston, Jamaica
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Chaleunvong K, Phoummalaysith B, Phonvixay B, Sychareun V, Durham J, Essink DR. Factors affecting knowledge of National Health Insurance Policy among out-patients in Lao PDR: an exit interview study. Glob Health Action 2021; 13:1791414. [PMID: 32741346 PMCID: PMC7480647 DOI: 10.1080/16549716.2020.1791414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Universal health coverage is target 3.8 of the Sustainable Development Goals. In many lower-middle-income countries, however, major coverage gaps exist. Those who do receive services often experience high out-of-pocket expenses. To achieve universal health coverage, Lao PDR, a lower-middle-income country in South-East Asia, is shifting from a fragmented model of health financing to a national health insurance scheme. OBJECTIVE The objective of this cross-sectional survey was to assess the knowledge of the NHI in Lao PDR among insured in- and out-patients using health services at selected public health facilities at provincial, district and health centre level in six provinces. METHODS This was a cross-sectional survey. Healthcare facilities were selected based on the rate of use of health services at the health facility and participants selected using systematic random sampling. Exit interviews were conducted with in- and out-patients of each selected health facility, using a pre-tested structured questionnaire. Descriptive statistics were generated including means (median), frequency and percentages. Poisson regression was applied to determine the factors associated with knowledge of the insurance scheme. RESULTS In total 326 participants were recruited (response rate 93%). Of these, less than two-thirds (62.3%) said they had their eligibility documents with them. Only 23.6% knew the co-payment fee at the health centre level; while 18.1% and 18.7% knew about the co-payment fee at the district and provincial healthcare level, respectively. A key determinant of accessing NHI and health services was knowledge of the scheme and its benefits. CONCLUSION This study suggests in Lao PDR, awareness about health insurance is low. More innovative demand-side strategies are needed to create awareness and understanding of the NHI and its benefits. Without an understanding of what insurance policies mean, universal health coverage cannot be achieved, even where appropriate and acceptable services are accessible.
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Affiliation(s)
- Kongmany Chaleunvong
- Institute of Research and Education Development, University of Health Sciences , Vientiane, Lao PDR
| | | | | | - Vanpahnom Sychareun
- Institute of Research and Education Development, University of Health Sciences , Vientiane, Lao PDR
| | - Jo Durham
- School of Public Health, Queensland University of Technology , Brisbane, Australia
| | - Dirk R Essink
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit , Amsterdam, Netherlands
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Gessesse A, Yitayal M, Kebede M, Amare G. Health Service Utilization Among Out-of-Pocket Payers and Fee-Wavier Users in Saesie Tsaeda-Emba District, Tigray Region, Northern Ethiopia: A Comparative Cross-Sectional Study. Risk Manag Healthc Policy 2021; 14:695-703. [PMID: 33633475 PMCID: PMC7900824 DOI: 10.2147/rmhp.s287504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/19/2020] [Accepted: 02/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background Health service utilization among out-of-pocket payers and fee-wavier users and factors associated with it in Saesie Tsaeda-Emba District, Tigray Region, Northern Ethiopia. Methods A comparative community-based cross-sectional study was conducted in Northern Ethiopia. Households with at least one person who experienced illness during the last six months were included in the study. Data were collected using a structured and interviewer-administered questionnaire. Bivariable and multivariable logistic regression analyses were used to identify factors associated with the HSU. Results In this study, 652 individuals (489 OOP payers and 163 fee waiver users) participated with overall response rate of 98%. The overall HSU among the participants was 44.3% (41.9 for OOP users and 51.5% for fee waiver users). The study revealed that educational status (AOR = 0.35; 95% CI: 0.21, 0.59), family size (AOR = 0.60; 95% CI: 0.37, 0.97) and income level (AOR = 2.09; 95% CI: 1.12, 3.90, and AOR = 4.12; 95% CI: 2.41, 7.53) were factors significantly associated with the HSU among OOP payers. The study also revealed that educational status (AOR = 0.65; 95% CI: 0.21, 0.59), family size (AOR = 0.4; 95% CI: 0.37, 0.97), income level (AOR = 1.12; 95% CI: 1.21, 4.87), and payment mechanism (AOR = 2.21; 95% CI = 1.34, 4.67 were significantly associated with the HSU among all study participants. Conclusion This study shows that the level of the HSU is low. Educational status, family size, economic status, and payment mechanism were significantly associated with the HSU. Therefore, improving the community’s educational level, promoting family planning, devising income-generating strategies, and strengthening the fee waiver mechanism may enhance the HSU.
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Affiliation(s)
| | - Mezgebu Yitayal
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mihiretu Kebede
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.,Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - Getasew Amare
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Desai R, Dietrich EA, Park H, Smith SM. Out-of-Pocket Payment for Ambulatory Blood Pressure Monitoring Among Commercially Insured in the United States. Am J Hypertens 2020; 33:999-1002. [PMID: 32930343 DOI: 10.1093/ajh/hpaa120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/07/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Clinical guidelines increasingly recommended ambulatory blood pressure monitoring (ABPM) for hypertension diagnosis and management. Yet, ABPM is used infrequently in the United States, possibly because of low insurance coverage and high patient costs. We sought to analyze out-of-pocket payments (OPPs) for ABPM among privately insured patients. METHODS We conducted a retrospective analysis using IBM® MarketScan® commercial claims of beneficiaries aged ≥18 years receiving ABPM from January 2012 to December 2018. The date of first ABPM claim (Healthcare Common Procedure Coding System codes 93784, 93786, 93788, or 93790) was considered the index date. Patients with 12 months of continuous enrollment preindex and 30-day postindex were included. Per beneficiary OPP was calculated by aggregating all ABPM-related OPPs within the 30-day postindex window (ABPM episode). RESULTS Of 22,317 beneficiaries receiving ABPM, 62% had $0 OPP and 38% had OPP >$0. Among the latter, median OPP per beneficiary for an ABPM episode was $23 (interquartile range [IQR], $14, $32), driven primarily by full ABPM claims (median, $22; IQR, $14, $24). Among individual components, scan analysis and report claims (median, $25; IQR, $13, $49) had the greatest OPP. The median OPP per ABPM episode did not change substantively from 2012 through 2018. CONCLUSIONS Among commercially insured in the United States, nearly 4-in-10 have an OPP for ABPM. Though most OPPs are relatively modest, some patients incur substantial OPP. Our findings highlight the need for policymakers to ensure adequate ABPM coverage in the commercial insurance marketplace.
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Affiliation(s)
- Raj Desai
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Eric A Dietrich
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- Division of General Internal Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Haesuk Park
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Steven M Smith
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida, USA
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El Ibrahimi S, Hallvik S, Johnston K, Leichtling G, Choo E, Hartung DM. A comparison of trends in opioid dispensing patterns between Medicaid pharmacy claims and prescription drug monitoring program data. Pharmacoepidemiol Drug Saf 2020; 29:1168-1174. [PMID: 32939909 DOI: 10.1002/pds.5097] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/29/2020] [Accepted: 07/19/2020] [Indexed: 11/06/2022]
Abstract
PURPOSE Public and private payers have implemented benefit limitations to reduce high-risk opioid prescriptions. The effect of these policies on the increase of out-pocket payment is unclear. To understand this gap, we compared the discrepancies in trends between opioid prescription fills vs claims among Medicaid beneficiaries. METHODS Data from the Oregon Prescription Drug Monitoring Program (PDMP) and Oregon Medicaid administrative claims were used to identify Medicaid beneficiaries 18 years and older enrolled at least one full month from 2015 to 2017. Generalized linear models assessed the trends in the monthly rates of opioid PDMP prescription fills and pharmacy claims per 1000 eligible members. Rates by morphine equivalent dose (MED) tier (<50, 50-89, 90-120, >120 MED) and co-prescribed opioid and benzodiazepine were also assessed. RESULTS During the study period, an average of 495 355 Medicaid members had 2 797 054 opioid PDMP fills and 2 472 155 opioid Medicaid pharmacy claims. Study participants had 15.4 (95% confidence interval [CI] 13.6 to 17.0; P < .001) more prescriptions per 1000 member per month in the PDMP data (114.1 [SD 7.4]) compared with the Medicaid claims data (98.7 [SD 7.9]). Similarly, there were 1.9 more co-occurring opioid/benzodiazepine prescriptions per 1000 members per month observed in the PDMP data than the Medicaid claims data (95% CI 1.7 to 2.1; P < .001). At each MED tier, the PDMP fills were consistently higher than the claims (P < .001). CONCLUSIONS Higher rate of fills in the PDMP compared to pharmacy claims suggests that there may be an increasing trend of out-of-pocket payment among Medicaid beneficiaries.
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Affiliation(s)
- Sanae El Ibrahimi
- Department of Research and Evaluation, Comagine Health, Portland, Oregon.,Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, Nevada
| | - Sara Hallvik
- Department of Research and Evaluation, Comagine Health, Portland, Oregon
| | - Kirbee Johnston
- College of Pharmacy, Oregon State University, Corvallis, Oregon
| | - Gillian Leichtling
- Department of Research and Evaluation, Comagine Health, Portland, Oregon
| | - Esther Choo
- Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Portland, Oregon
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11
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Zhang D, Rahman KMA. Government health expenditure, out-of-pocket payment and social inequality: A cross-national analysis of China and OECD countries. Int J Health Plann Manage 2020; 35:1111-1126. [PMID: 32725673 DOI: 10.1002/hpm.3017] [Citation(s) in RCA: 4] [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] [Received: 07/05/2019] [Revised: 04/05/2020] [Accepted: 06/05/2020] [Indexed: 12/29/2022] Open
Abstract
This study aims to assess the association between Chinese out-of-pocket payments and government health spending, investigating their variation ratio in the context of OECD countries. Aggregated time-series data of 37 countries (from China and official OECD members) were collected from the World Bank Open Data source and analyzed using the multiple linear regression models. Benchmarking approach was applied to evaluate the causes of healthcare expenditure rise per capita. The results showed that China's government health expenditure was positively associated with out-of-pocket payment rise, with a higher variation score of 42.70%. The association was statistically significant at 5%. Likewise, the association between government expenditure and out-of-pocket payment in the OECD countries was positively significant at 1%, and their variation score was 2.41%. Health financing in OECD countries showed higher stability and equity than that in China. Policy implications for China is to reduce the distributional disparity of government health funds by tax adjustments in health services, universal health coverage, the removal of social health insurance disparities, and a single health payment method.
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Affiliation(s)
- Dunfu Zhang
- School of Sociology and Political Science, Shanghai University, Shanghai, China
| | - K M Atikur Rahman
- School of Sociology and Political Science, Shanghai University, Shanghai, China
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12
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Chaleunvong K, Phoummalaysith B, Phonvixay B, Vonglokham M, Sychareun V, Durham J, Essink D. Factors associated with patient payments exceeding National Health Insurance fees and out-of-pocket payments in Lao PDR. Glob Health Action 2020; 13:1791411. [PMID: 32741345 PMCID: PMC7480633 DOI: 10.1080/16549716.2020.1791411] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 06/09/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Attaining universal health coverage is a target in the Sustainable Development Goals. In Lao PDR, to achieve universal health coverage, the government is implementing a national insurance scheme, initially targeting the informal sector. OBJECTIVE The purpose was to assess: i) the percentage of NHI patients who paid above the scheduled amount, based on individual billing payment; and ii) the factors related to overpayment. METHODS Descriptive cross-sectional study based on a structured questionnaire administered at health facilities in face-to-face interviews with 1,850 patients in six provinces. RESULTS All 1,850 participants worked in the informal sector. Of these, 78.8% of respondents (77.9% of in-patients; 79.5% of out-patients) made co-payments or were exempted from. Factors associated with in-patients paying above the scheduled fee were living in the province and district (OR = 2.8; 95%CI 1.2 to 6.3); not having documents with them (OR = 21.2; 95%CI 5.6 to 80.3); or not having documents (OR: 7.8; 95% CI 2.1 to 28.6). Significant factors associated with additional costs for out-patients were level of facility used at the provincial hospital (OR:1.4; 95% CI 1.1 to 1.9); older age (OR = 2.2; 95%CI 1.5 to 3.1); living in the province and district (OR = 2.3; 95%CI 1.5 to 3.7); living more than 5 km from the facility (OR = 1.4; 95%CI 1.1 to 1.9); buying medicine or supplies outside of the health facility (OR: 5.6; 95% CI 3.1 to 10.2); not bringing documents (OR:9.1; 95% CI 6.1 to 13.5), not having the right documents (OR: 8.9; 95% CI 5.4 to 14.8). CONCLUSIONS A number of patients paid above scheduled fee rates, which may deter people from utilising services when needing them. There is a need for increased understanding of the benefits of the national insurance scheme among patients and healthcare staff.
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Affiliation(s)
- Kongmany Chaleunvong
- Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao PDR
| | - Bounfeng Phoummalaysith
- Director General of the Lao National Health Insurance, Ministry of Health, Vientiane, Lao PDR
| | - Bouaphat Phonvixay
- Vice Director General of the Lao National Health Insurance, Ministry of Health, Vientiane, Lao PDR
| | | | | | - Jo Durham
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove QLD, Australia
| | - Dirk Essink
- Athena Institute, Faculty Science, VU University Amsterdam, Amsterdam, Netherlands
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13
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Chowdhury AS, Ahmed MS, Ahmed S, Khanam F, Farjana F, Reza S, Islam S, Islam A, Khan JAM, Rahman M. Estimating Catastrophic Costs due to Pulmonary Tuberculosis in Bangladesh. J Epidemiol Glob Health 2020; 11:83-91. [PMID: 32959604 PMCID: PMC7958273 DOI: 10.2991/jegh.k.200530.001] [Citation(s) in RCA: 4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 05/13/2020] [Indexed: 11/24/2022] Open
Abstract
To eliminate TB from the country by the year 2030, the Bangladesh National Tuberculosis (TB) Program is providing free treatment to the TB patients since 1993. However, the patients are still to make Out-of-their Pocket (OOP) payment, particularly before their enrollment Directly Observed Treatment Short-course (DOTS). This places a significant economic burden on poor-households. We, therefore, aimed to estimate the Catastrophic Health Expenditure (CHE) due to TB as well as understand associated difficulties faced by the families when a productive family member age (15–55) suffers from TB. The majority of the OOP expenditures occur before enrolling in. We conducted a cross-sectional study using multistage sampling in the areas of Bangladesh where Building Resources Across Communities (BRAC) provided TB treatment during June 2016. In total, 900 new TB patients, aged 15–55 years, were randomly selected from a list collected from BRAC program. CHE was defined as the OOP payments that exceeded 10% of total consumption expenditure of the family and 40% of total non-food expenditure/capacity-to-pay. Regular and Bayesian simulation techniques with 10,000 replications of re-sampling with replacement were used to examine robustness of the study findings. We also used linear regression and logit model to identify the drivers of OOP payments and CHE, respectively. The average total cost-of-illness per patient was 124 US$, of which 68% was indirect cost. The average CHE was 4.3% of the total consumption and 3.1% of non-food expenditure among the surveyed households. The poorest quintile of the households experienced higher CHE than their richest counterpart, 5% vs. 1%. Multiple regression model showed that the risk of CHE increased among male patients with smear-negative TB and delayed enrolling in the DOTS. Findings suggested that specific groups are more vulnerable to CHE who needs to be brought under innovative safety-net schemes.
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Affiliation(s)
| | - Md Shakil Ahmed
- BRAC Institute of Governance and Development, BRAC University, Dhaka, Bangladesh
| | - Sayem Ahmed
- icddr,b, Dhaka, Bangladesh.,Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
| | - Fouzia Khanam
- BRAC Research and Evaluation Division, BRAC Centre, Dhaka, Bangladesh
| | - Fariha Farjana
- Economics Discipline Khulna University, Khulna-9208, Bangladesh
| | - Saifur Reza
- BRAC Tuberculosis Control Programme, BRAC Centre, Dhaka 1212, Bangladesh
| | - Shayla Islam
- BRAC Tuberculosis Control Programme, BRAC Centre, Dhaka 1212, Bangladesh
| | - Akramul Islam
- BRAC Tuberculosis Control Programme, BRAC Centre, Dhaka 1212, Bangladesh
| | - Jahangir A M Khan
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden.,Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Mahfuzar Rahman
- BRAC Research and Evaluation Division, BRAC Centre, Dhaka, Bangladesh.,Centre for Injury Prevention, Health Development and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
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14
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Tak CR, Kim J, Gunning K, Sherwin CM, Nickman NA, Biskupiak JE. Cost-Sharing Requirements for the Herpes Zoster Vaccine in Adults Aged 60. J Pharm Technol 2019; 35:258-269. [PMID: 34752508 PMCID: PMC6726872 DOI: 10.1177/8755122519860074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Rates of zoster vaccination in US adults aged 60+ were approximately 30.6% in 2015. Out-of-pocket cost-sharing has been identified as a major barrier to vaccination for patients. To date, herpes zoster vaccine cost-sharing requirements for adults aged 60 to 64 has not been described. Objective: Compare the cost-sharing requirements for zoster vaccination in adults aged 60 to 64 and adults aged 65+. Methods: A retrospective cohort design examined pharmacy claims for zoster vaccination from the Utah All Payer Claims Database for adults aged 60+. Descriptive statistics and a 2-part cost model compared cost-sharing requirements for adults aged 60 to 64 and adults 65+. Results: Of the 30 293 zoster vaccine claims, 13 398 (45.8%) had no cost-sharing, 1716 (5.9%) had low cost-sharing (defined as $1 to less than $30), and 14 133 (48.3%) had high cost-sharing (defined as $30 or more). In the cost models, adults aged 65+ had higher odds of any cost-sharing (odds ratio = 39.86) and 29% higher cost-sharing as compared with adults aged 60 to 64. Conclusions: Adults aged 60 to 64 encounter lower cost-sharing requirements than adults aged 65+. Providers should be cognizant of this dynamic and encourage zoster vaccination prior to the age of 65.
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Affiliation(s)
- Casey R Tak
- University of North Carolina at Chapel Hill, NC, USA.,UNC Health Sciences at MAHEC, Asheville, NC, USA
| | | | | | - Catherine M Sherwin
- Wright State University, Dayton, OH, USA.,Dayton Children's Hospital, Dayton, OH, USA
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15
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Matsubara C, Nguyen TA, Murakami H. Exploring affordability and healthcare-seeking behaviour for delivery and antenatal care among the poor and ethnic minorities in rural Northwestern Viet Nam. Glob Health Action 2019; 12:1556573. [PMID: 31154990 PMCID: PMC6338261 DOI: 10.1080/16549716.2018.1556573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/26/2022] Open
Abstract
Background: Health insurance (HI) has been introduced to achieve universal health coverage. In Viet Nam, mandatory HI for the poor and the minorities has been strengthened since 2012. Objective: The study explored affordability and healthcare-seeking behaviour for delivery and antenatal care (ANC) among the poor and ethnic minority women after HI-reform in rural Northwestern Viet Nam. Methods: A cross-sectional study was conducted in 2014 in Luong Son District, where the ethnic Muong live. Stratified simple random sampling was used to select 315 participants who had delivered a baby in the previous year. Results: The HI coverage was 72.7% (229/315) and 30.9% of the mothers were living on less than USD 1.25 per household person per day. HI enrolment was predicted by ethnic minority status (Muong, aOR 18.3, 95% CI 6.4–52.6), rather than the household income. More than 80% of majority and minority respondents selected the institution by their trust in the quality of its care. The institutional delivery was 100%, irrespective of HI status. The out-of-pocket expenses for normal delivery were significantly smaller for the insured than the uninsured (p < 0.001). The total cost of normal delivery proved to be a catastrophic payment (households spending > 5% of annual household income) for 17.6% and 31.7% of the insured and uninsured, respectively. The average number of ANC visits was more than four times for all quartiles, irrespective of the mothers’ HI status; however, all quartiles demonstrated more frequent visits to private clinics than commune health centres (public facility). Conclusions: The results indicated that Vietnamese HI reform reduced the economic burden for both the poor and ethnic minorities in rural villages. However, further HI reforms should consider ways to reduce the catastrophic payments, fix the role of private facilities for appropriate resource mobilisation, and enhance the move towards universal health coverage.
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Affiliation(s)
- Chieko Matsubara
- a Bureau of International Medical Cooperation , National Center for Global Health and Medicine , Tokyo , Japan
| | - Tai Anh Nguyen
- b Center for Community Development Aid , Hoa Binh , Hoa Binh province , Viet Nam
| | - Hitoshi Murakami
- a Bureau of International Medical Cooperation , National Center for Global Health and Medicine , Tokyo , Japan
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16
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Getachew B, Liabsuetrakul T. Health care expenditure for delivery care between maternity waiting home users and nonusers in Ethiopia. Int J Health Plann Manage 2019; 34:e1334-e1345. [PMID: 30924204 DOI: 10.1002/hpm.2782] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To compare the health care expenditures between maternity waiting home (MWH) users and nonusers in Ethiopia. METHODS A cross-sectional study was done in Ethiopia between December 2017 and June 2018. The study setting included eight health facilities in the Gurage zone of Ethiopia. Health expenditure for delivery care was the outcome variable that was then classified into out-of-pocket (OOP) payments, women's costs, total costs, and overall costs. Those health expenditures were then compared among MWH users and nonusers. OOP payments were further analyzed using quantile regression to explore associated factors. RESULTS A total of 812 postpartum women were included in this study of whom half were MWH users. Significantly higher OOP payment, women's costs, total costs, and overall cost were found among MWH users compared with nonusers regardless of duration of MWH stay. The MWH users were more likely to have higher OOP payment compared with MWH nonusers in linear and quantile regressions for both unadjusted and adjusted analyses. Higher OOP payments were observed for longer distance traveled and cesarean section (CS) delivery women at the 75th and 90th quantiles of expenditure. Using public transportation was significantly associated with higher OOP payment in all quantile levels. CONCLUSION Utilization of MWH incurred higher OOP payments, total costs, women's costs, and overall costs compared with MWH nonusers. Higher OOP payments for delivery care among MWH users were observed in all quantiles of expenditure.
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Affiliation(s)
- Biniam Getachew
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Tippawan Liabsuetrakul
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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17
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Bhandari NR, Li C. Impact of The Affordable Care Act's Elimination of Cost-Sharing on the Guideline-Concordant Utilization of Cancer Preventive Screenings in the United States Using Medical Expenditure Panel Survey. Healthcare (Basel) 2019; 7:E36. [PMID: 30832276 DOI: 10.3390/healthcare7010036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/30/2019] [Accepted: 02/26/2019] [Indexed: 12/21/2022] Open
Abstract
Currently available evidence regarding the association of the Affordable Care Act’s (ACA) elimination of cost-sharing and the utilization of cancer screenings is mixed. We determined whether the ACA’s zero cost-sharing policy affected the guideline-concordant utilization of cancer screenings, comparing adults (≥21 years) from 2009 with 2011–2014 data from the Medical Expenditure Panel Survey. Study participants were categorized as: 21–64 years with any private insurance, ≥65 years with Medicare only, and 21–64 years uninsured, with a separate sample for each type of screening test. Adjusted weighted prevalence and prevalence ratios (PR (95%CI)) were estimated. In 2014 (vs. 2009), privately-insured women reported 2% (0.98 (0.97–0.99)) and 4% (0.96 (0.93–0.99)) reduction in use of Pap tests and mammography, respectively. Privately-insured non-Hispanic Asian women had 16% (0.84 (0.74–0.97)) reduction in mammography in 2014 (vs. 2009). In 2011 (vs. 2009), privately-insured and Medicare-only men reported 9% (1.09 (1.03–1.16)) and 13% (1.13 (1.02–1.25)) increases in colorectal cancer (CRC) screenings, respectively. Privately-insured women reported a 6–7% rise in 2013–2014 (vs. 2009), and Hispanic Medicare beneficiaries also reported 40–44%, a significant rise in 2011–2014 (vs. 2009), in the utilization of CRC screenings. While the guideline-concordant utilization of Pap tests and mammography declined in the post-ACA period, the elimination of cost-sharing appeared to have positively affected CRC screenings of privately-insured males, females, and Hispanic Medicare-only beneficiaries. Greater awareness about the zero cost-sharing policy may help in increasing the uptake of cancer screenings.
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18
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Myint ANM, Liabsuetrakul T, Htay TT, Wai MM, Sundby J, Bjertness E. Impoverishment and catastrophic expenditures due to out-of-pocket payments for antenatal and delivery care in Yangon Region, Myanmar: a cross-sectional study. BMJ Open 2018; 8:e022380. [PMID: 30478109 PMCID: PMC6254407 DOI: 10.1136/bmjopen-2018-022380] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES (1) To assess the levels of impoverishment and catastrophic expenditure due to out-of-pocket (OOP) payments for antenatal care (ANC) and delivery care in Yangon Region, Myanmar; and (2) to explore the determinants of impoverishment and catastrophic expenditure. DESIGN, SETTING AND PARTICIPANTS A community-based cross-sectional survey among women giving birth within the past 12 months in Yangon, Myanmar, was conducted during October to November 2016 using three-stage cluster sampling procedure. OUTCOME MEASURES Poverty headcount ratio, normalised poverty gap and catastrophic expenditure incidence due to OOP payments in the utilisation of ANC and delivery care as well as the determinants of impoverishment and catastrophic expenditure. RESULTS Of 759 women, OOP payments were made by 75% of the women for ANC and 99.6% for delivery care. The poverty headcount ratios after payments increased to 4.3% among women using the ANC services, to 1.3% among those using delivery care and to 6.1% among those using both ANC and delivery care. The incidences of catastrophic expenditure after payments were found to be 12% for ANC, 9.1% for delivery care and 20.9% for both ANC and delivery care. The determinants of impoverishment and catastrophic expenditure were women's occupation, number of household members, number of ANC visits and utilisation of skilled health personnel and health facilities. The associations of the outcomes with these variables bear both negative and positive signs. CONCLUSIONS OOP payments for all ANC and delivery care services are a challenge to women, as one of fifteen women become impoverished and a further one-fifth incur catastrophic expenditures after visiting facilities that offer these services.
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Affiliation(s)
- Aye Nyein Moe Myint
- International Relations Division, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | | | - Thein Thein Htay
- Department of Community and Global Health, University of Oslo, Norway
| | - Myint Myint Wai
- Department of Medical Services (Planning), Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Johanne Sundby
- Department of Community and Global Health, University of Oslo, Norway
| | - Espen Bjertness
- Department of Community and Global Health, University of Oslo, Norway
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19
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Dyer SJ, Vinoos L, Ataguba JE. Poor recovery of households from out-of-pocket payment for assisted reproductive technology. Hum Reprod 2018; 32:2431-2436. [PMID: 29069451 DOI: 10.1093/humrep/dex315] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/27/2017] [Indexed: 01/15/2023] Open
Abstract
STUDY QUESTION How do households recover financially from direct out-of-pocket payment for government subsidized ART? SUMMARY ANSWER After a mean of 3.8 years, there was poor recovery from initiated financial coping strategies with the poorest households being disproportionatley affected. WHAT IS KNOWN ALREADY Out-of-pocket payment for health services can create financial burdens for households and inequities in access to care. A previous study conducted at a public-academic institution in South Africa documented that patient co-payment for one cycle of ART resulted in catastrophic expenditure for one in five households, and more frequently among the poorest, requiring diverse financial coping strategies to offset costs. STUDY DESIGN, SIZE, DURATION An observational follow-up study was conducted ~4 years later to assess financial recovery among the 135 couples who had participated in this previous study. Data were collected over 12 months from 73 informants. PARTICIPANTS/MATERIALS, SETTING, METHOD The study was conducted at a level three referral hospital in the public-academic health sector of South Africa. At this institution ART is subsidized but requires patient co-payments. A purpose-built questionnaire capturing socio-economic information and recovery from financial coping strategies which had been activated was administered to all informants. Financial recovery was defined as the resolution of strategies initiated for the specific purpose of covering the original ART cycle. Results were analysed by strategy and household with the latter including analysis by tertiles based on socio-economic status at the time of the original expenditure. In addition to descriptive statistics, the Pearson Chi squared test was used to determine differences between socioeconomic tertiles and associations between recovery and other variables. MAIN RESULTS AND THE ROLE OF CHANCE The participation rate in this follow-up study was 54.1% with equal representation from the three socio-economic tertiles. The average duration of follow-up was 46.1 months (±9.78 SD) and respondents' mean age was 42 years (range 31-52). The recovery rate was below 50% for four of five strategies evaluated: 23.1% of households had re-purchased a sold asset; 23.5% had normalized a previous reduction in household spending, 33.8% had regained their savings, and 48.7% were no longer bolstering income through additional work. Two-thirds of households (60.0%) had repaid all loans and debts. The poorest households showed lower rates of recovery when compared to households in the richest tertile. Complete recovery from all strategies initiated was reported by only 10 households (13.7%): 1 of 19 in the lowest tertile, 3 of 30 in the middle and by 6 of 24 households in the richest tertile (P > 0.05). No association was found between the degree of financial recovery and additional cost burdens incurred, including related to babies born; or between the degree of recovery and ongoing pursuit of ART. LIMITATIONS, REASONS FOR CAUTION The sample size was limited. The participation rate was just over 50%. Results were dependent on participants' narrative and recall. WIDER IMPLICATIONS OF THE FINDINGS The willingness of patients to pay for ART does not necessarily imply the ability to pay. As a result, the lack of comprehensive third-party funding for ART can create immediate and long-term financial hardship which is more pronounced among poorer households. While more data on the impact of out-of-pocket payment for ART are needed to illustrate the problem in other low resource settings, the results from South Africa provide useful information for similar developing countries. The current absence of more extensive data should therefore not be a barrier to the promotion of financial risk protection for infertile couples, especially the poorest, in need of ART. STUDY FUNDING/COMPETING INTEREST(S) The study was supported by a Masters Student Grant from the Faculty of Health Sciences, University of Cape Town. The authors had no competing interests. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Silke J Dyer
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Main Road, Observatory 7925, Cape Town, South Africa
| | - Latiefa Vinoos
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Main Road, Observatory 7925, Cape Town, South Africa
| | - John E Ataguba
- Health Economics Unit, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa
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20
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Sabatino SA, Thompson TD, Miller JW, Breen N, White MC, Breslau E, Shoemaker ML. Prevalence of Out-Of-Pocket Payments for Mammography Screening Among Recently Screened Women. J Womens Health (Larchmt) 2018; 28:910-918. [PMID: 30265611 DOI: 10.1089/jwh.2018.6973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Because cost may be a barrier to receiving mammography screening, cost sharing for "in-network" screening mammograms was eliminated in many insurance plans with implementation of the Affordable Care Act. We examined prevalence of out-of-pocket payments for screening mammography after elimination in many plans. Materials and Methods: Using 2015 National Health Interview Survey data, we examined whether women aged 50-74 years who had screening mammography within the previous year (n = 3,278) reported paying any cost for mammograms. Logistic regression models stratified by age (50-64 and 65-74 years) examined out-of-pocket payment by demographics and insurance (ages 50-64 years: private, Medicaid, other, and uninsured; ages 65-74 years: private ± Medicare, Medicare+Medicaid, Medicare Advantage, Medicare only, and other). Results: Of women aged 50-64 years, 23.5% reported payment, including 39.1% of uninsured women. Compared with that of privately insured women, payment was less likely for women with Medicaid (adjusted OR 0.17 [95% CI 0.07-0.41]) or other insurance (0.49 [0.25-0.96]) and more likely for uninsured women (1.99 [0.99-4.02]) (p < 0.001 across groups). For women aged 65-74 years, 11.9% reported payment, including 22.5% of Medicare-only beneficiaries. Compared with private ± Medicare beneficiaries, payment was less likely for Medicare+Medicaid beneficiaries (adjusted OR 0.21 [95% CI 0.06-0.73]) and more likely for Medicare-only beneficiaries (1.83 [1.01-3.32]) (p = 0.005 across groups). Conclusions: Although most women reported no payment for their most recent screening mammogram in 2015, some payment was reported by >20% of women aged 50-64 years or aged 65-74 years with Medicare only, and by almost 40% of uninsured women aged 50-64 years. Efforts are needed to understand why many women in some groups report paying out of pocket for mammograms and whether this impacts screening use.
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Affiliation(s)
- Susan A Sabatino
- 1Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Trevor D Thompson
- 1Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jacqueline W Miller
- 1Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nancy Breen
- 2National Institute on Minority Health and Health Disparities, Bethesda, Maryland
| | - Mary C White
- 1Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Erica Breslau
- 3Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Meredith L Shoemaker
- 1Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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Abstract
The purpose of this study was to disclose the psychological meaning structure of dentistry as a free market within the context of leading Swedish policymaking. Following the criteria for the descriptive phenomenological psychological method data was collected from leading policy makers about the experiential aspects of dentistry as a free market within the context of a welfare state. The analysis showed that dentistry as a free market was experienced as a complex business relationship between buyers and sellers that transcended the traditional dentist and patient roles. The lived experience of the proposed business transaction was based on two inherently conflicting views: the belief in the individual’s ability to make a free choice versus the understanding that all individuals in a society do not have the ability or the means necessary to make a free choice. Dentistry as a free market within a welfare state, such as Sweden, can thus be seen as a persistent attempt to hold on to a compromise between two very distinctive political ideologies.
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Affiliation(s)
- Bengt Franzon
- a Faculty of Odontology, Department of Oral Diagnostics , Malmö University , Malmö , Sweden
| | | | - Björn Axtelius
- a Faculty of Odontology, Department of Oral Diagnostics , Malmö University , Malmö , Sweden
| | - Björn Klinge
- c Department of Odontology, Division of Oral Diseases, Karolinkska Institutet, Faculty of Odontology, Department of Periodontology , Malmö University , Malmö , Sweden
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Jung Y, Byeon J, Chung H. Prescription Drug Use Among Adults With Chronic Conditions in South Korea: Dual Burden of Health Care Needs and Socioeconomic Vulnerability. Asia Pac J Public Health 2015; 28:39-50. [PMID: 26512028 DOI: 10.1177/1010539515612906] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study is to identify the social determinants of prescription drug use among adults with chronic diseases by examining the associations between socioeconomic position and prescription medicine use and perceived burden for pharmaceutical expenditure, using a sample of the Korean population from the 2008 Korea Health Panel, with 4 analytic models. Controlled with health status and the type of health insurance, the probability of using prescription drugs and overall spending on drugs significantly increased with rising income level, while perceived burden for out-of-pocket payment significantly decreased. These results imply that the poor are likely to underuse prescription drugs compared with their wealthier counterparts with the same need for health care, probably due to economic barriers.
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Affiliation(s)
- Youn Jung
- Institute of Health & Environment, Seoul National University, Seoul, Republic of Korea
| | - Jinok Byeon
- Health Insurance Policy Research Institute, National Health Insurance Service, Seoul, Republic of Korea
| | - Haejoo Chung
- Department of Public Health Sciences, Graduate School, Korea University, Seoul, Republic of Korea School of Health Policy & Management, College of Health Science, Korea University, Seoul, Republic of Korea
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Marzban S, Rajaee R, Gholami S, Keykale MS, Najafi M. Study of Out-of-Pocket Expenditures for Outpatient Imaging Services in Imam-Khomeini Hospital in 2014. Electron Physician 2015; 7:1183-9. [PMID: 26396732 PMCID: PMC4578538 DOI: 10.14661/2015.1183-1189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 06/28/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Direct out-of-pocket (OOP) payment is the most inequitable way to pay for healthcare services, and this trend exposes patients and their families to backbreaking financial risks. The aim of this study was to estimate the out-of-pocket expenditures for outpatient imaging services in Imam-Khomeini Hospital in Tehran. METHODS This cross-sectional study was conducted in 2014 on 100 users of outpatient imaging services (radiology, ultrasonography, CT-scan, and MRI) in Imam-Khomeini Hospital in Tehran. Structured interviews and the analysis of related documents were used to acquire the pertinent data. The percentage of out-of-pocket expenditures was obtained by dividing the out-of-pocket expenditures by the total expenditures paid to the service provider, i.e., the sum of out-of-pocket expenditures and insurance payments. To analyze the data, we used descriptive-analytic statistics, distribution indices, the t-test, and the Pearson product-moment correlation coefficient. RESULTS Health insurance covered 84% of costs incurred by users of outpatient imaging services. There was no significant relationship between the user's age and the amount of out-of-pocket expense (p = 0.01). The relationship between the user's gender and out-of-pocket expense was significant (p = 0.05). The average payment for males was greater than the average payment for females. The highest percentage of the total payment the users incurred was 41% for a CT-scan, and the lowest percentage the users incurred was 30% for radiology services. CONCLUSION It is suggested that expensive diagnostic tests, such as CT-scans, be prescribed according to the actual needs of patients to make the financial burden of diagnostic services reasonable for all patients.
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Affiliation(s)
- Sima Marzban
- Assistant Professor, Faculty of Health Care Management, School of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roya Rajaee
- M.Sc. of Health Care Management, School of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Alborz University of Medical Sciences, Shahid Sabzeparvar Health Center, Alborz, Iran
| | - Soheyla Gholami
- M.Sc. Student of Health Services Management, Metabolic Diseases Research Center, Qazvin University of Medical Science, Qazvin, Iran
| | - Meysam Safi Keykale
- Ph.D. of Health in Emergencies and Disasters, School of Health, Safety, and Environment, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marziye Najafi
- M.Sc. of Health Care Management, School of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Emam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Sheingold S, Nguyen NX. Impacts of generic competition and benefit management practices on spending for prescription drugs: evidence from Medicare's Part D benefit. Medicare Medicaid Res Rev 2014; 4:mmrr2014-004-01-a01. [PMID: 24918023 PMCID: PMC4049516 DOI: 10.5600/mmrr.004.01.a01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE This study estimates the effects of generic competition, increased cost-sharing, and benefit practices on utilization and spending for prescription drugs. DATA AND METHODS We examined changes in Medicare price and utilization from 2007 to 2009 of all drugs in 28 therapeutic classes. The classes accounted for 80% of Medicare Part D spending in 2009 and included the 6 protected classes and 6 classes with practically no generic competition. All variables were constructed to measure each drug relative to its class at a specific plan sponsor. RESULTS We estimated that the shift toward generic utilization had cut in half the rate of increase in the price of a prescription during 2007-2009. Specifically, the results showed that (1) rapid generic penetration had significantly held down costs per prescription, (2) copayment and other benefit practices shifted utilization to generics and favored brands, and (3) price increases were generally greater in less competitive classes of drugs. CONCLUSION In many ways, Part D was implemented at a fortuitous time; since 2006, there have been relatively few new blockbuster drugs introduced, and many existing high-volume drugs used by beneficiaries were in therapeutic classes with multiple brands and generic alternatives. Under these conditions, our paper showed that plan sponsors have been able to contain costs by encouraging use of generics or drugs offering greater value within therapeutic classes. It is less clear what will happen to future Part D costs if a number of new and effective drugs for beneficiaries enter the market with no real competitors.
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Affiliation(s)
- Steven Sheingold
- U.S. Department of Health and Human Services-Office of the Assistant Secretary for Planning and Evaluation
| | - Nguyen Xuan Nguyen
- U.S. Department of Health and Human Services-Office of the Assistant Secretary for Planning and Evaluation
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Onwujekwe O, Hanson K, Ichoku H, Uzochukwu B. Financing incidence analysis of household out-of-pocket spending for healthcare: getting more health for money in Nigeria? Int J Health Plann Manage 2013; 29:e174-85. [PMID: 23390079 DOI: 10.1002/hpm.2166] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 12/07/2012] [Accepted: 01/07/2013] [Indexed: 11/11/2022] Open
Abstract
The study examined the burden of out-of-pocket spending (OOPS) to households, because available data showed that OOPS dominates household expenditure on health in Nigeria. The study took place in rural and urban districts in Nigeria. A household questionnaire was used to collect data from 4873 households on their healthcare expenditures and payment mechanisms by using a 1-month expenditure recall period. Financing incidence analysis was assessed at the household level on the basis of socio-economic status (SES) groups and rural-urban location of the households. Concentration curves of OOPS were plotted with the Lorenz curve of total household expenditures to show the distribution of the burden of OOPS by SES compared with total household expenditure. The Kakwani index was computed to examine the overall progressivity or regressivity of OOPS. There was lack of financial risk protection for healthcare in the study area. The results showed that 3150 (98.8%) of payments were made using OOPS, nine (0.3%) using reimbursement by employers, one (0.03%) through private voluntary health insurance (PVHI), nine (0.3%) using instalment and 14 (0.44%) through 'others'. The average monthly household OOPS was 2219.1 Naira. The Kakwani index for financing incidence of OOPS was -0.18, showing that OOPS was regressive. The most-poor SES groups and rural dwellers experienced the highest burden of health expenditure. Urgent steps should be taken by the government to increase or enhance universal coverage in the country with financial protection mechanisms such as the National Health Insurance Scheme in addition to possibly abolishing some of the user fees that cause high incidence and burden of OOPS.
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Affiliation(s)
- Obinna Onwujekwe
- Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu State, Nigeria
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Tobe M, Stickley A, del Rosario RB, Shibuya K. Out-of-pocket medical expenses for inpatient care among beneficiaries of the National Health Insurance Program in the Philippines. Health Policy Plan 2012; 28:536-48. [PMID: 23048125 DOI: 10.1093/heapol/czs092] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The National Health Insurance Program (NHIP) in the Philippines is a social health insurance system partially subsidized by tax-based financing which offers benefits on a fee-for-service basis up to a fixed ceiling. This paper quantifies the extent to which beneficiaries of the NHIP incur out-of-pocket expenses for inpatient care, and examines the characteristics of beneficiaries making these payments and the hospitals in which these payments are typically made. METHODS Probit and ordinary least squares regression analyses were carried out on 94 531 insurance claims from Benguet province and Baguio city during the period 2007 to 2009. RESULTS Eighty-six per cent of claims involved an out-of-pocket payment. The median figure for out-of-pocket payments was Philippine Pesos (PHP) 3016 (US$67), with this figure varying widely [inter-quartile range (IQR): PHP 9393 (US$209)]. Thirteen per cent of claims involved very large out-of-pocket payments exceeding PHP 19 213 (US$428)-the equivalent of 10% of the average annual household income in the region. Membership type, disease severity, age and residential location of the patient, length of hospitalization, and ownership and level of the hospital were all significantly associated with making out-of-pocket payments and/or the size of these payments. CONCLUSION Although the current NHIP reduces the size of out-of-pocket payments, NHIP beneficiaries are not completely free from the risk of large out-of-pocket payments (as the size of these payments varies widely and can be extremely large), despite NHIP's attempts to mitigate this by setting different benefit ceilings based on the level of the hospital and the severity of the disease. To reduce these large out-of-pocket payments and to increase financial risk protection further, it is essential to ensure more investment for health from social health insurance and/or tax-based government funding as well as shifting the provider payment mechanism from a fee-for-service to a case-based payment method (which up until now has only been partially implemented).
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Affiliation(s)
- Makoto Tobe
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan.
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Muhammad Malik A, Azam Syed SI. Socio-economic determinants of household out-of-pocket payments on healthcare in Pakistan. Int J Equity Health 2012; 11:51. [PMID: 22947067 PMCID: PMC3478199 DOI: 10.1186/1475-9276-11-51] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 08/27/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Out-of-pocket (OOP) payment on healthcare is dominant mode of financing in developing countries. In Pakistan it is 67% of total expenditure on healthcare. Analysis of determinants of OOP health expenditure is a key aspect of equity in healthcare financing. It helps to formulate an effective health policy. Evidence on OOP in Pakistan is sparse. This paper attempts to fill this research gap. METHODS We estimated determinants of OOP payments on healthcare in Pakistan. We used data sets of Pakistan Household Integrated Economic Survey (HIES) and Pakistan Standard of Living Measurement (PSLM) Survey for the year 2004-05. We developed a multiple regression model for the determinants of OOP payments using methods of Ordinary Least Square (OLS). We mainly used social, economic, demographic and health variables in our analysis. RESULTS Median household OOP healthcare in the year 2004-05 was Pakistani Rupees (PKR) 2500 (US$ 41.99) in 2004-05. Household non-food expenditure was the single highest significant predictor of household OOP health expenditure. Household features like literate head and spouse, at least one obstetric delivery in last three years, unsafe water, unhygienic toilet and household belonging to Khyber Pukhtonkhwa (KPK) province were significant positive predictors of OOP payments. Households with male head, bricks used in housing construction, household with at least one child and no elderly, and head of household in a white collar profession were negative predictors of OOP payments. CONCLUSION Our analysis confirms earlier findings that economic status and number of old aged members are significant positive predictors of OOP payments. This association can direct government to enhance allocations to healthcare and to include program focusing on non-communicable diseases. Our findings suggest further research to explore beneficiaries of government healthcare programs and determinants of high OOP payments by household residing in KPK province than other province. The interaction between white collar profession and their economic status in predicting OOP payments is also an area for further research.
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Affiliation(s)
- Ashar Muhammad Malik
- Community Health Sciences Department, Aga Khan University, Stadium Road, Karachi, 78400, Pakistan
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Chen LC, Lee YY, Lin TH, Lee CS, Li CJ, Wu DC. How Does Out-of-Pocket Payment Affect Choices When Accessing Health Care?-A Qualitative Study on Hypertensive Outpatients in Southern Taiwan. Value Health Reg Issues 2012; 1:105-110. [PMID: 29702816 DOI: 10.1016/j.vhri.2012.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The National Health Insurance in Taiwan provides the entire population with universal coverage and full freedom to access health care, and thus results in accelerating medical utilization and costs. A differential outpatient co-payment was introduced on July 15, 2005, to deter nonessential visits and encourage initial contact in primary care and a stepwise access to health care (referral system). A previous study, however, showed a limited impact of this co-payment policy on reducing medical utilization and improving the referral system. This qualitative study aimed to explore Taiwanese patients' decision-making process to access health care and how the cost issue impacts patients' access to health care and explore patients' cost-saving strategies. METHODS Hypertensive patients from different tiers of medical facilities (community, regional hospitals, and medical centers) in the Kao-Ping area of southern Taiwan were invited to participate in focus groups from October 2008 to January 2009. RESULTS Of all, 40 participants were recruited for nine focus groups. The physicians' reputation, tiers of hospitals, and the convenience of transport and registration are the three major reasons why participants accessed different medical facilities. Participants expressed that the current out-of-pocket payment is affordable and not as important as other reasons for their choices. Continuous prescription was considered a cost-saving strategy for patients visiting higher tiers of medical facilities. Most participants were not fully aware of current National Health Insurance regulations such as co-payment, continuous prescriptions, and the referral policy. CONCLUSIONS The current out-of-pocket payment is affordable for hypertensive patients receiving regular treatments, but it fails to reduce the demand of health care. To establish a proper evaluation of the co-payment policy, future study is suggested to consider the views from health care providers and financially vulnerable patients.
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Affiliation(s)
- Li-Chia Chen
- Division for Social Research in Medicines and Health, School of Pharmacy, University of Nottingham, Nottingham, UK; Graduate Institute of Clinical Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.
| | - Yung-Ying Lee
- Graduate Institute of Clinical Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC; Department of Internal Medicine, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Chee-Siong Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC; Department of Internal Medicine, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Chuen-Jing Li
- Department of Pharmacy, Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
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Dyer S, Patel M. The economic impact of infertility on women in developing countries ‑ a systematic review. Facts Views Vis Obgyn 2012; 4:102-9. [PMID: 24753897 PMCID: PMC3987499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND It is the responsibility of health systems to provide quality health care and to protect consumers against impoverishing health costs. In the case of infertility in developing countries, quality care is often lacking and treatment costs are usually covered by patients. Additional financial hardship may be caused by various social consequences. The economic implications of infertility and its treatment have not been systematically explored. METHODS A systematic MEDLINE search was conducted to identify English language publications providing original data from developing countries on out-of-pocket payment (OoPP) for infertility treatment and on other economic consequences of involuntary childlessness. FINDINGS Twenty one publications were included in this review. Information on OoPP was scant but suggests that infertility treatment is associated with a significant risk of catastrophic expenditure, even for basic or ineffective interventions. Other economic disadvantages, which may be profound, are caused by loss of access to child labour and support, divorce, as well as customary laws or negative attitudes which discriminate against infertile individuals. Women in particular are affected. CONCLUSION Pertinent data on OoPP and other economic disadvantages of infertility in developing countries are limited. According to the evidence available, infertility may cause impoverishing health costs as well as economic instability or deprivation secondary to social consequences. Health systems in developing countries do not appear to meet their responsibilities vis-à-vis infertile patients.
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Rao KD, Bhatnagar A, Murphy A. Socio-economic inequalities in the financing of cardiovascular & diabetes inpatient treatment in India. Indian J Med Res 2011; 133:57-63. [PMID: 21321420 PMCID: PMC3100147] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND & OBJECTIVES Cardiovascular disease (CVD) and diabetes have become a leading threat to public health in India. This study examines socio-economic differences in self-reported morbidity due to CVD and diabetes, where people having these conditions seek care, how much households pay for and how they finance hospital treatment for these conditions. METHODS Data for this study are taken from the National Sample Survey Organization (NSSO) 60 th round on 'Morbidity and Health Care' conducted between January and June 2004. Information from 2,129 and 438 individuals hospitalized for CVD and diabetes was analyzed. RESULTS The self-reported prevalence among adults was 12 per cent for CVD, 4 per cent (7% urban and 3% rural) for heart disease and 6 per cent (10% in urban and 4% in rural) for diabetes. Both self-reported CVD and diabetes appeared to afflict the wealthier more. The private sector was the main provider of outpatient and inpatient care for CVD and diabetes treatment, though the poor depended more on the public sector. Out-of-pocket payments (OOPS) for hospital treatment claimed a large share of annual household expenditures; 30 per cent for CVD and 17 per cent for diabetes. The OOPS share for diabetes treatment declined with increasing income. The majority of OOPS for hospital treatment paid by the poor was financed through borrowings. INTERPRETATION & CONCLUSIONS The considerable financial strain which households, particularly the poor, face in treating CVD and diabetes is alarming. As the burden due to CVD and diabetes increases in India, more households will be subject to these financial strains and unfortunately, the economically vulnerable among them will be the worst affected. While primary prevention of these conditions need more emphasis, in addition, insurance schemes targeted at the poor like the RSBY have an important role to play in financially protecting vulnerable households.
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Affiliation(s)
- Krishna D. Rao
- Public Health Foundation of India, New Delhi, India,Reprint requests: Dr K.D. Rao, Head, Health Economics and Financing, Public Health Foundation of India, PHD House, 2nd Floor, 4/2 Sirifort Institutional Area, August Karanti Marg, New Delhi 110 016, India e-mail:
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