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Shaltynov A, Semenova Y, Abenova M, Baibussinova A, Jamedinova U, Myssayev A. An analysis of financial protection and financing incidence of out-of-pocket health expenditures in Kazakhstan from 2018 to 2021. Sci Rep 2024; 14:8869. [PMID: 38632372 PMCID: PMC11024138 DOI: 10.1038/s41598-024-59742-9] [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: 01/18/2024] [Accepted: 04/15/2024] [Indexed: 04/19/2024] Open
Abstract
Universal health coverage relies on providing essential medical services and shielding individuals from financial risks. Our study assesses the progressivity of out-of-pocket (OOP) payments, identifies factors contributing to healthcare expenditure inequality, and examines catastrophic health expenditures (CHE) prevalence in Kazakhstan from 2018 to 2021. Using retrospective analysis of National Statistics Bureau data, we employed STATA 13 version for calculations CHE incidence, progressivity, Lorenz and concentration curves. In 2020-2021, OOP expenditures in Kazakhstan decreased, reflecting a nearly twofold reduction in the CHE incidence to 1.32% and 1.24%, respectively. However, during these years, we observe a transition towards a positive trend in the Kakwani index to 0.003 and 0.005, respectively, which may be explained by household size and education level factors. Increased state financing and quarantine measures contributed to reduced OOP payments. Despite a low healthcare expenditure share in gross domestic product, Kazakhstan exhibits a relatively high private healthcare spending proportion. The low CHE incidence and proportional expenditure system suggest private payments do not significantly impact financial resilience, prompting considerations about the role of government funding and social health insurance in the financing structure.
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Affiliation(s)
- Askhat Shaltynov
- Epidemiology and Biostatistics Department, Semey Medical University, Semey, Kazakhstan.
| | - Yulia Semenova
- School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Madina Abenova
- Epidemiology and Biostatistics Department, Semey Medical University, Semey, Kazakhstan
| | - Assel Baibussinova
- Epidemiology and Biostatistics Department, Semey Medical University, Semey, Kazakhstan
| | - Ulzhan Jamedinova
- Epidemiology and Biostatistics Department, Semey Medical University, Semey, Kazakhstan
| | - Ayan Myssayev
- Department of the Science and Human Resources, Ministry of Healthcare of the Republic of Kazakhstan, Astana, Kazakhstan
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Wu KY, Cheong IS, Lai JN, Hu CY, Hung KC, Chen YT, Chiu LT, Tsai HT, Jou YC, Tzai TS, Tsai YS. Risk of secondary primary malignancies in survivors of upper tract urothelial carcinoma: A nationwide population-based analysis. Cancer Epidemiol 2024; 89:102536. [PMID: 38281454 DOI: 10.1016/j.canep.2024.102536] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND To investigate the cancer types and risk factors of secondary primary malignancy (SPM) in patients with upper tract urothelial carcinoma (UTUC) in Taiwan. METHODS Using National Health Insurance Research Dataset and catastrophic illness registry, we enrolled newly diagnosed UTUC patients from 2000 to 2013. Those without catastrophic illness registration were excluded from the study. The cancer types and hazard ratios (HRs) of subsequent SPMs were calculated according to the antecedent malignancy. We analyzed the risk factors for developing SPMs using multivariate Cox proportional hazard models. RESULTS A total of 9050 UTUC patients were registered and 2187 (24.2%) patients developed SPMs during the study period. As compared with primary UTUC, the relative risk ratios of SPM was 2.5 folds and 18% higher in those with antecedent non-UC malignancy and with bladder cancer history, respectively. Totally, 387 (37.8%) of 1022 UTUC patients with antecedent non-UC malignancy developed subsequent SPM after UTUC diagnosis. The antecedent and subsequent cancer types are similar and kidney cancer is most common, followed by hepatoma. Multivariate analysis showed that a history of antecedent non-UC malignancy is the most unfavorable factor for SPM development (HR, 2.50; 95% CI, 2.23-2.81), followed by liver disease, male gender, antecedent bladder cancer history, age ≥ 75 years, and chronic kidney disease. CONCLUSIONS Our study, conducted in Taiwan and involving 9050 UTUC patients, meticulously examined the types of SPM and the associated risk factors. Our research unearthed several pivotal discoveries: a preceding history of non-UC malignancies emerged as the single most influential factor contributing to the occurrence of subsequent cancers, followed by liver disease, male gender, antecedent bladder cancer history, age ≥75 years, and chronic kidney disease. Futhermore, kidney cancer emerged as the predominant subsequent malignancy, closely trailed by hepatoma..
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Affiliation(s)
- Kuan-Yu Wu
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Ian-Seng Cheong
- Department of Urology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi 600, Taiwan
| | - Jung-Nien Lai
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 404, Taiwan; Department of Chinese Medicine, China Medical University Hospital, Taichung 404, Taiwan
| | - Che-Yuan Hu
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, No.901, ChungHwa Road, Yung Kung Dist, Tainan 710, Taiwan; Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan 717, Taiwan
| | - Yi-Ting Chen
- Department of Anesthesiology, Chia-Yi Chang Gung Memorial Hospital, Chia-Yi 613, Taiwan
| | - Lu-Ting Chiu
- Management office for Health Data, China Medical University Hospital, Taichung 404, Taiwan
| | - Hsin-Tzu Tsai
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Yeong-Chin Jou
- Division of Urology, Department of Surgery, St Martin De Porres Hospital, Chia-Yi 600, Taiwan
| | - Tzong-Shin Tzai
- Department of Urology, An Nan Hospital, China Medical University, Tainan 709, Taiwan.
| | - Yuh-Shyan Tsai
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.
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Du X, Gu S, Wu Y, Zhao J, Liao H, Li S, Han D, Zhang M, Wang J. The association between dual sensory loss and healthcare expenditure: Mediating effect of depression. J Affect Disord 2024; 349:462-471. [PMID: 38199408 DOI: 10.1016/j.jad.2024.01.032] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 12/04/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Previous studies have suggested the dual sensory loss (DSL) is linked to depression, and that they are associated with higher healthcare expenditures, respectively. However, the association between DSL, depression and healthcare expenditures remains ambiguous. OBJECTIVES The current study aims to examine the association between DSL, depression and healthcare expenditures as well as catastrophic health expenditures (CHE) among Chinese people aged 45 and above. METHODS We first utilized the China Health and Retirement Longitudinal Survey (CHARLS) 2018 to obtain data from a total of 13,412 Chinese individuals aged 45 and above to conduct a cross-sectional study. DSL was defined as a combined variable of self-reported vision loss and hearing loss. Depression was measured using The Center for Epidemiologic Studies Depression Scale (CESD-10). The healthcare expenditures, including outpatient out-of-pocket cost and inpatient out-of-pocket cost, were obtained from the Harmonized CHARLS section. CHE were defined as out-of-pocket (OOP) health spending equal to or higher than 40 % of a household's capacity to pay. A Tobit linear regression with three models and a path analysis were conducted to estimate the association between DSL, depression and healthcare expenditures and CHE. Then we utilized 2011CHARLS and 2018CHARLS to present a longitudinal analysis. A path analysis was conducted to estimate the association between 2011DSL, 2018depression and 2018healthcare expenditures and CHE. RESULTS Depression has a significant mediating effect between DSL and healthcare expenditures. (For outpatient OOP cost: a = 0.453, b = 23.559, c = 25.257, the proportion of mediating effect in total effect = 29.71 %; for inpatient OOP cost: a = 0.453, b = 13.606, c = 15.463, the proportion of mediating effect in total effect = 28.50 %; all P < 0.05). The mediating effect of depression also exists in the association between DSL and CHE (a = 0.453, b = 0.018, c = 0.043, the proportion of mediating effect in total effect = 15.90 %; P < 0.05). The mediation effect of depression on healthcare expenditures and CHE also exists in the longitudinal analysis using CHARLS 2011 and CHARLS 2018 (all P < 0.05). LIMITATIONS The DSL status were based on self-report and we used 2018CHARLS to conduct the study, which may cause some bias. CONCLUSION Significant mediating effect of depression exists between DSL and higher healthcare expenditures and CHE. The mental health of elder people with DSL should be focused on, and we should have an overall viewpoint on the topic of healthcare expenditures and CHE.
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Affiliation(s)
- Xinnan Du
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China.
| | - Shiping Gu
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Yunyi Wu
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Jie Zhao
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China.
| | - Hui Liao
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Sangsang Li
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China.
| | - Dan Han
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China.
| | - Mei Zhang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Jing Wang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China; The Key Research Institute of Humanities and Social Science of Hubei Province, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China; Institute for Poverty Reduction and Development, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China.
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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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Li J, Gao T, Zhao D, Chai S, Luo J, Wang X, Wang X, Sun J, Li P, Zhou C. Catastrophic health expenditure and health-related quality of life among older adults in Shandong, China: the moderation effect of daily care by adult children. Int J Equity Health 2024; 23:51. [PMID: 38468257 DOI: 10.1186/s12939-023-02057-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/12/2023] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Catastrophic health expenditure (CHE) has a considerable impact on older people in later life, but little is known about the relationship between catastrophic health expenditure and health-related quality of life (HRQOL). The aim of this study was to examine the relationship between catastrophic health expenditure and health-related quality of life in older people, and to explore whether the daily care provided by adult children is a moderator in this relationship. METHODS Data from the sixth National Health Services Survey in Shandong Province, China. The sample consisted of 8599 elderly people (age ≥ 60 years; 51.7% of female). Health-related quality of life was measured by the health utility value of EQ-5D-3 L. Interaction effects were analyzed using Tobit regression models and marginal effects analysis. RESULTS The catastrophic health expenditure prevalence was 60.5% among older people in Shandong, China. catastrophic health expenditure was significantly associated with lower health-related quality of life (β= - 0.142, P < 0.001). We found that adult children providing daily care services to their parents mitigated the effect of catastrophic health expenditure on health-related quality of life among older people (β = 0.027, P = 0.040). CONCLUSIONS Our findings suggested that catastrophic health expenditure was associated with health-related quality of life and the caring role of older adult children moderated this relationship. Reducing the damage caused by catastrophic health expenditure helps to improve health-related quality of life in older people. Adult children should increase intergenerational contact, provide timely financial and emotional support to reduce the negative impact of catastrophic health expenditure on health-related quality of life.
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Affiliation(s)
- Jiayan Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China
| | - Tingting Gao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China
| | - Dan Zhao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China
| | - Shujun Chai
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China
| | - Jingjing Luo
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China
| | - Xuehong Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China
| | - Xueqing Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China
| | - Jingjie Sun
- Shandong Health Commission Medical Management Service Center, Jinan, 250012, China
| | - Peilong Li
- Shandong Health Commission Medical Management Service Center, Jinan, 250012, China
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, Shandong, 250012, China.
- Institute of Health and Elderly Care, Shandong University, Jinan, 250012, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University), Jinan, 250012, China.
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Rahman T, Gasbarro D, Alam K, Alam K. Rural‒urban disparities in household catastrophic health expenditure in Bangladesh: a multivariate decomposition analysis. Int J Equity Health 2024; 23:43. [PMID: 38413959 PMCID: PMC10898052 DOI: 10.1186/s12939-024-02125-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/08/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Rural‒urban disparity in catastrophic healthcare expenditure (CHE) is a well-documented challenge in low- and middle-income countries, including Bangladesh, limiting financial protection and hindering the achievement of the Universal Health Coverage target of the United Nations Sustainable Development Goals. However, the factors driving this divide remain poorly understood. Therefore, this study aims to identify the key determinants of the rural‒urban disparity in CHE incidence in Bangladesh and their changes over time. METHODS We used nationally representative data from the latest three rounds of the Bangladesh Household Income and Expenditure Survey (2005, 2010, and 2016). CHE incidence among households seeking healthcare was measured using the normative food, housing, and utilities method. To quantify covariate contributions to the rural‒urban CHE gap, we employed the Oaxaca-Blinder multivariate decomposition approach, adapted by Powers et al. for nonlinear response models. RESULTS CHE incidence among rural households increased persistently during the study period (2005: 24.85%, 2010: 25.74%, 2016: 27.91%) along with a significant (p-value ≤ 0.01) rural‒urban gap (2005: 9.74%-points, 2010: 13.94%-points, 2016: 12.90%-points). Despite declining over time, substantial proportions of CHE disparities (2005: 87.93%, 2010: 60.44%, 2016: 61.33%) are significantly (p-value ≤ 0.01) attributable to endowment differences between rural and urban households. The leading (three) covariate categories consistently contributing significantly (p-value ≤ 0.01) to the CHE gaps were composition disparities in the lowest consumption quintile (2005: 49.82%, 2010: 36.16%, 2016: 33.61%), highest consumption quintile (2005: 32.35%, 2010: 15.32%, 2016: 18.39%), and exclusive reliance on informal healthcare sources (2005: -36.46%, 2010: -10.17%, 2016: -12.58%). Distinctively, the presence of chronic illnesses in households emerged as a significant factor in 2016 (9.14%, p-value ≤ 0.01), superseding the contributions of composition differences in household heads with no education (4.40%, p-value ≤ 0.01) and secondary or higher education (7.44%, p-value ≤ 0.01), which were the fourth and fifth significant contributors in 2005 and 2010. CONCLUSIONS Rural‒urban differences in household economic status, educational attainment of household heads, and healthcare sources were the key contributors to the rural‒urban CHE disparity between 2005 and 2016 in Bangladesh, with chronic illness emerging as a significant factor in the latest period. Closing the rural‒urban CHE gap necessitates strategies that carefully address rural‒urban variations in the characteristics identified above.
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Affiliation(s)
- Taslima Rahman
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia.
- Institute of Health Economics, University of Dhaka, Dhaka, 1000, Bangladesh.
| | - Dominic Gasbarro
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia
| | - Khorshed Alam
- School of Business, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
| | - Khurshid Alam
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia
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Hedayati M, Maleki M, Asl IM, Fazaeli AA, Goharinezhad S. Exploring the driving forces and scenario analysis for catastrophic and impoverishing health expenditures in Iran. BMC Health Serv Res 2024; 24:245. [PMID: 38409010 PMCID: PMC10898180 DOI: 10.1186/s12913-024-10551-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 01/03/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND The extent of healthcare expenditure within households stands as a crucial indicator in low and middle-income countries (LMICs). When out-of-pocket healthcare expenses surpass household income or become unduly burdensome, it serves as a significant socio-economic alarm, resulting in a reduced quality of life, a phenomenon referred to as 'catastrophic health expenditure (CHE).' Multiple factors can contribute to the occurrence of CHE. The study's objective was to identify the key uncertainties and driving forces influencing CHE to develop scenarios in Iran on the horizon of 2030. METHODS This study was conducted between December 2021 and January 2023, data were collected through a literature review, and experts' opinions were gathered via questionnaires, interviews, and expert panels. The statistical population included experts in the fields of health policy, health economics, and futures studies. Scenario Wizard software and MICMAC analysis were employed for data analysis, providing valuable insights into potential future scenarios of health expenditures in Iran. RESULTS Based on the results of the scoping review and semi-structured interview, 65 key factors in the fields of economics, politics, technology, social, and environmental were identified. The findings of the MICMAC analysis presented 10 key variables. Finally, six main scenario spaces are depicted using Scenario Wizard. These scenarios included catastrophic cost crises, sanction relief, selective information access, technological ambiguity, induced demand management, and incremental reforms. CONCLUSIONS Each of the six drawn scenarios provides images of the future of health expenditure in Iranian households on the horizon of 2030. The worst-case scenario from all scenarios was scenario one, with the most probable and critical features to derive Iran's health expenditures. The current study is a valuable addition to the literature depicting the key drivers that all developing nations can consider to decrease exposing households to catastrophic and impoverishing health expenditures.
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Affiliation(s)
- Maryam Hedayati
- Department of Health Service Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, No. 6, Rashid Yasemi St. Vali -e Asr Ave, P.O Box: 1996713883, Tehran, Iran
| | - Mohammadreza Maleki
- Department of Health Service Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, No. 6, Rashid Yasemi St. Vali -e Asr Ave, P.O Box: 1996713883, Tehran, Iran.
| | - Iravan Masoudi Asl
- Department of Health Service Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, No. 6, Rashid Yasemi St. Vali -e Asr Ave, P.O Box: 1996713883, Tehran, Iran
| | - Ali Akbar Fazaeli
- Department of Health Management, Policy and Economics, Tehran University of Medical Sciences, Tehran, Iran
| | - Salime Goharinezhad
- Preventive Medicine and Public Health Research Center, Psychosocial Research Institute, Iran University of Medical Sciences, Tehran, Iran
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Bodhisane S, Pongpanich S. Laos' Social Health Insurance (SHI) program's impact on older people's accessibility and financial security against catastrophic health expense. BMC Health Serv Res 2023; 23:1317. [PMID: 38031065 PMCID: PMC10688000 DOI: 10.1186/s12913-023-10063-z] [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] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
Laos has introduced various SHI schemes for multiple groups of the population, such as government officials and other population groups under the NHI schemes. There is no specific health insurance policy for this group of people who need special health services and may have a higher possibility of entering financial catastrophe. This study aims to assess the impact of SHI schemes on accessibility and financial catastrophe against catastrophic health expenditures for older people in Laos. A structured questionnaire has been used to retrieve information from 400 older people across 39 villages in Kaysone Phomvihane District, Savannakhet province, the largest province in Laos. In the analytical process, this study used a cross-sectional study design and binary logistic regression models to predict the likelihood of accessing health facilities and experiencing financial catastrophe. The study outcome shows that the increase in age, occupation, number of older people within a household, and presence of chronic conditions increase the likelihood of using health services. Despite the existence of various SHI schemes, this study found that 74 out of 165 households reported using health services experienced catastrophic health expenditure. Several characteristics are associated with catastrophic health expenditure: age, income level, and gender are prone to suffer from catastrophic health expenditure. The difficult problems stem from the absence of comprehensive legislation regarding the older population. Recommendations for policymakers in various timeframes have been made, which cover short- and long-term policy proposals, including providing a specialized lane or fast-track for an older population, building health facilities exclusively for older people, and providing transportation services for older individuals living alone.
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Affiliation(s)
- Somdeth Bodhisane
- College of Public Health Sciences (CPHS), Chulalongkorn University, Bangkok, Thailand.
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Zewde IF, Kedir A, Norheim OF. Incidence and determinants of out-of-pocket health expenditure in Ethiopia 2012-16. Health Policy Plan 2023; 38:1131-1138. [PMID: 37702718 DOI: 10.1093/heapol/czad080] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 08/15/2023] [Accepted: 09/08/2023] [Indexed: 09/14/2023] Open
Abstract
This study assesses the incidence of catastrophic health expenditure (CHE) and identifies the significant factors that expose households to higher levels of out-of-pocket (OOP) health expenditure. Data from the fifth and the sixth Ethiopian National Health Accounts household surveys, which were conducted in 2012-13 and 2015-16, respectively, are used. The incidence of CHE is estimated using both the capacity-to-pay and the budget share approaches. To ensure the robustness of our findings, both unconditional and conditional quantile estimators are adopted as multivariate regression techniques to estimate the impact of socio-economic variables on the distribution of households' OOP expenditure. Our findings show that the incidence of CHE in Ethiopia ranges from 1.7% to 4.7% depending on the approach and the threshold adopted. Larger families, the unemployed, the extremely poor, those who seek care at private-owned providers and families with members affected by chronic illness face higher OOP expenditure. Hence, policy should target those with these identified socio-economic characteristics in the provision of financial risk protection such as fee waiver systems and subsidies.
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Affiliation(s)
- Israel Fekade Zewde
- Human Capital Development (HCD), Foreign, Commonwealth & Development Office, PO BOX 858, Addis Ababa, Ethiopia
| | - Abbi Kedir
- Sheffield University Management School (SUMS), University of Sheffield Conduit Road, Sheffield s10 1FL, United Kingdom
| | - Ole F Norheim
- Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, N-5020, Bergen, Norway
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Yadav J, Tripathi N, Menon GR, Nair S, Singh J, Singh R, Rao MVV. Measuring the financial impact of disabilities in India (an analysis of national sample survey data). PLoS One 2023; 18:e0292592. [PMID: 37824482 PMCID: PMC10569625 DOI: 10.1371/journal.pone.0292592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND People with disabilities are vulnerable because of the many challenges they face attitudinal, physical, and financial. The National Policy for Persons with Disabilities (2006) recognizes that Persons with Disabilities are valuable human resources for the country and seeks to create an environment that provides equal opportunities, and protection of their rights, and full. There are limited studies on health care burden due to disabilities of various types. AIM The present study examines the socioeconomic and state-wise differences in the prevalence of disabilities and related household financial burden in India. METHODS Data for this study was obtained from the National Sample Survey (NSS), 76th round Persons with Disabilities in India Survey 2018. The survey covered a sample of 1,18,152 households, 5,76,569 individuals, of which 1,06,894 of had any disability. This study performed descriptive statistics, and bivariate estimates. RESULTS The finding of the analysis showed that prevalence of disability of any kind was 22 persons per 1000. Around, one-fifth (20.32%) of the household's monthly consumption expenditure was spent on out-of-pocket expenditure for disability. More than half (57.1%) of the households were pushed to catastrophic health expenditure due to one of the members being disabled. Almost one-fifth (19.1%) of the households who were above the poverty line before one of members was treated for disability were pushed below the poverty line after the expenditure of the treatment and average percentage shortfall in income from the poverty line was 11.0 percent due to disability treatment care expenditure. CONCLUSION The study provides an insight on the socioeconomic differentials in out-of-pocket expenditure, catastrophic expenditure for treatment of any kind of disability. To attain SDG goal 3 that advocates healthy life and promote well-being for all at all ages, there is a need to recognize the disadvantaged and due to disability.
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Affiliation(s)
- Jeetendra Yadav
- ICMR-National Institute of Medical Statistics (NIMS), New Delhi, India
| | - Niharika Tripathi
- Department of Sociology, Indraprastha College for Women, University of Delhi, New Delhi, India
| | - Geetha R. Menon
- ICMR-National Institute of Medical Statistics (NIMS), New Delhi, India
| | - Saritha Nair
- ICMR-National Institute of Medical Statistics (NIMS), New Delhi, India
| | - Jitenkumar Singh
- ICMR-National Institute of Medical Statistics (NIMS), New Delhi, India
| | - Ravinder Singh
- Indian Council of Medical Research (ICMR), New Delhi, India
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Kolesar RJ, Erreygers G, Van Damme W, Chea V, Choeurng T, Leng S. Hardship financing, productivity loss, and the economic cost of illness and injury in Cambodia. Int J Equity Health 2023; 22:208. [PMID: 37805483 PMCID: PMC10559627 DOI: 10.1186/s12939-023-02016-z] [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: 01/19/2022] [Accepted: 09/18/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Financial risk protection is a core dimension of universal health coverage. Hardship financing, defined as borrowing and selling land or assets to pay for healthcare, is a measure of last recourse. Increasing indebtedness and high interest rates, particularly among unregulated money lenders, can lead to a vicious cycle of poverty and exacerbate inequity. METHODS To inform efforts to improve Cambodia's social health protection system we analyze 2019-2020 Cambodia Socio-economic Survey data to assess hardship financing, illness and injury related productivity loss, and estimate related economic impacts. We apply two-stage Instrumental Variable multiple regression to address endogeneity relating to net income. In addition, we calculate a direct economic measure to facilitate the regular monitoring and reporting on the devastating burden of excessive out-of-pocket expenditure for policy makers. RESULTS More than 98,500 households or 2.7% of the total population resorted to hardship financing over the past year. Factors significantly increasing risk are higher out-of-pocket healthcare expenditures, illness or injury related productivity loss, and spending of savings. The economic burden from annual lost productivity from illness or injury amounts to US$ 459.9 million or 1.7% of GDP. The estimated household economic cost related to hardship financing is US$ 250.8 million or 0.9% of GDP. CONCLUSIONS Such losses can be mitigated with policy measures such as linking a catastrophic health coverage mechanism to the Health Equity Funds, capping interest rates on health-related loans, and using loan guarantees to incentivize microfinance institutions and banks to refinance health-related, high-interest loans from money lenders. These measures could strengthen social health protection by enhancing financial risk protection, mitigating vulnerability to the devastating economic effects of health shocks, and reducing inequities.
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Affiliation(s)
- Robert John Kolesar
- Abt Associates, Phnom Penh, Cambodia
- Faculty of Business and Economics, University of Antwerp, Antwerp, Belgium
- General Secretariat for the National Social Protection Council, Cambodian Ministry of Economy and Finance, Phnom Penh, Cambodia
- Centre d’Etudes et de Recherches sur le Développement International (CERDI), Université Clermont Auvergne, Clermont-Ferrand, France
| | - Guido Erreygers
- Faculty of Business and Economics, University of Antwerp, Antwerp, Belgium
- Centre for Health Policy, University of Melbourne, Melbourne, Australia
| | | | - Vanara Chea
- General Secretariat for the National Social Protection Council, Cambodian Ministry of Economy and Finance, Phnom Penh, Cambodia
| | - Theany Choeurng
- General Secretariat for the National Social Protection Council, Cambodian Ministry of Economy and Finance, Phnom Penh, Cambodia
| | - Soklong Leng
- General Secretariat for the National Social Protection Council, Cambodian Ministry of Economy and Finance, Phnom Penh, Cambodia
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Nanda M, Sharma R. A comprehensive examination of the economic impact of out-of-pocket health expenditures in India. Health Policy Plan 2023; 38:926-938. [PMID: 37409740 DOI: 10.1093/heapol/czad050] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 03/27/2023] [Accepted: 07/04/2023] [Indexed: 07/07/2023] Open
Abstract
More than 50% of health expenditure is financed through out-of-pocket payments in India, imposing a colossal financial burden on households. Amidst the rising incidence of non-communicable diseases, injuries, and an unfinished agenda of infectious diseases, this study examines comprehensively the economic impact of out-of-pocket health expenditure (OOPE) across 17 disease categories in India. Data from the latest round of the National Sample Survey (2017-18), titled 'Household Social Consumption: Health', were employed. Outcomes, namely, catastrophic health expenditure (CHE), poverty headcount ratio, distressed financing, foregone care, and loss of household earnings, were estimated. Results showed that 49% of households that sought hospitalization and/or outpatient care experienced CHE and 15% of households fell below the poverty line due to OOPE. Notably, outpatient care was more burdensome (CHE: 47.8% and impoverishment: 15.0%) than hospitalization (CHE: 43.1% and impoverishment: 10.7%). Nearly 16% of households used distressed sources to finance hospitalization-related OOPE. Cancer, genitourinary disorders, psychiatric and neurological disorders, obstetric conditions, and injuries imposed a substantial economic burden on households. OOPE and associated financial burden were higher among households where members sought care in private healthcare facilities compared with those treated in public facilities across most disease categories. The high burden of OOPE necessitates the need to increase health insurance uptake and consider outpatient services under the purview of health insurance. Concerted efforts to strengthen the public health sector, improved regulation of private healthcare providers, and prioritizing health promotion and disease prevention strategies are crucial to augment financial risk protection.
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Affiliation(s)
- Mehak Nanda
- University School of Management and Entrepreneurship, Delhi Technological University, Vivek Vihar Phase 2, Delhi 110095, India
| | - Rajesh Sharma
- University School of Management and Entrepreneurship, Delhi Technological University, Vivek Vihar Phase 2, Delhi 110095, India
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Puliyel JM. Health Insurance: Drawing inspiration from chit funds to pool health risks efficiently. Indian J Med Ethics 2023; VIII:255-257. [PMID: 36880466 DOI: 10.20529/ijme.2023.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The provision of government-funded public health services in India is grossly inadequate and 48.2% of "total health expenditure" for India is paid "out of pocket" [1]. When the total health expenditure in a household exceeds 10% of the annual income, it is considered catastrophic health expenditure (CHE) [2].
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Affiliation(s)
- Jacob M Puliyel
- Visiting Professor, International Institute of Health Management Research, New Delhi 110 075, INDIA
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Puteh SEW, Abdullah YR, Aizuddin AN. Catastrophic Health Expenditure (CHE) among Cancer Population in a Middle Income Country with Universal Healthcare Financing. Asian Pac J Cancer Prev 2023; 24:1897-1904. [PMID: 37378917 PMCID: PMC10505870 DOI: 10.31557/apjcp.2023.24.6.1897] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The study investigated healthcare expenditure from the perspective of cancer patients, to determine the level of Catastrophic Health Expenditure (CHE) and its associated factors. METHODS This cross-sectional study was conducted in three Malaysian public hospitals namely Hospital Kuala Lumpur, Hospital Canselor Tuanku Muhriz and the National Cancer Institute using a multi-level sampling technique to recruit 630 respondents from February 2020 to February 2021. CHE was defined as incurring a monthly health expenditure of more than 10% of the total monthly household expenditure. A validated questionnaire was used to collect the relevant data. RESULTS The CHE level was 54.4%. CHE was higher among patients of Indian ethnicity (P = 0.015), lower level education (P = 0.001), those unemployed (P < 0.001), lower income (P < 0.001), those in poverty (P < 0.001), those staying far from the hospital (P < 0.001), living in rural areas (P = 0.003), small household size (P = 0.029), moderate cancer duration (P = 0.030), received radiotherapy treatment (P < 0.001), had very frequent treatment (P < 0.001), and without a Guarantee Letter (GL) (P < 0.001). The regression analysis identified significant predictors of CHE as lower income aOR 18.63 (CI 5.71-60.78), middle income aOR 4.67 (CI 1.52-14.41), poverty income aOR 4.66 (CI 2.60-8.33), staying far from hospital aOR 2.62 (CI 1.58-4.34), chemotherapy aOR 3.70 (CI 2.01-6.82), radiotherapy aOR 2.99 (CI 1.37-6.57), combination chemo-radiotherapy aOR 4.99 (CI 1.48-16.87), health insurance aOR 3.99 (CI 2.31-6.90), without GL aOR 3.38 (CI 2.06-5.40), and without health financial aids aOR 2.94 (CI 1.24-6.96). CONCLUSIONS CHE is related to various sociodemographic, economic, disease, treatment and presence of health insurance, GL and health financial aids variables in Malaysia.
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Affiliation(s)
| | - Yang Rashidi Abdullah
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Malaysia.
| | - Azimatun Noor Aizuddin
- Department of Community Health, Faculty of Medicine, Hospital Canselor Tuanku Muhriz, Jalan Yaakob Latif Bandar Tun Razak, Malaysia.
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Oyando R, Were V, Koros H, Mugo R, Kamano J, Etyang A, Murphy A, Hanson K, Perel P, Barasa E. Evaluating the effectiveness of the National Health Insurance Fund in providing financial protection to households with hypertension and diabetes patients in Kenya. Int J Equity Health 2023; 22:107. [PMID: 37264458 PMCID: PMC10234077 DOI: 10.1186/s12939-023-01923-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 03/28/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) can impose a substantial financial burden to households in the absence of an effective financial risk protection mechanism. The national health insurance fund (NHIF) has included NCD services in its national scheme. We evaluated the effectiveness of NHIF in providing financial risk protection to households with persons living with hypertension and/or diabetes in Kenya. METHODS We carried out a prospective cohort study, following 888 households with at least one individual living with hypertension and/or diabetes for 12 months. The exposure arm comprised households that are enrolled in the NHIF national scheme, while the control arm comprised households that were not enrolled in the NHIF. Study participants were drawn from two counties in Kenya. We used the incidence of catastrophic health expenditure (CHE) as the outcome of interest. We used coarsened exact matching and a conditional logistic regression model to analyse the odds of CHE among households enrolled in the NHIF compared with unenrolled households. Socioeconomic inequality in CHE was examined using concentration curves and indices. RESULTS We found strong evidence that NHIF-enrolled households spent a lower share (12.4%) of their household budget on healthcare compared with unenrolled households (23.2%) (p = 0.004). While households that were enrolled in NHIF were less likely to incur CHE, we did not find strong evidence that they are better protected from CHE compared with households without NHIF (OR = 0.67; p = 0.47). The concentration index (CI) for CHE showed a pro-poor distribution (CI: -0.190, p < 0.001). Almost half (46.9%) of households reported active NHIF enrolment at baseline but this reduced to 10.9% after one year, indicating an NHIF attrition rate of 76.7%. The depth of NHIF cover (i.e., the share of out-of-pocket healthcare costs paid by NHIF) among households with active NHIF was 29.6%. CONCLUSION We did not find strong evidence that the NHIF national scheme is effective in providing financial risk protection to households with individuals living with hypertension and/diabetes in Kenya. This could partly be explained by the low depth of cover of the NHIF national scheme, and the high attrition rate. To enhance NHIF effectiveness, there is a need to revise the NHIF benefit package to include essential hypertension and/diabetes services, review existing provider payment mechanisms to explicitly reimburse these services, and extend the existing insurance subsidy programme to include individuals in the informal labour market.
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Affiliation(s)
- Robinson Oyando
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, P.O.BOX 43640-00100, Nairobi, Kenya.
| | - Vincent Were
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, P.O.BOX 43640-00100, Nairobi, Kenya
| | - Hillary Koros
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, P.O.BOX 43640-00100, Nairobi, Kenya
| | | | - Jemima Kamano
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Anthony Etyang
- Department of Epidemiology and Demography, KEMRI-Wellcome Trust Research Program, Kilifi, Kenya
| | - Adrianna Murphy
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Kara Hanson
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Pablo Perel
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, P.O.BOX 43640-00100, Nairobi, Kenya
- Center for Tropical Medicine and Global Health, Oxford University, Oxford, 01540, UK
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Kaiser AH, Okorafor O, Ekman B, Chhim S, Yem S, Sundewall J. Assessing progress towards universal health coverage in Cambodia: Evidence using survey data from 2009 to 2019. Soc Sci Med 2023; 321:115792. [PMID: 36842307 DOI: 10.1016/j.socscimed.2023.115792] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/27/2022] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
Over the past decades, many low- and middle-income countries have implemented health financing and system reforms to progress towards universal health coverage (UHC). In the case of Cambodia, out-of-pocket expenditure (OOPE) remains the main source of current health expenditure after several decades of reform, exposing households to financial risks when accessing healthcare and violating UHC's key tenet of financial protection. We use pre-pandemic data from the nationally representative Cambodia Socio-Economic Surveys of 2009 to 2019 to assess progress in financial protection to evaluate the reforms and obtain internationally comparable estimates. We find that following strong improvements in financial protection between 2009 and 2017, there was a reversal in the trend thereafter. The OOPE budget share rose, and the incidence of catastrophic spending and impoverishment increased in nearly all geographical and socioeconomic strata. For example, 17.7% of households experienced catastrophic health expenditure in 2019 at the threshold of 10% of total household consumption expenditure, and 3.9% of households were pushed into poverty by OOPE. The distribution of all financial protection indicators varied strongly across socioeconomic and geographical strata in all years. Fundamentally, the demonstrated trend reversal may jeopardize Cambodia's ability to progress towards UHC. To improve financial protection in the short term, there is a need to address the burden created by OOPE through targeted interventions to household groups that are most affected. In the medium term, our findings emphasize the importance of expanding health pre-payment schemes to currently uncovered vulnerable groups, specifically the near-poor. The government also needs to consider extending the scope of services covered and the range of providers to include the private sector under these schemes to reduce reliance on OOPE.
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Affiliation(s)
- Andrea Hannah Kaiser
- Lund University, Department of Clinical Sciences, Malmö (IKVM), Division of Social Medicine and Global Health (SMGH), CRC, Jan Waldenströms Gata 35, Malmö, Sweden; Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH Cambodia, Improving Social Protection and Health Project, Sayon Building, Samdach Pan Ave No. 41, 12211, Phnom Penh, Cambodia.
| | - Okore Okorafor
- Forte Metrix Consulting, 58 Sara Circle, Langeberg Heights, Durbanville, 7550, Western Cape, South Africa.
| | - Björn Ekman
- Lund University, Department of Clinical Sciences, Malmö (IKVM), Division of Social Medicine and Global Health (SMGH), CRC, Jan Waldenströms Gata 35, Malmö, Sweden.
| | - Srean Chhim
- National Institute of Public Health Cambodia, Lot 80, Street 566 & Corner with Street 289, Boeung Kak 2, Toul Kork, Phnom Penh, Cambodia.
| | - Sokunthea Yem
- National Institute of Public Health Cambodia, Lot 80, Street 566 & Corner with Street 289, Boeung Kak 2, Toul Kork, Phnom Penh, Cambodia.
| | - Jesper Sundewall
- Lund University, Department of Clinical Sciences, Malmö (IKVM), Division of Social Medicine and Global Health (SMGH), CRC, Jan Waldenströms Gata 35, Malmö, Sweden; HEARD, University of KwaZulu-Natal, South Africa.
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Memirie ST, Tolla MT, Rumpler E, Sato R, Bolongaita S, Tefera YL, Tesfaye L, Tadesse MZ, Getnet F, Mengistu T, Verguet S. Out-of-pocket expenditures and financial risks associated with treatment of vaccine-preventable diseases in Ethiopia: A cross-sectional costing analysis. PLoS Med 2023; 20:e1004198. [PMID: 36897870 PMCID: PMC10004560 DOI: 10.1371/journal.pmed.1004198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 02/10/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Vaccine-preventable diseases (VPDs) remain major causes of morbidity and mortality in low- and middle-income countries (LMICs). Universal access to vaccination, besides improved health outcomes, would substantially reduce VPD-related out-of-pocket (OOP) expenditures and associated financial risks. This paper aims to estimate the extent of OOP expenditures and the magnitude of the associated catastrophic health expenditures (CHEs) for selected VPDs in Ethiopia. METHODS AND FINDINGS We conducted a cross-sectional costing analysis, from the household (patient) perspective, of care-seeking for VPDs in children aged under 5 years for pneumonia, diarrhea, measles, and pertussis, and in children aged under 15 years for meningitis. Data on OOP direct medical and nonmedical expenditures (2021 USD) and household consumption expenditures were collected from 995 households (1 child per household) in 54 health facilities nationwide between May 1 and July 31, 2021. We used descriptive statistics to measure the main outcomes: magnitude of OOP expenditures, along with the associated CHE within households. Drivers of CHE were assessed using a logistic regression model. The mean OOP expenditures per disease episode for outpatient care for diarrhea, pneumonia, pertussis, and measles were $5·6 (95% confidence interval (CI): $4·3, 6·8), $7·8 ($5·3, 10·3), $9·0 ($6·4, 11·6), and $7·4 ($3·0, 11·9), respectively. The mean OOP expenditures were higher for inpatient care, ranging from $40·6 (95% CI: $12·9, 68·3) for severe measles to $101·7 ($88·5, 114·8) for meningitis. Direct medical expenditures, particularly drug and supply expenses, were the major cost drivers. Among those who sought inpatient care (345 households), about 13·3% suffered CHE, at a 10% threshold of annual consumption expenditures. The type of facility visited, receiving inpatient care, and wealth were significant predictors of CHE (p-value < 0·001) while adjusting for area of residence (urban/rural), diagnosis, age of respondent, and household family size. Limitations include inadequate number of measles and pertussis cases. CONCLUSIONS The OOP expenditures induced by VPDs are substantial in Ethiopia and disproportionately impact those with low income and those requiring inpatient care. Expanding equitable access to vaccines cannot be overemphasized, for both health and economic reasons. Such realization requires the government's commitment toward increasing and sustaining vaccine financing in Ethiopia.
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Affiliation(s)
- Solomon Tessema Memirie
- Addis Center for Ethics and Priority Setting, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
| | - Mieraf Taddesse Tolla
- Addis Center for Ethics and Priority Setting, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eva Rumpler
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Ryoko Sato
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Sarah Bolongaita
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Latera Tesfaye
- National Data Management Center for Health, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Fentabil Getnet
- National Data Management Center for Health, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Luo Y, Shi Z, Guo D, He P. Toward Universal Health Coverage: Regional Inequalities and Potential Solutions for Alleviating Catastrophic Health Expenditure in the Post-poverty Elimination Era of China. Int J Health Policy Manag 2023; 12:7332. [PMID: 37579440 PMCID: PMC10125131 DOI: 10.34172/ijhpm.2023.7332] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 01/02/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND This study took Beijing as an example to estimate the incidence and regional inequalities of catastrophic health expenditures (CHE) in a megacity of China. METHODS This study used data from the Health Services Survey Beijing (HSSB) 2018. Logistic regressions were used to investigate the risk factors for experiencing CHE, and concentration curves, the concentration index and its decomposition method based on probit models were used to estimate the inequalities in CHE. RESULTS CHE occurred in 25.51% of the households of the outer suburb villages, 6.78% of the households of the inner-city area communities, 17.10% of the households of the villages of the inner-city areas, and 11.91% of the households of the communities of the outer suburbs. In areas in the outer suburbs, households with private insurance coverage were associated with a lowered risk of CHE, and lower educational attainment and lower occupational class were related to an increasing risk of CHE. This study also discovered pro-rich financing disparities in CHE in Beijing, with the outer suburbs having the highest levels of CHE disparity. When it comes to the observed contributions of disparities in CHE, a significant portion of them is connected to the sorts of occupations, educational levels, and residential status. CONCLUSION The impoverishment brought on by medical expenses and CHE must still be taken into account in the post-poverty elimination era. The megacity of China was discovered to have significant regional differences in the incidence of pro-rich financing inequity in CHE. Disparities in socioeconomic status (SES), one of the controllable variables, may be a key area to address to lower the risk and minimize CHE inequality in megacities towards the path to UHC. Additionally, it is important to consider the financial protection impact of inclusive supplementary medical insurance on lowering the likelihood of CHE in the periphery areas.
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Affiliation(s)
- Yanan Luo
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Zhenyu Shi
- School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Dan Guo
- School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Ping He
- China Center for Health Development Studies, Peking University, Beijing, China
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Kassa AM. In Ethiopia's Kutaber district, does community-based health insurance protect households from catastrophic health-care costs? A community- based comparative cross-sectional study. PLoS One 2023; 18:e0281476. [PMID: 36791097 PMCID: PMC9931134 DOI: 10.1371/journal.pone.0281476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 01/24/2023] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE Every health system needs to take action to shield households from the expense of medical costs. The Ethiopian government implemented community-based health insurance (CBHI) to protect households from catastrophic health care expenditure (CHE) and enhance the utilization of health care services. The impact of CBHI on CHE with total household expenditure and non-food expenditure measures hadn't been studied, so the study aimed to evaluate the impact of CBHI on CHE among households in Kutaber district, Ethiopia. METHODS A total of 472 households (225 insured and 247 uninsured) were selected by multistage sampling techniques. Households total out-of-pocket (OOP) health payments ≥10% threshold of total household expenditure or ≥40% threshold of household non-food expenditure categorized as CHE. The co-variants for participation in the CBHI scheme were estimated by using a probit regression model. A propensity score matching analysis was used to determine the impact of CBHI on CHE. A Chi-square (χ2) test was computed to compare CHE between insured and uninsured households. RESULTS The magnitude of CHE was 39.1% with total household expenditure and 1.8% with non-food expenditure measures among insured households. Insured households were 46.3% protected from CHE when compared to uninsured households with total household expenditure measures and 24.2% to 25% with non-food expenditure measures. CONCLUSION The magnitude of CHE was lower among CBHI-enrolled households. CBHI is an effective means of financial protection benefits for households as a share of total household expenditure and non-food expenditure measures. Therefore, increasing the upper limits of benefit packages, minimizing exclusions, and CBHI scale-up to uninsured households is essential.
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Tsega Y, Tsega G, Taddesse G, Getaneh G. Leaving no one behind in health: Financial hardship to access health care in Ethiopia. PLoS One 2023; 18:e0282561. [PMID: 36913429 PMCID: PMC10010508 DOI: 10.1371/journal.pone.0282561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 02/20/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Financial hardship (of health care) is a global and a national priority area. All people should be protected from financial hardship to ensure inclusive better health outcome. However, financial hardship of healthcare has not been well studied in Ethiopia in general and in Debre Tabor town in particular. Therefore, this study aimed to assess the incidence of financial hardship of healthcare and associated factors among households in Debre Tabor town. METHODS Community based cross sectional study was conducted, from May 24/2022 to June 17/2022, on 423 (selected through simple random sampling) households. Financial hardship was measured through catastrophic (using 10% threshold level) and impoverishing (using $1.90 poverty line) health expenditures. Patient perspective bottom up and prevalence based costing approach were used. Indirect cost was estimated through human capital approach. Bi-variable and multiple logistic regressions were used. RESULTS The response rate was 95%. The mean household annual healthcare expenditure was Ethiopian birr 12050.64 ($227.37). About 37.1% (95%CI: 32, 42%) of the households spend catastrophic health expenditure with a 10% threshold level and 10.4% of households were impoverished with $1.90 per day poverty line. Being old, with age above 60, (AOR: 4.21, CI: 1.23, 14.45), being non-insured (AOR: 2.19, CI: 1.04, 4.62), chronically ill (AOR: 7.20, CI: 3.64, 14.26), seeking traditional healthcare (AOR: 2.63, CI: 1.37. 5.05) and being socially unsupported (AOR: 2.77, CI: 1.25, 6.17) were statistically significant factors for catastrophic health expenditure. CONCLUSION The study showed that significant number of households was not yet protected from financial hardship of healthcare. The financial hardship of health care is stronger among the less privileged populations: non-insured, the chronically diseased, the elder and socially unsupported. Therefore, financial risk protection strategies should be strengthened by the concerned bodies.
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Affiliation(s)
- Yawkal Tsega
- School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
- * E-mail:
| | - Gebeyehu Tsega
- Department of Health Systems Management and Health Economics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Getasew Taddesse
- Department of Health Systems Management and Health Economics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gebremariam Getaneh
- Department of Health Systems Management and Health Economics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Rai S, Gautam S, Yadav GK, Niraula SR, Singh SB, Rai R, Poudel S, Sah RB. Catastrophic health expenditure on chronic non-communicable diseases among elder population: A cross-sectional study from a sub-metropolitan city of Eastern Nepal. PLoS One 2022; 17:e0279212. [PMID: 36512634 PMCID: PMC9747046 DOI: 10.1371/journal.pone.0279212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION This study was conducted with the objective to analyze the out-of-pocket (OOP) healthcare expenditure and catastrophic healthcare expenditure (CHE) on chronic non-communicable diseases (CNCD) among the elderly population, and the association of CHE on CNCD with associated factors among the same population. MATERIALS AND METHODS We collected data from the elderly population of Dharan Sub-metropolitan city of the Eastern Nepal via door-to-door survey and face-to-face interview. The ten wards out of twenty were chosen by lottery method, and the equal proportion out of 280 samples was purposively chosen from each of ten wards (28 participants from each selected ward). The data were entered in Microsoft Excel 2019 v16.0 and statistical analysis was performed by using statistical package for social sciences, IBM SPSS® v21. The chi-square test was used to test the group differences. Multivariable logistic regression was used to determine independent factors associated with CHE (all variables with P < 0.20), and adjusted odds ratios (AOR) were calculated at 95% confidence interval (CI). RESULTS The median household, food and health expenditures were 95325 (72112.50-126262.50), 45000 (33000-60000) and 2100 (885.00-6107.50) NPR respectively. The proportion of the participants with CHE was 14.6%. The single living participants had 3.4 times higher odds of catastrophic health expenditure (AOR = 3.4, 95% CI = 1.2-9.6, P-value = 0.022) than those who are married. Similarly, those who had cancer had 0.1 times lower odds of CHE (AOR = 0.1, 95% CI = 0.0-0.2, P-value = <0.001) than those without cancer. CONCLUSION The elder population had significant financial health shocks due to chronic health ailments. There should be the provision of mandatory health insurance programmes for elderly to cut down the catastrophic healthcare expenditure. Similarly, there should be the provision of exemption scheme for vulnerable elderly who are more likely to face catastrophic expenditure from all available health facilities.
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Affiliation(s)
- Sangita Rai
- School of Public Health and Community Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
- Ministry of Health, Biratnagar, Nepal
- * E-mail:
| | - Swotantra Gautam
- Department of Internal Medicine, Advent Health, Orlando, Florida, United States of America
| | - Gopal Kumar Yadav
- Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
- Ministry of Health and Population, Amphipath, Kathmandu, Nepal
| | - Surya Raj Niraula
- School of Public Health and Community Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Suman Bahadur Singh
- School of Public Health and Community Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Rajan Rai
- Department of Anaesthesiology and Critical Care, Koshi Hospital, Biratnagar, Nepal
| | - Sagar Poudel
- Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ram Bilakshan Sah
- School of Public Health and Community Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
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Sato R. Catastrophic health expenditure and its determinants among Nigerian households. Int J Health Econ Manag 2022; 22:459-470. [PMID: 35157187 DOI: 10.1007/s10754-022-09323-y] [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: 06/17/2021] [Accepted: 01/24/2022] [Indexed: 06/14/2023]
Abstract
Health expenditure can be substantial, especially in countries without national health insurance schemes, and it can negatively affect people's welfare. This study uses recent data to evaluate the extent to which Nigerian households suffer from catastrophic health expenditure (CHE) and evaluates its determinants. We used the Living Standards Survey 2018-2019 to estimate the headcount of Nigerian households that experience CHE-the proportion of health expenditures exceeding a certain ratio of such expenditures to non-food expenditures. To evaluate the determinants of CHE, we used ordinary least square regression with state fixed effects. The total sample was 22,110 nationally representative households. Many households, especially poorer ones, do not have any health care expenses; only 60.6% of the poorest households had some health-related expenditure. Even with the limited health-seeking behaviors in this demographic, the percentage of households that suffered from CHE was very high: with a 15% cutoff for CHE thresholds, 34.9 to 44.2% of households experienced CHE. Lower education, higher non-food consumption, and rural residence were correlated with higher amounts of health expenditure and higher odds of CHE. Health-seeking behaviors such as clinic visits for sickness treatment and prevention are limited, especially among the poorer households. Even so, the headcount of households experiencing CHE is very high in Nigeria. Advancing the implementation of national health insurance scheme is important to reduce the burden of health expenditure, especially among the poor, as well as to remove financial barriers to their seeking adequate health services.
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Affiliation(s)
- Ryoko Sato
- Harvard T.H. Chan School of Public Health, Boston, USA.
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Kim CO. Effect of Health Shocks on Poverty Status in South Korea: Exploring the Mechanism of Medical Impoverishment. Int J Health Policy Manag 2022; 11:2090-2102. [PMID: 34523865 PMCID: PMC9808294 DOI: 10.34172/ijhpm.2021.97] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/04/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND South Korea has the highest out-of-pocket burden for medical expenses among the Organisation for Economic Co-operation and Development (OECD) member countries and has no formal sickness benefit system, along with United States and Switzerland, greatly increasing the risk of poverty due to a sudden illness. METHODS We identify the causal effect of health shocks on poverty status and explore the mechanisms of medical impoverishment by analyzing longitudinal data from 13 670 households that participated in the representative Korean Welfare Panel Study (KOWEPS) from 2007 to 2016. In this study, we define a health shock as a case in which no household members were hospitalized in the previous year, but together they had more than 30 days of hospitalization in this year. The propensity score matching method was combined with a mediation analysis in this work. RESULTS The proportion of households in absolute poverty increased by 4.6-8.0 percentage points among households that experienced a health shock compared with matched controls. The selection effects due to health shock were estimated to be 5.6-8.2 percentage points. On average, a sudden hospitalization reduces annual non-medical expenditures and equivalized disposable income by just over 3.2 million KRW (2500 USD) and 1.2 million KRW (1000 USD), respectively. Health shock induces impoverishment after one year through both the medical expense and work capacity pathways, which explain 12.8% and 12.8% of the total effect, respectively. However, when we decompose the mediation effect of a health shock on poverty status after two years, we find that a health shock leads to poverty mainly through labor force nonparticipation (9.9%). CONCLUSION Income stabilizing scheme to protect households that experience a health shock should be introduced as a policy alternative to confront the issue of medical impoverishment.
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Affiliation(s)
- Chang-O Kim
- Visiting Doctors Program of Medical Home, Seoul, Republic of Korea
- Institute of Social Welfare, SungKongHoe University, Seoul, Republic of Korea
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Nikoloski Z, Cheatley J, Mossialos E. Financial Risk Protection and Unmet Healthcare Need in Russia. Int J Health Policy Manag 2022; 11:1715-1724. [PMID: 34380196 PMCID: PMC9808245 DOI: 10.34172/ijhpm.2021.72] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 06/22/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Achieving universal health coverage (UHC) includes financial risk protection. To date, catastrophic healthcare expenditure (CHE), the impoverishing effect of out-of-pocket (OOP) healthcare payments, and unmet healthcare need are the most widely used indicators for assessing the financial risk protection of a healthcare system. This study aimed to estimate the Russian healthcare system's financial risk protection by focusing on CHE, OOP and unmet healthcare need. METHODS The study used eight waves of the Russia Longitudinal Monitoring Survey (RLMS) (2010-2017) to analyze the financial risk protection of the Russian healthcare system. Commonly used indicators - CHE, both incidence and intensity, the impoverishing effect of CHE and unmet need -were used. RESULTS We found low incidence and intensity of CHE in the Russian Federation. Our results are robust to various definitions of CHE (eg, as a share of total household expenditure or total household income). Furthermore, the impoverishing effect of OOP healthcare payments remains limited, despite the most recent economic slowdown (2014- 2016). This could be explained by a noticeable reduction in CHE during the crisis years, as postponing healthcare was adopted as a coping mechanism, particularly among households heavily affected by the crisis. CONCLUSION As stressed by the UHC framework, our findings suggest that CHE only partly captures inefficiencies and inequities in coverage, because one tenth of households forwent medical care for medicines and certain services. As spending on medicines and dental care are the main drivers of CHE, policy interventions should focus on extending coverage for pharmaceutical and dental care and target financial barriers to seeking care, particularly for the poor and vulnerable.
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Affiliation(s)
- Zlatko Nikoloski
- Department of Health Policy, London School of Economics and Political Science, London, UK
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López-López S, Del Pozo-Rubio R, Ortega-Ortega M, Escribano-Sotos F. Catastrophic household expenditure associated with out-of-pocket payments for dental healthcare in Spain. Eur J Health Econ 2022; 23:1187-1201. [PMID: 35066677 DOI: 10.1007/s10198-021-01420-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To estimate the prevalence of catastrophic health expenditure due to dental healthcare (CHED) in Spain, quantify its intensity and examine the related sociodemographic household characteristics. METHODS Data from the Spanish Household Budget Survey, which addresses more than 20,000 households each year for the period 2008-2015 were included, and the methodology proposed by Wagstaff and van Doorslaer was followed. The prevalence (number of households that devote more than a certain threshold of their income to such payments) and intensity (amount that exceeds a certain percentage of income) were estimated. Ordered logistic regression models were estimated to analyse the sociodemographic factors associated with the prevalence of catastrophic payments. RESULTS The prevalence and intensity remained stable during the period under analysis. In terms of prevalence, a mean proportion of 7.36% of the population dedicated, in terms of intensity, more than 10% of their resources to dental care payments [mean: €292.75 per year (SD €2144.14)] and 2.05% dedicated more than 40% [mean: €143.02 per year (SD €1726.42)]. This represents 36.32% and 51.34% (for the thresholds of 10% and 40%) of the total catastrophic expenditure derived from out-of-pocket payments for dental healthcare in Spain. CONCLUSION This study shows that a significant proportion of catastrophic healthcare payments correspond to dental services. Being male, aged over 40 years, unattached (single, separated, divorced or widowed), having a low level of education, a low household income, being unemployed and living in an urban area are all associated with a greater risk of CHED. This finding highlights the need to establish policies aimed at increasing dental care coverage to mitigate related financial burdens on a large part of the Spanish population.
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Affiliation(s)
- Samuel López-López
- Castilla-La Mancha Health Services, SESCAM, Hospital of Cuenca, C/ Hermandad de Donantes de Sangre, 1, 16 002, Cuenca, Spain.
| | - Raúl Del Pozo-Rubio
- Department of Economic Analysis and Finance, University of Castilla-La Mancha, Avda. Los Alfares, 44, 16 071, Cuenca, Spain
- Research Group on Food, Economy and Society, University of Castilla-La Mancha, Albacete, Spain
| | - Marta Ortega-Ortega
- Department of Applied and Public Economics, and Political Economy, Complutense University of Madrid, Campus de Somosaguas s/n, Pozuelo de Alarcón, 28 223, Madrid, Spain
| | - Francisco Escribano-Sotos
- Department of Economic Analysis and Finance, University of Castilla-La Mancha, Plaza de la Universidad s/n, 02 001, Albacete, Spain
- Research Group on Food, Economy and Society, University of Castilla-La Mancha, Albacete, Spain
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Adeniji FIP, Lawanson AO, Osungbade KO. The microeconomic impact of out-of-pocket medical expenditure on the households of cardiovascular disease patients in general and specialized heart hospitals in Ibadan, Nigeria. PLoS One 2022; 17:e0271568. [PMID: 35849602 PMCID: PMC9292125 DOI: 10.1371/journal.pone.0271568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 07/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Cardiovascular diseases (CVDs) present a huge threat to population health and in addition impose severe economic burden on individuals and their households. Despite this, there is no research evidence on the microeconomic impact of CVDs in Nigeria. Therefore, this study estimated the incidence and intensity of catastrophic health expenditures (CHE), poverty headcount due to out-of-pocket (OOP) medical spending and the associated factors among the households of a cohort of CVDs patients who accessed healthcare services in public and specialized heart hospitals in Ibadan, Nigeria.
Methods
This study adopts a descriptive cross-sectional study design. A standardized data collection questionnaire developed by the Initiative for Cardiovascular Health Research in Developing Countries was adapted to electronically collect data from all the 744 CVDs patients who accessed healthcare services in public and specialized heart hospitals in Ibadan between 4th November 2019 to the 31st January 2020. A sensitivity analysis, using rank-dependent thresholds of CHE which ranged from 5%-40% of household total expenditures was carried out. The international poverty line of $1.90/day recommended by the World Bank was utilized to ascertain poverty headcounts pre-and post OOP payments for healthcare services. Categorical variables like household socio-demographic and clinical characteristics, CHE and poverty headcounts, were presented using percentages and proportions. Unadjusted and adjusted logistic regression models were used to assess the factors associated with CHE and poverty. Data were analyzed using STATA version 15 and estimates were validated at 5% level of significance.
Results
Catastrophic OOP payment ranged between 3.9%-54.6% and catastrophic overshoot ranged from 1.8% to 12.6%. Health expenditures doubled poverty headcount among households, from 8.13% to 16.4%. Having tertiary education (AOR: 0.49, CI: 0.26–0.93, p = 0.03) and household size (AOR: 0.40, CI: 0.24–0.67, p = 0.001) were significantly associated with CHE. Being female (AOR: 0.41, CI: 0.18–0.92, p = 0.03), household economic status (AOR: 0.003, CI: 0.0003–0.25, p = <0.001) and having 3–4 household members (AOR: 0.30, CI: 0.15–0.61, p = 0.001) were significantly associated with household poverty status post payment for medical services.
Conclusion
OOP medical spending due to CVDs imposed enormous strain on household resources and increased the poverty rates among households. Policies and interventions that supports universal health coverage are highly recommended.
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Affiliation(s)
- Folashayo Ikenna Peter Adeniji
- Department of Health Policy & Management, College of Medicine, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
- * E-mail:
| | - Akanni Olayinka Lawanson
- Department of Economics, Faculty of Economics & Management Sciences, University of Ibadan, Ibadan, Nigeria
| | - Kayode Omoniyi Osungbade
- Department of Health Policy & Management, College of Medicine, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
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Chwo MJ, Huang YC, Huang SH, Chung RJ, Sun CA, Chung CH, Wang BL, Chien WC. Males with low income and catastrophic illnesses are important risk factors for in-hospital homicide-related deaths in Taiwan from 1998 to 2015: A cross-sectional study. Medicine (Baltimore) 2022; 101:e29785. [PMID: 35801749 PMCID: PMC9259112 DOI: 10.1097/md.0000000000029785] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
This study aimed to investigate not only the differences in in-hospital deaths between male and female homicides in Taiwan from 1998 to 2015, but also the epidemiological characteristics and long-term trend analysis. We collected data on 76,125 hospitalized patients injured in attempted homicides from January 1, 1998, to December 31, 2015, from the National Health Insurance Research Database (NHIRD), identifying 59,161 male and 16,694 female patients. Age, gender, and index date match. Multiple logistic regression was used to analyze the risks of gender differences in terms of homicide. The death risk of male patients was 1.673 times that of female patients and the mortality risk of low-income male patients was 3.447 times greater than that of non-low-income male patients. Moreover, the in-hospital death risk was 23.584 and 5.064 times higher for male and female patients with catastrophic illness, respectively, compared to patients with noncritical diseases. There is a higher trend of male than female patients hospitalized after an attempted homicide. Gender differences are significantly related to homicide, with males having a higher risk of death risk from homicide than females, especially in terms of low-income and catastrophic illness.
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Affiliation(s)
- Miao-Ju Chwo
- Department of Nursing, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yao-Ching Huang
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei City, Taiwan
| | - Shi-Hao Huang
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei City, Taiwan
| | - Ren-Jei Chung
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei City, Taiwan
| | - Chien-An Sun
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
- Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan
| | - Bing-Long Wang
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei City, Taiwan
- * Correspondence: Wu-Chien Chien, Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, 7115R, No. 325, Section 2, Cheng-Kung Road, Nei-hu District, Taipei, Taiwan (e-mail: )
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Jbaily A, Haakenstad A, Kiros M, Riumallo-Herl C, Verguet S. Examining the density in out-of-pocket spending share in the estimation of catastrophic health expenditures. Eur J Health Econ 2022; 23:903-912. [PMID: 34355280 PMCID: PMC9170678 DOI: 10.1007/s10198-021-01316-x] [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] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 04/28/2021] [Indexed: 06/13/2023]
Abstract
Universal health coverage (UHC) aims to provide access to health services for all without financial hardship. Moving toward UHC while ensuring financial risk protection (FRP) from out-of-pocket (OOP) health expenditures is a critical objective of the Sustainable Development Goal for Health. In tracking country progress toward UHC, analysts and policymakers usually report on two summary indicators of lack of FRP: the prevalence of catastrophic health expenditures (CHE) and the prevalence of impoverishing health expenditures. In this paper, we build on the CHE indicator: we examine the distribution (density) of health OOP budget share as a way to capture both the magnitude and dispersion in the ratio of households' OOP health expenditures relative to consumption or income at the population level. We illustrate our approach with country-specific examples using data from the World Health Organization's World Health Surveys.
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Affiliation(s)
- Abdulrahman Jbaily
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Annie Haakenstad
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Mizan Kiros
- Ethiopian Health Insurance Agency, Addis Ababa, Ethiopia
| | | | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA USA
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Ahid S. Impact of Out-of-Pocket Costs on Catastrophic Healthcare Expenditures. Value Health Reg Issues 2022; 30:170-171. [PMID: 35753091 DOI: 10.1016/j.vhri.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Samir Ahid
- Faculty of Pharmacy, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco; Pharmacoeconomics and Pharmacoepidemiology Research Team, Mohammed V University of Rabat, Rabat, Morocco.
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Rahman T, Gasbarro D, Alam K. Financial risk protection in health care in Bangladesh in the era of Universal Health Coverage. PLoS One 2022; 17:e0269113. [PMID: 35749437 PMCID: PMC9231789 DOI: 10.1371/journal.pone.0269113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 05/15/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Ensuring financial risk protection in health care and achieving universal health coverage (UHC) by 2030 is one of the crucial Sustainable Development Goals (SDGs) targets for many low- and middle-income countries (LMICs), including Bangladesh. We examined the critical trajectory of financial risk protection against out-of-pocket (OOP) health expenditure in Bangladesh. METHODS Using Bangladesh Household Income and Expenditure Survey data from 2005, 2010, and 2016, we examined the levels and distributions of catastrophic health expenditure (CHE) and impoverishment incidences. We used the normative food, housing, and utilities method, refining it by categorizing households with zero OOP expenses by reasons. RESULTS OOP expenditure doubled between 2005 and 2016 (USD 115.6 in 2005, USD 162.1 in 2010, USD 242.9 in 2016), accompanied by rising CHE (11.5% in 2005, 11.9% in 2010, 16.6% in 2016) and impoverishment incidence (1.5% in 2005, 1.6% in 2010, 2.3% in 2016). While further impoverishment of the poor households due to OOP expenditure (3.6% in 2005, 4.1% in 2010, 3.9% in 2016) was a more severe problem than impoverishment of the non-poor, around 5.5% of non-poor households were always at risk of impoverishment. The poorest households were the least financially protected throughout the study period (lowest vs. highest quintile CHE: 29.5% vs. 7.6%, 33.2% vs. 7.2%, and 37.6% vs. 13.0% in 2005, 2010, and 2016, respectively). The disparity in CHE among households with and without chronic illness was also remarkable in 2016 (25.0% vs. 9.1%). CONCLUSION Financial risk protection in Bangladesh exhibits a deteriorated trajectory from 2005 to 2016, posing a significant challenge to achieving UHC and, thus, the SDGs by 2030. The poorest and chronically ill households disproportionately lacked financial protection. Reversing the worsening trends of CHE and impoverishment and addressing the inequities in their distributions calls for implementing UHC and thus providing financial protection against illness.
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Affiliation(s)
- Taslima Rahman
- Murdoch Business School, Murdoch University, Perth, Western Australia, Australia
- Institute of Health Economics, University of Dhaka, Dhaka, Bangladesh
- * E-mail:
| | - Dominic Gasbarro
- Murdoch Business School, Murdoch University, Perth, Western Australia, Australia
| | - Khurshid Alam
- Murdoch Business School, Murdoch University, Perth, Western Australia, Australia
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Hong YR, Xie Z, Suk R, Tabriz AA, Turner K, Qiu P. Analysis of US Household Catastrophic Health Care Expenditures Associated With Chronic Disease, 2008-2018. JAMA Netw Open 2022; 5:e2214923. [PMID: 35622368 PMCID: PMC9142861 DOI: 10.1001/jamanetworkopen.2022.14923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
This cross-sectional study evaluates trends in catastrophic health care expenditures associated with chronic diseases in US households from 2008 to 2018.
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Affiliation(s)
- Young-Rock Hong
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville
- UF Health Cancer Center, Gainesville, Florida
| | - Zhigang Xie
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville
| | - Ryan Suk
- Department of Management, Policy and Community Health, The University of Texas Health Science Center School of Public Health, Houston
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa
| | - Peihua Qiu
- Department of Biostatistics, University of Florida, Gainesville
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Abstract
This article defines the concept of “multidimensional health poverty,” considering both the monetary aspects and multidimensional health deprivation of health poverty. Moreover, we set up the multidimensional health poverty index (MHPI) to measure health poverty in China by revising the traditional A-F MPI method, specifically we use the Catastrophic Health Expenditure (CHE) as a sufficient condition and income poverty as a necessary condition, and take physical, mental, and social health into account. The measurement result evidences that physical health, monetary dimensions (CHE and income poverty), and mental health contribute most to health poverty in China. In addition, the MHPI is significantly higher in rural areas than urban because of higher out-of-pocket medical payments and health deprivation in more dimensions. Compared with the traditional method, the MHPI is more accurate, stable, and comprehensive, making it more suitable for measuring health poverty.
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Affiliation(s)
- Xin-Xin Chi
- School of Economics, Qingdao University, Qingdao, China
| | - Xi-Hua Liu
- School of Economics, Qingdao University, Qingdao, China
- *Correspondence: Xi-Hua Liu
| | - Ze-Zhong Zhang
- School of Economics and Management, Qinghai Minzu University, Xining, China
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Abstract
A previously well 31-year-old woman initially presented to the emergency department with pneumonia, however, was found to be hypertensive and have new-onset cardiomegaly. She was admitted for intravenous antibiotics and concurrently a series of investigations were conducted to investigate hypertension and cardiomegaly. During the course of admission, she developed acute kidney injury and was found to have acute chronic occlusion in the abdominal aorta. She was diagnosed with catastrophic antiphospholipid syndrome. This is a rare form of antiphospholipid syndrome with a high mortality rate. Thus, it is important that clinicians are aware of this syndrome to facilitate early diagnosis and initiation of treatment.
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Affiliation(s)
- Seojung Kwak
- General Medicine, Tamworth Rural Referral Hospital, Tamworth, New South Wales, Australia
| | - Malcolm Green
- General Medicine, Tamworth Rural Referral Hospital, Tamworth, New South Wales, Australia
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Ehsani-Chimeh N, Miller M, Brown M. Catastrophic Bleeding Complications in 2 High-Risk Patients After Dermatologic Surgery. Dermatol Surg 2021; 47:1664-1665. [PMID: 34608088 DOI: 10.1097/dss.0000000000003244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Nazanin Ehsani-Chimeh
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado
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Doshmangir L, Hasanpoor E, Abou Jaoude GJ, Eshtiagh B, Haghparast-Bidgoli H. Incidence of Catastrophic Health Expenditure and Its Determinants in Cancer Patients: A Systematic Review and Meta-analysis. Appl Health Econ Health Policy 2021; 19:839-855. [PMID: 34318445 DOI: 10.1007/s40258-021-00672-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Cancer is the third leading cause of mortality in the world, and cancer patients are more exposed to financial hardship than other diseases. This paper aimed to review studies of catastrophic healthcare expenditure (CHE) in cancer patients, measure their level of exposure to CHE, and identify factors associated with incidence of CHE. METHODS This study is a systematic review and meta-analysis. Several databases were searched until February 2020, including MEDLINE, Web of Science, Scopus, ProQuest, ScienceDirect and EMBASE. The results of selected studies were extracted and analyzed using a random effects model. In addition, determinants of CHE were identified. RESULTS Among the 19 studies included, an average of 43.3% (95% CI 36.7-50.1) of cancer patients incurred CHE. CHE varied substantially depending on the Human Development Index (HDI) of the country in which a study was conducted. In countries with the highest HDI, 23.4% of cancer patients incurred CHE compared with 67.9% in countries with the lowest HDI. Key factors associated with incidence of CHE at the household level included household income, gender of the household head, and at the patient level included the type of health insurance, education level of the patient, type of cancer and treatment, quality of life, age and sex. CONCLUSION The proportion of cancer patients that incur CHE is very high, especially in countries with lower HDI. The results from this review can help inform policy makers to develop fairer and more sustainable health financing mechanisms, addressing the factors associated with CHE in cancer patients.
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Affiliation(s)
- Leila Doshmangir
- Department of Health Policy & Management, Tabriz Health Services Management Research Center, School of Management & Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Edris Hasanpoor
- Research Center for Evidence-Based Health Management, Maragheh University of Medical Sciences, Maragheh, Iran.
| | - Gerard Joseph Abou Jaoude
- Institute for Global Health, Center for Global Health Economics, University College London, London, UK
| | - Behzad Eshtiagh
- Institute for Global Health, Center for Global Health Economics, University College London, London, UK
| | - Hassan Haghparast-Bidgoli
- Department of Health Policy & Management, Tabriz Health Services Management Research Center, School of Management & Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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Che X, Li J, Fu W, Fang F. Association between livelihood capital and catastrophic health expenditure among patients with critical illness: a cross-sectional study in rural Shandong, China. BMJ Open 2021; 11:e051234. [PMID: 34716163 PMCID: PMC8559106 DOI: 10.1136/bmjopen-2021-051234] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The objective of this study is to examine the association between livelihood capital and catastrophic health expenditure (CHE). DESIGN Between July and August 2019, a cross-sectional study was conducted in critically ill patients. SETTING Shandong, China. PARTICIPANTS 1041 households with critically ill patients from 77 villages. PRIMARY AND SECONDARY OUTCOME MEASURES We defined expenditure as being catastrophic if a household's out-of-pocket payments were greater than or equal to 40% of their capacity to pay. Using the sustainable livelihoods framework, this study explored the associations between CHE and the various forms of livelihood capital-inclusive of human capital, natural capital, physical capital, financial capital and social capital. χ2 tests, t-tests, Wilcoxon tests and binary logistic regression analysis were performed to examine these associations. RESULTS The incidence of CHE among households with critically ill patients was 76.37% in this study. Better livelihood capital was significantly associated with lower incidence of CHE. After controlling for confounding factors, households with healthier patients (OR 0.47, 95% CI 0.23 to 0.96), more real estate ownership (OR 0.35, 95% CI 0.19 to 0.67) and better economic status (OR 0.33, 95% CI 0.18 to 0.62) were associated with a reduction in the occurrence of CHE. CONCLUSIONS Livelihood capital was significantly associated with CHE in rural families with critically ill patients. This association suggests that, in addition to providing health insurance to the critically ill, more attention should be paid to their ability to create and preserve livelihood capital.
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Affiliation(s)
- Xin Che
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jiajia Li
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research,Shandong University, Jinan, China
| | - Wenhao Fu
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research,Shandong University, Jinan, China
| | - Feng Fang
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
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Darvishi B, Behzadifar M, Ghanbari MK, Ehsanzadeh SJ, Bakhtiari A, Behzadifar M, Azari S, Bragazzi NL. Financial Protection Indexes and the Iranian Health Transformation Plan: A Systematic Review. Yale J Biol Med 2021; 94:465-476. [PMID: 34602884 PMCID: PMC8461582] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background: On May 5, 2014, the Iranian Ministry of Health and Medical Education launched the Health Transformation Plan (HTP) as a major healthcare reform to curb out-of-pocket (OOP) expenses and protect people from catastrophic health expenditures (CHEs). Therefore, in this study, we conducted a comprehensive literature search with the aim of systematically investigating the impacts of HTP on OOP and CHE after the implementation of the plan. Method: Web of Science, PubMed, Scopus, Embase, and Iranian bibliographic thesauri and repositories such as MagIran, Elmnet, and Scientific Information Database were searched. Studies published between May 2014 and December 2020 that reported the impact of HTP on the financial indicators under investigation in this study (OOP and CHEs) that were conducted in Iran. Estimated pooled change both for OOP and CHEs was calculated as effect size utilizing meta-analytical techniques. Also, heterogeneity among studies was assessed with the I2 statistics. Results: Seventeen studies were included, nine of which evaluated the OOP index, six studies assessed the CHEs index, and two studies examined both the OOP and CHEs indexes. The OOP was found to decrease after the implementation of the HTP (with an estimated decrease of 13.02% (95% CI: 9.09-16.94). Also, CHEs experienced a decrease of 5.80% (95% CI: 3.85-7.74). Conclusion: The findings show that the implementation of HTP has reduced health costs. In this regard and in order to keep reducing the costs that many people are unable to pay, the government and other organizations involved in the health system should provide sustainable financial resources in order to continue running HTP. However, there remain gaps and weaknesses that can be solved through discussion with all the actors involved.
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Affiliation(s)
- Banafshe Darvishi
- Social Determinants of Health Research Center, Lorestan
University of Medical Sciences, Khorramabad, Iran
| | - Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan
University of Medical Sciences, Khorramabad, Iran
| | - Mahboubeh Khaton Ghanbari
- Health Management and Economics Research Center, Health
Management Research Institute, Iran University of Medical Sciences, Tehran,
Iran
| | - Seyed Jafar Ehsanzadeh
- School of Health Management and Information Sciences,
Iran University of Medical Sciences, Tehran, Iran
| | - Ahad Bakhtiari
- Department of Health Economics and Management, School
of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Meysam Behzadifar
- Social Determinants of Health Research Center, Lorestan
University of Medical Sciences, Khorramabad, Iran
| | - Samad Azari
- Hospital Management Research Center, Iran University of
Medical Sciences, Tehran, Iran
| | - Nicola Luigi Bragazzi
- Department of Health Sciences (DISSAL), School of
Public Health, University of Genoa, Genoa, Italy
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Dwivedi R, Pradhan J, Athe R. Measuring catastrophe in paying for healthcare: A comparative methodological approach by using National Sample Survey, India. Int J Health Plann Manage 2021; 36:1887-1915. [PMID: 34196030 DOI: 10.1002/hpm.3272] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 06/19/2021] [Accepted: 06/20/2021] [Indexed: 11/07/2022] Open
Abstract
Healthcare expenditure significantly varies among various segments of the population. The appropriate measures of catastrophic health expenditure (CHE) will help to unravel the real burden of spending among households. Present study provides a link between the theoretical insights from Grossman's model and various methodological approaches for the estimation of CHE by using data from the three rounds of nationally representative Consumer Expenditure Surveys, India. Statistical analysis has been carried out by using multivariate logistic regression to identify the major determinants of CHE. Findings indicate that the occurrence of CHE has increased during 1993-2012. Rural residents and households with varying age composition such as with higher numbers of children and elderly were at higher risk. Economic status is significantly associated with CHE and increased demand for healthcare. The measurements differ as per the methodological approaches of CHE and definition of household's capacity to pay. Approach-based variations in the results can be of key importance in determining trends and magnitude in CHE. Despite these variations in measurements, study finds a limited incidence of CHE among the disadvantaged segment of the population though a greater share was devoted to health expenditure in recent years. Better risk pooling mechanism is required to address the healthcare needs of the disadvantaged segment such as elderly, children, poor and rural population in India.
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Affiliation(s)
- Rinshu Dwivedi
- Department of Science and Humanities, Indian Institute of Information Technology, Trichy, Tamil Nadu, India
| | - Jalandhar Pradhan
- Department of Humanities and Social Sciences, National Institute of Technology, Rourkela, Odisha, India
| | - Ramesh Athe
- Department of Humanities and Sciences, Indian Institute of Information Technology, Dharwad, Karnataka, India
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Begum A, Hamid SA. Impoverishment impact of out-of-pocket payments for healthcare in rural Bangladesh: Do the regions facing different climate change risks matter? PLoS One 2021; 16:e0252706. [PMID: 34086781 PMCID: PMC8177643 DOI: 10.1371/journal.pone.0252706] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/20/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Out-of-pocket (OOP) payments for healthcare severely affect the current consumption, future health and earnings capacity of poor/underprivileged households and hence it is crucial for priority setting. This study assesses the variation in overall as well as disease-specific impoverishment impact of OOP payments between the regions experiencing different climate change risks, defined as high disaster-prone (HDP) areas and low-disaster-prone (LDP) areas, in Bangladesh. MATERIALS AND METHODS This paper estimated three poverty measures, such as poverty headcount, poverty intensity and normalized poverty gap for all ailments, catastrophic events, diseases types (communicable, non-communicable (NCDs), and accident and injury), illness conditions (acute and chronic) and hospitalization using 3,791 randomly selected rural households (1,203 from HDP and 2,588 from LDP areas) across the regions. Cost of basic need approach was used for estimating poverty line expenditure. RESULTS About 13 percent households annually fall into poverty due to OOP outlays for healthcare. Despite having significantly (p-value≤0.01) less OOP payments (HDP areas: BDT 5,117; LDP areas: BDT5,811) the impoverishment impact of OOP payments for healthcare in HDP areas (16.5%) has substantially higher than LDP areas (11.3%). Population in HDP areas, especially char (river island; 19.55 percent) and haor (water submerged; 16.80 percent) are more susceptible to any level of OOP payments due to low level of earnings. Catastrophic healthcare expenditure (61.79%) and NCDs (14.29 percent) are exacerbating the poverty level in Bangladesh. Both absolute and relative average poverty gap are more widen in HDP than LDP areas due to catastrophic OOP outlays for healthcare. CONCLUSION The impoverishment effect due to OOP payments for healthcare in both HDP and LDP areas are high, especially for NCDs and catastrophic healthcare expenditure. However, the situation is bit worse in HDP areas. Preventing the escalation of NCDs as well as catastrophic expenditure and hence reducing the level of impoverishment thereof call for restricting tobacco use, increasing physical activity, encouraging to intake healthy diets, ensuring food safety, controlling air pollution, and improving mental health. Moreover, government should give more emphasis, especially in the HDP areas, on making community clinics more functional through providing screening equipment and training to the Community Health Care Providers for early detection of NCDs, and ensuring availability of medicine all the time. Note that other than community clinics, there is little option for providing healthcare in HDP areas due to poor functionality of public facilities as well as lack of private facilities in HDP areas.
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Affiliation(s)
- Afroza Begum
- Department of Statistics, University of Chittagong, Chittagong, Bangladesh
- * E-mail:
| | - Syed Abdul Hamid
- Institute of Health Economics, University of Dhaka, Dhaka, Bangladesh
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Kyriopoulos I, Nikoloski Z, Mossialos E. Financial protection in health among the middle-aged and elderly: Evidence from the Greek economic recession. Health Policy 2021; 125:1256-1266. [PMID: 34226052 DOI: 10.1016/j.healthpol.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 11/18/2022]
Abstract
Since the late 2000s, the Greek economy has entered a long period of recession, with reforms and retrenchment in health care being among the main public policy priorities. This study investigates the extent to which financial protection in health has changed among older households during the Greek crisis. We focus on the middle-aged and elderly, the heavy users of health services, who have faced a substantial health and financial burden during the crisis. Our analysis shows that the headcount and overshoot of catastrophic health expenditure (CHE) substantially increased from 2007 to 2015, suggesting that financial protection has eroded to a great extent. Prior to the crisis, CHE was mainly due to inpatient care, followed by outpatient care and medicines. However, the contribution of spending for outpatient medicines to CHE substantially increased during the study period. The headcount of CHE rose across all socioeconomic groups we examined, with low-income households and households with chronic patients being disproportionately affected. In 2007, we do not report signs of socioeconomic inequalities in the risk of CHE. On the contrary, our results show that households of low socioeconomic status are more likely to incur CHE in 2015, revealing substantial inequalities in the risk of CHE. This finding raises significant distributional and equity concerns. Strengthening financial protection among older households is an imperative challenge for the Greek health system, and several policy responses need to be adopted towards this direction.
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Affiliation(s)
- Ilias Kyriopoulos
- Department of Health Policy, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom.
| | - Zlatko Nikoloski
- Department of Health Policy, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom.
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom.
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Verma VR, Kumar P, Dash U. Assessing the household economic burden of non-communicable diseases in India: evidence from repeated cross-sectional surveys. BMC Public Health 2021; 21:881. [PMID: 33962625 PMCID: PMC8106177 DOI: 10.1186/s12889-021-10828-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/09/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Financing for NCDs is encumbered by out-of-pocket expenditure (OOPE) assuming catastrophic proportions. Therefore, it is imperative to investigate the extent of catastrophic health expenditure (CHE) on NCDs, which are burgeoning in India. Thus, our paper aims to examine the extent of CHE and impoverishment in India, in conjunction with socio-economic determinants impacting the CHE. METHODS We used cross-sectional data from nationwide healthcare surveys conducted in 2014 and 2017-18. OOPE on both outpatient and inpatient treatment was coalesced to estimate CHE on NCDs. Incidence of CHE was defined as proportion of households with OOPE exceeding 10% of household expenditure. Intensity of catastrophe was ascertained by the measure of Overshoot and Mean Positive Overshoot Indices. Further, impoverishing effects of OOPE were assessed by computing Poverty Headcount Ratio and Poverty Gap Index using India's official poverty line. Concomitantly, we estimated the inequality in incidence and intensity of catastrophic payments using Concentration Indices. Additionally, we delineated the factors associated with catastrophic expenditure using Multinomial Logistic Regression. RESULTS Results indicated enormous incidence of CHE with around two-third households with NCDs facing CHE. Incidence of CHE was concentrated amongst poor that further extended from 2014(CI = - 0.027) to 2017-18(CI = - 0.065). Intensity of CHE was colossal as households spent 42.8 and 34.9% beyond threshold in 2014 and 2017-18 respectively with poor enduring greater overshoot vis-à-vis rich (CI = - 0.18 in 2014 and CI = - 0.23 in 2017-18). Significant immiserating impact of NCDs was unraveled as one-twelfth in 2014 and one-eighth households in 2017-18 with NCD burden were pushed to poverty with poverty deepening effect to the magnitude of 27.7 and 30.1% among those already below poverty on account of NCDs in 2014 and 2017-18 respectively. Further, large inter-state heterogeneities in extent of CHE and impoverishment were found and multivariate analysis indicated absence of insurance cover, visiting private providers, residing in rural areas and belonging to poorest expenditure quintile were associated with increased likelihood of incurring CHE. CONCLUSION Substantial proportion of households face CHE and subsequent impoverishment due to NCD related expenses. Concerted efforts are required to augment the financial risk protection to the households, especially in regions with higher burden of NCDs.
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Affiliation(s)
- Veenapani Rajeev Verma
- Department of Humanities and Social Sciences, Indian Institute of Technology Madras, Chennai, India
| | - Piyush Kumar
- Department of Humanities and Social Sciences, Indian Institute of Technology Madras, Chennai, India
| | - Umakant Dash
- Department of Humanities and Social Sciences, Indian Institute of Technology Madras, Chennai, India
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Liu S, Coyte PC, Fu M, Zhang Q. Measurement and determinants of catastrophic health expenditure among elderly households in China using longitudinal data from the CHARLS. Int J Equity Health 2021; 20:62. [PMID: 33608014 PMCID: PMC7893946 DOI: 10.1186/s12939-020-01336-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 11/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Catastrophic health expenditure (CHE) among the Chinese elderly warrants attention. However, the incidence, intensity and determinants of CHE have not been fully investigated. This study explores the incidence, intensity and determinants of CHE among elderly Chinese citizens, i.e., those aged 60 years or older. METHODS Data were obtained from three waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011, 2013 and 2015. The cut-off points used in this study for CHE were 10% of the total expenditures and 40% of non-food expenditure. Under the guidance of Andersen's model of health services utilization, this study used logistic regression analysis to explore the determinants of CHE. RESULTS The incidence of CHE defined as more than 40% of non-food expenditure rose over the study period, 2011-2015, from 20.86% (95% CI: 19.35 to 22.37%) to 31.00% (95% CI: 29.28 to 32.72%). The intensity of CHE also increased. The overshoot (O) based on non-food expenditure rose from 3.12% (95% CI: 2.71 to 3.53%) to 8.75% (95% CI: 8.14 to 9.36%), while the mean positive overshoot (MPO) rose from 14.96% (95% CI: 12.99 to 16.92%) to 28.23% (95% CI: 26.26 to 30.19%). Thus, the problem of CEH was even more serious in 2015 than in 2011. Logistic regression revealed that households were more likely to face CHE if they had a spouse as a household member, reported an inpatient event in the last year, reported an outpatient visit in the last month, were disabled, were members of a poor expenditure quartile, lived in the middle and western zones or resided in an urban area. In contrast, CEH was not significantly affected by respondents being older than 75 years or having a chronic health condition, by household size or by insurance type. CONCLUSIONS Key policy recommendations include the gradual improvement of medical assistance and the expansion of the use of health insurance to reduce household liability for health expenditures.
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Affiliation(s)
- Shiai Liu
- Center for Social Security Studies of Wuhan University, Wuhan, Hubei, China
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Mingqi Fu
- Center for Social Security Studies of Wuhan University, Wuhan, Hubei, China
| | - Qilin Zhang
- Center for Social Security Studies of Wuhan University, Wuhan, Hubei, China.
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Ssewanyana S, Kasirye I. Estimating Catastrophic Health Expenditures from Household Surveys: Evidence from Living Standard Measurement Surveys (LSMS)-Integrated Surveys on Agriculture (ISA) from Sub-Saharan Africa. Appl Health Econ Health Policy 2020; 18:781-788. [PMID: 32909224 PMCID: PMC7481041 DOI: 10.1007/s40258-020-00609-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Out of pocket (OOP) payments for healthcare remain a significant health financing challenge in sub-Saharan Africa (SSA). Understanding the drivers and impacts of this financial health burden is both an economic and a public health priority. OBJECTIVE This study examines how the burden of OOP health expenditures varies with different thresholds for financial catastrophe. METHODS The analysis is based on Livings Standards Measurement Surveys (LSMS)-Integrated Surveys on Agriculture (ISA) for five SSA countries-Ethiopia, Malawi, Nigeria, Tanzania, and Uganda. We estimate the degree by which OOP payments as share of total household non-food expenditures exceed either the 15 or 25% threshold. RESULTS For the countries considered, the severity of OOP payments is substantial-the average positive overshoot (beyond the 25% threshold) is above 10%, except for Nigeria. This reflects a higher percentage of OOP in total household health expenditures-compared to taxes and contributions-especially among the poor in these specific countries. Regarding sensitivity of distribution of catastrophic health expenditures, we find that households with low non-food expenditures are more likely to incur catastrophic payments with the exception for Uganda where catastrophic payments increase with the increase of non-food household expenditures. CONCLUSION The burden of catastrophic health expenditures remains large. In order to reduce this burden, public health expenditures need to be expanded as an alternative. This calls for renewed attention to expand public revenues as the most sustainable methods of financing health expenditures in Africa.
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Affiliation(s)
- Sarah Ssewanyana
- Economic Policy Research Centre (EPRC), Makerere University, Kampala, Uganda
| | - Ibrahim Kasirye
- Economic Policy Research Centre (EPRC), Makerere University, Kampala, Uganda
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Kiros M, Dessie E, Jbaily A, Tolla MT, Johansson KA, Norheim OF, Memirie ST, Verguet S. The burden of household out-of-pocket health expenditures in Ethiopia: estimates from a nationally representative survey (2015-16). Health Policy Plan 2020; 35:1003-1010. [PMID: 32772112 PMCID: PMC7553759 DOI: 10.1093/heapol/czaa044] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2020] [Indexed: 11/13/2022] Open
Abstract
In Ethiopia, little is known about the extent of out-of-pocket health expenditures and the associated financial hardships at national and regional levels. We estimated the incidence of both catastrophic and impoverishing health expenditures using data from the 2015/16 Ethiopian household consumption and expenditure and welfare monitoring surveys. We computed incidence of catastrophic health expenditures (CHE) at 10% and 25% thresholds of total household consumption and 40% threshold of household capacity to pay, and impoverishing health expenditures (IHE) using Ethiopia's national poverty line (ETB 7184 per adult per year). Around 2.1% (SE: 0.2, P < 0.001) of households would face CHE with a 10% threshold of total consumption, and 0.9% (SE: 0.1, P < 0.001) of households would encounter IHE, annually in Ethiopia. CHE rates were high in the regions of Afar (5.8%, SE: 1.0, P < 0.001) and Benshangul-Gumuz (4.0%, SE: 0.8, P < 0.001). Oromia (n = 902 000), Amhara (n = 275 000) and Southern Nations Nationalities and Peoples (SNNP) (n = 268 000) regions would have the largest numbers of affected households, due to large population size. The IHE rates would also show similar patterns: high rates in Afar (5.0%, SE: 0.96, P < 0.001), Oromia (1.1%, SE: 0.22, P < 0.001) and Benshangul-Gumuz (0.9%, SE: 0.4, P = 0.02); a large number of households would be impoverished in Oromia (n = 356 000) and Amhara (n = 202 000) regions. In summary, a large number of households is facing financial hardship in Ethiopia, particularly in Afar, Benshangul-Gumuz, Oromia, Amhara and SNNP regions and this number would likely increase with greater health services utilization. We recommend regional-level analyses on services coverage to be conducted as some of the estimated low CHE/IHE regional values might be due to low services coverage. Periodic analyses on the financial hardship status of households could also be monitored to infer progress towards universal health coverage.
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Affiliation(s)
- Mizan Kiros
- Ethiopia Health Insurance Agency, Addis Ababa, Ethiopia
| | - Ermias Dessie
- Federal Ministry of Health, Addis Ababa, Ethiopia
- World Health Organization, Addis Ababa, Ethiopia
| | - Abdulrahman Jbaily
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mieraf Taddesse Tolla
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kjell Arne Johansson
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ole F Norheim
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Solomon Tessema Memirie
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Gutiérrez-Barrios A, Gheorghe L, Camacho-Freire S, Valencia-Serrano F, Cañadas-Pruaño D, Calle-Pérez G, Alarcón de la Lastra I, Silva E, García-Molinero D, Agarrado-Luna A, Zayas-Ruedas R, Vázquez-García R, Serra A. Primary Angioplasty in a Catastrophic Presentation: Acute Left Main Coronary Total Occlusion-The ATOLMA Registry. J Interv Cardiol 2020; 2020:5246504. [PMID: 32774186 PMCID: PMC7403907 DOI: 10.1155/2020/5246504] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/01/2020] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES To determine the outcome predictors of in-hospital mortality in acute total occlusion of the left main coronary artery (ATOLMA) patients referred to emergent angioplasty and to describe the clinical presentation and the long-term outcome of these patients. BACKGROUND ATOLMA is an uncommon angiographic finding that usually leads to a catastrophic presentation. Limited and inconsistent data have been previously reported regarding true ATOLMA, yet comprehensive knowledge remains scarce. METHODS This is a multicenter retrospective cohort that includes patients presenting with myocardial infarction due to a confirmed ATOLMA who underwent emergency percutaneous coronary intervention (PCI). RESULTS In the period of the study, 7930 emergent PCI were performed in the five participating centers, and 46 of them had a true ATOLMA (0.58%). At admission, cardiogenic shock was present in 89% of patients, and cardiopulmonary resuscitation was required in 67.4%. All the patients had right dominance. Angiographic success was achieved in 80.4% of the procedures, 13 patients (28.2%) died during the catheterization, and the in-hospital mortality rate was 58.6% (27/46). At one-year and at the final follow-up, 18 patients (39%) were alive, including four cases successfully transplanted. Multivariate analysis showed that postprocedural TIMI flow was the only independent predictor of in-hospital mortality (OR 0.23, (95% CI 0.1-0.36), p < 0.001). CONCLUSIONS Our study confirms that the clinical presentation of ATOLMA is catastrophic, presenting a high in-hospital mortality rate; nevertheless, primary angioplasty in this setting is feasible. Postprocedural TIMI flow resulted as the only independent predictor of in-hospital mortality. In-hospital survivors presented an encouraging outcome. ATOLMA and left dominance could be incompatible with life.
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Affiliation(s)
- A. Gutiérrez-Barrios
- Departamento de Cardiología Hospital Universitario Puerta del Mar, Cádiz, Spain
- Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Cádiz, Spain
| | - L. Gheorghe
- Departamento de Cardiología Hospital Universitario Puerta del Mar, Cádiz, Spain
- Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Cádiz, Spain
| | - S. Camacho-Freire
- Departamento de Cardiología Hospital Juan Ramón Jiménez, Huelva, Spain
| | | | - D. Cañadas-Pruaño
- Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Cádiz, Spain
- Departamento de Cardiología Hospital de Jerez, Cádiz, Spain
| | - G. Calle-Pérez
- Departamento de Cardiología Hospital Universitario Puerta del Mar, Cádiz, Spain
- Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Cádiz, Spain
| | | | - E. Silva
- Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Cádiz, Spain
| | - D. García-Molinero
- Departamento de Cardiología Hospital Universitario Puerta del Mar, Cádiz, Spain
| | | | - R. Zayas-Ruedas
- Departamento de Cardiología Hospital Universitario Puerta del Mar, Cádiz, Spain
- Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Cádiz, Spain
| | - R. Vázquez-García
- Departamento de Cardiología Hospital Universitario Puerta del Mar, Cádiz, Spain
- Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Cádiz, Spain
| | - A. Serra
- Departamento de Cardiología Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Li J, Jiao C, Nicholas S, Wang J, Chen G, Chang J. Impact of Medical Debt on the Financial Welfare of Middle- and Low-Income Families across China. Int J Environ Res Public Health 2020; 17:ijerph17124597. [PMID: 32604840 PMCID: PMC7344870 DOI: 10.3390/ijerph17124597] [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] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/10/2020] [Accepted: 06/15/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Medical debt is a persistent global issue and a crucial and effective indicator of long-term family medical financial burden. This paper fills a research gap on the incidence and causes of medical debt in Chinese low- and middle-income households. METHOD Data were obtained from the 2015 China Household Finance Survey, with medical debt measured as borrowings from families, friends and third parties. Tobit regression models were used to analyze the data. The concentration index was employed to measure the extent of socioeconomic inequality in medical debt incidence. RESULTS We found that 2.42% of middle-income families had medical debt, averaging US$6278.25, or 0.56 times average household yearly income and 3.92% of low-income families had medical debts averaging US$5419.88, which was equivalent to 2.49 times average household yearly income. The concentration index for low and middle-income families' medical debt was significantly pro-poor. Medical debt impoverished about 10% of all non-poverty households and pushed poverty households deeper into poverty. While catastrophic health expenditure (CHE) was the single most important factor in medical debt, age, education, and health status of householder, hospitalization and types of medical insurance were also significant factors determining medical debt. CONCLUSIONS Using a narrow definition of medical debt, the incidence of medical debt in Chinese low- and middle-income households was relatively low. But, once medical debt happened, it imposed a long-term financial burden on medical indebted families, tipping many low and middle-income households into poverty and imposing on households several years of debt repayments. Further studies need to use broader definitions of medical debt to better assess the long-term financial impact of medical debt on Chinese families. Policy makers need to modify China's basic medical insurance schemes to manage out-of-pocket, medical debt and CHE and to take account of pre-existing medical debt.
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Affiliation(s)
- Jiajing Li
- Center for Health Economics Experiment and Public Policy, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua West Road, Lixia District, Jinan 250012, China; (J.L.); (C.J.)
| | - Chen Jiao
- Center for Health Economics Experiment and Public Policy, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua West Road, Lixia District, Jinan 250012, China; (J.L.); (C.J.)
| | - Stephen Nicholas
- School of Economics and School of Management, Tianjin Normal University, No. 339 Binshui West Avenue, Tianjin 300387, China;
- Guangdong Institute for International Strategies, Guangdong University of Foreign Studies, 2 Baiyun North Avenue, Guangzhou, Guangdong 510420, China
- Top Education Institute, 1 Central Avenue, Australian Technology Park, Eveleigh, Sydney, NSW 2015, Australia
- Newcastle Business School, University of Newcastle, University Drive, Newcastle, NSW 2308, Australia
| | - Jian Wang
- Dong Fureng Institute of Economics and Social Development, Wuhan University, No. 54 Dongsi Lishi Hutong, Dongcheng District, Beijing 100010, China;
- Center for Health Economics and Management, Economics and Management School, Wuhan University, Luojia Hill, Wuhan 430072, China
| | - Gong Chen
- Institute of Population Research, Peking University, No. 5 Yiheyuan Road, Haidian District, Beijing 100871, China;
| | - Jinghua Chang
- Institute of Population Research, Peking University, No. 5 Yiheyuan Road, Haidian District, Beijing 100871, China;
- Correspondence:
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Prouvot J, Aglaé C, Daniel L, Moranne O. A catastrophic antiphospholipid syndrome complicated with heparin-induced thrombocytopaenia, successfully managed with double filtration plasmapheresis, steroids and a direct thrombin inhibitor. BMJ Case Rep 2019; 12:e231161. [PMID: 31527216 PMCID: PMC6754638 DOI: 10.1136/bcr-2019-231161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2019] [Indexed: 01/08/2023] Open
Abstract
A middle-aged woman with history of antiphospholipid syndrome, admitted to our hospital for lethargy and persistent chest pain, developed during hospitalisation intracerebral transverse sinus and sigmoid vein thromboses, retinal thromboses, acute renal failure and cardiac involvement associated with thrombocytopaenia. Diagnosis of catastrophic antiphospholipid syndrome was made and treated with IV steroids, heparin infusion and double filtration plasmapheresis (DFPP) without fresh frozen plasma. Heparin-induced thrombocytopaenia was second diagnosed because of persistent severe thrombocytopaenia after 2 weeks of treatment associated with positive conversion of antibodies against platelet factor 4, and a positive functional assay. The clinical course was complicated by cerebellar haematomas that appeared a few days after the last session of DFPP. Heparin-induced thrombocytopaenia was managed by administration of argatroban, a direct thrombin inhibitor with an increase in platelet count. Neurologically, the patient recovered completely and was discharged on vitamin K antagonist treatment and regular dialysis.
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Affiliation(s)
- Julien Prouvot
- Service de Néphrologie-Dialyse-Aphérèse, Centre Hospitalier Universitaire Caremeau, Nîmes, France
- Faculté de Médecine, Université de Montpellier, Montpellier, France
| | - Cédric Aglaé
- Service de Néphrologie-Dialyse-Aphérèse, Centre Hospitalier Universitaire Caremeau, Nîmes, France
- Faculté de Médecine, Université de Montpellier, Montpellier, France
| | - Laurent Daniel
- Laboratoire d'Anatomie et Cytologie Pathologiques, Centre Hospitalier Universitaire de la Timone, Marseille, France
| | - Olivier Moranne
- Service de Néphrologie-Dialyse-Aphérèse, Centre Hospitalier Universitaire Caremeau, Nîmes, France
- Faculté de Médecine, Université de Montpellier, Montpellier, France
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48
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Missner SC, Cohen ZE. The Impact of the Psychiatrist on the Life Care Plan. J Am Acad Psychiatry Law 2019; 47:208-216. [PMID: 31000575 DOI: 10.29158/jaapl.003837-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A life care plan is a tool that is used for medical treatment planning and management purposes in many settings, including legal and forensic applications. This article summarizes the life care planning process and emphasizes the role of the psychiatrist in establishing a strong medical foundation for the plan. The psychiatrist's expertise in determining the nature and extent of the evaluee's psychiatric illness, prognosis, need for and likely benefit from treatment, and costs of care inform the life care planning process. Advising life care planners on these matters is a natural extension of the work of psychiatrists and forensic psychiatrists, who are accustomed to providing medical opinions to the courts. There are specific challenges when the psychiatrist creates recommendations for the life care plan; they include determining long-term prognosis, devising treatment plans, and identifying malingering. These questions are explored to assist the psychiatrist in providing the foundation for a life care plan.
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Affiliation(s)
- Shani C Missner
- Dr. Missner is a Sponsored University Associate at Georgetown University, Washington, DC. Dr. Cohen is Clinical Assistant Professor of Psychiatry, Weill Cornell Medical College, and Adjunct Assistant Professor of Clinical Psychiatry, Columbia College of Physicians and Surgeons, New York, NY.
| | - Ziv E Cohen
- Dr. Missner is a Sponsored University Associate at Georgetown University, Washington, DC. Dr. Cohen is Clinical Assistant Professor of Psychiatry, Weill Cornell Medical College, and Adjunct Assistant Professor of Clinical Psychiatry, Columbia College of Physicians and Surgeons, New York, NY
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49
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Adhikari A, Chisti MM, Bastola S, KC O. Rare case of catastrophic antiphospholipid syndrome with spontaneous intracranial haemorrhage. BMJ Case Rep 2019; 12:e227171. [PMID: 30898956 PMCID: PMC6453383 DOI: 10.1136/bcr-2018-227171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2019] [Indexed: 02/06/2023] Open
Abstract
Catastrophic antiphospholipid syndrome (CAPS) is a rare but severe form of antiphospholipid syndrome (APS). The syndrome manifests itself as a rapidly progressive multiorgan failure that is believed to be caused by widespread micro-thrombosis. Seldom does bleeding comanifest with thrombosis. We present a patient with APS who presented with nausea, vomiting and fatigue, and rapidly progressed into multiorgan failure before being diagnosed with CAPS. The clinical course was complicated by an atraumatic intracranial haemorrhage which demanded discontinuation of anticoagulation. The patient was treated with high dose steroid, intravenous immunoglobulin, followed by weekly rituximab infusion. Although the trigger for CAPS was not obvious during her hospital stay, she was diagnosed with acute cytomegalovirus (CMV) infection soon after discharge. In this case report, we explore the differential diagnoses of CAPS, investigate the possibility of CMV infection as a potential trigger, present the therapeutic challenges of anticoagulation and discuss the emerging use of rituximab.
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Affiliation(s)
- Anju Adhikari
- Internal Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Mohammad Muhsin Chisti
- Hematology and Medical Oncology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Sanjog Bastola
- Internal Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Ojbindra KC
- Internal Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
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50
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Gu JY, Lu C, Shi H, Yang CD. [Case series and clinical analysis of 14 cases of catastrophic antiphospholipid syndrome]. Beijing Da Xue Xue Bao Yi Xue Ban 2018; 50:1033-1038. [PMID: 30562777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Catastrophic antiphospholipid syndrome (CAPS), also known as Asherson's syndrome, is a special subtype of antiphospholipid syndrome (APS) characterized by multiple intravascular thrombosis involving multiple organs systems or tissues simultaneously or continuously, high titer antiphospholipid antibodies and high mortality rate. This article's aims was to analyze the clinical manifestation, laboratory examination and treatment therapy of CAPS for the purpose of improving the understanding, diagnosis and treatment of the disease in clinical practice. METHODS Retrospective analysis and descriptive statistics were applied to the clinical manifestations and laboratory findings of 14 CAPS cases from APS Shanghai Database (APS-SH) with catastrophic antiphospholipid. RESULTS Of the 14 CAPS patients, 12 cases satisfied the 2003 CAPS Classification Criteria accepted in the 10th International Congress on Antiphospholipid Antibody, and were diagnosed as definite APS and 2 cases were diagnosed as probable CAPS. Three cases were categorized as primary APS and 11 as APS secondary to systemic lupus erythematosus (SLE). Infection was mostly commonly seen before the onset of CAPS, followed by SLE activity and surgery. Among the involved organs, systems and tissues, brain and lung were most commonly affected sites of arterial thrombosis while peripheral vein was most commonly affected in venous thrombosis events among the clinical events. Triple positivity of anticardiolipin antibody (aCL), anti-β2 glyeoprotein I antibody (aβ2GPI), lupus anticoagulant (LA) were detected in 54.55% of the patients. Thrombocytopenia and decreased hemoglobin were frequently seen in the CAPS patients, and the majority proved to be hemolytic anemia. Of all the cases, 6 ended with death. The triple therapy strategy (anticoagulants, glucocorticoid, intravenous immunoglobulin and/or plasma exchange) could help to improve prognosis, cyclophosphamide and rituximab might benefit the patients with other comorbidities such as SLE and micro-angiopathic hemolytic anemia (MHA). CONCLUSION CAPS patients suffer from life-threatening acute multiple small vessel thrombosis with high titer of antiphospholipid antibody, potentially leading to multiple organ failure and a poor prognosis, thus early diagnosis and sufficient treatment are critical to prevent the progression of disease and improve the prognosis.
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Affiliation(s)
- J Y Gu
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - C Lu
- Department of Rheumatism, Central Hospital of Songjiang District, Shanghai 201600, China
| | - H Shi
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - C D Yang
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
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