Out-of-pocket payments and catastrophic household expenditure to access essential surgery in Malawi - A cross-sectional patient survey

ObjectiveTo examine the impact of cigarette price and smoking environment on allocation of household expenditure and its implication on nutrition consumption.DesignA cross-sectional study was conducted using the 2014 National Socioeconomic Survey (SUSENAS), the 2014 Village Potential Survey (PODES) and the 2013 Basic National Health Survey (RISKESDAS). SUSENAS and PODES data were collected by the Central Bureau of Statistics. RISKESDAS was conducted by National Institute of Health Research and Development (Balitbangkes), Indonesian Ministry of Health (MOH).Setting and participantsThe sample covered all districts in Indonesia; with sample size of 285 400 households. These households are grouped into low, medium and high smoking prevalence districts.Primary and secondary outcome measuresThe impact of cigarette price and smoking environment on household consumption of cigarette, share of eight food groups, as well as calorie and protein intake.Result1% increase in cigarette price will increase the cigarette budget share by 0.0737 points and reduce the budget share for eggs/milk, prepared food, staple food, nuts, fish/meat and fruit, from 0.0200 points (eggs/milk) up to 0.0033 points (fruit). Reallocation of household expenditure brings changes in food composition, resulting in declining calorie and protein intake. A 1% cigarette price increase reduces calorie and protein intake as much as 0.0885% and 0.1052%, respectively. On the other hand, existence of smoke-free areas and low smoking prevalence areas reduces the household budget for cigarettes.ConclusionA pricing policy must be accompanied by non-pricing policies to reduce cigarette budget share.

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Catastrophic Household Expenditure Associated with Out-of-Pocket Healthcare Payments in Spain

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18030932 ◽

2021 ◽

Vol 18 (3) ◽

pp. 932

Author(s):

Samuel López-López ◽

Raúl del Pozo-Rubio ◽

Marta Ortega-Ortega ◽

Francisco Escribano-Sotos

Keyword(s):

Health Care ◽

Logistic Regression ◽

Regression Models ◽

Financial Risk ◽

Household Expenditure ◽

Financial Protection ◽

Logistic Regression Models ◽

Ordered Logistic Regression ◽

Out Of Pocket Payments ◽

The Subject

Background. The financial effect of households’ out-of-pocket payments (OOP) on access and use of health systems has been extensively studied in the literature, especially in emerging or developing countries. However, it has been the subject of little research in European countries, and is almost nonexistent after the financial crisis of 2008. The aim of the work is to analyze the incidence and intensity of financial catastrophism derived from Spanish households’ out-of-pocket payments associated with health care during the period 2008–2015. Methods. The Household Budget Survey was used and catastrophic measures were estimated, classifying the households into those above the threshold of catastrophe versus below. Three ordered logistic regression models and margins effects were estimated. Results. The results reveal that, in 2008, 4.42% of Spanish households dedicated more than 40% of their income to financing out-of-pocket payments in health, with an average annual gap of EUR 259.84 (DE: EUR 2431.55), which in overall terms amounts to EUR 3939.44 million (0.36% of GDP). Conclusion. The findings of this study reveal the existence of catastrophic households resulting from OOP payments associated with health care in Spain and the need to design financial protection policies against the financial risk derived from facing these types of costs.

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Hospital Processes and the Nurse-Patient Interaction in Breast Cancer Care. Findings from a Cross-Sectional Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18158224 ◽

2021 ◽

Vol 18 (15) ◽

pp. 8224

Author(s):

Johanna Sophie Lubasch ◽

Susan Lee ◽

Christoph Kowalski ◽

Marina Beckmann ◽

Holger Pfaff ◽

...

Keyword(s):

Breast Cancer ◽

Social Support ◽

Cancer Patients ◽

Perceived Social Support ◽

Patient Characteristics ◽

Patient Survey ◽

Breast Cancer Patients ◽

Cross Sectional ◽

Patient Interaction ◽

Hospital Structures

(1) Background: Evidence suggests that organizational processes of hospitals have an impact on patient-professional interactions. Within the nurse-patient interaction, nurses play a key role providing social support. Factors influencing the nurse-patient interaction have seldomly been researched. We aimed to examine whether the process organization in hospitals is associated with breast cancer patients’ perceived social support from nurses.; (2) Methods: Data analysis based on a cross-sectional patient survey (2979 breast cancer patients, 83 German hospitals) and information on hospital structures. Associations between process organization and perceived social support were analyzed with logistic hierarchical regression models adjusted for patient characteristics and hospital structures.; (3) Results: Most patients were 40–69 years old and classified with UICC stage II or III. Native language, age and hospital ownership status showed significant associations to the perception of social support. Patients treated in hospitals with better process organization at admission (OR 3.61; 95%-CI 1.67, 7.78) and during the hospital stay (OR 2.11; 95%-CI 1.04; 4.29) perceived significantly more social support from nurses.; (4) Conclusions: Designing a supportive nursing work environment and improving process organization in hospitals may create conditions conducive for a supportive patient-nurse interaction. More research is needed to better understand mechanisms behind the associations found.

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Trend and status of out-of-pocket payments for healthcare in Iran: equity and catastrophic effect

Journal of Egyptian Public Health Association ◽

10.1186/s42506-020-00055-w ◽

2020 ◽

Vol 95 (1) ◽

Author(s):

Satar Rezaei ◽

Abraha Woldemichael ◽

Mohammad Ebrahimi ◽

Sina Ahmadi

Keyword(s):

Household Income ◽

Cross Sectional Study ◽

Publicly Funded ◽

Socioeconomically Disadvantaged ◽

Time Series Regression ◽

Cross Sectional ◽

Out Of Pocket Payments ◽

Main Determinants ◽

Over Time ◽

Yearly Data

Abstract Background Equity in the distribution of health care resources and mitigating the risk of out-of-pocket (OOP) catastrophic healthcare expenditures (CHE) are the major objectives of the health system of a country. This study aims to measure equity in OOP payments for healthcare and the incidence of CHE among Iranian households over time. Methods This retrospective cross-sectional study utilized data extracted from the household income and expenditure survey (HIES) of Iran, collected by the Statistical Center of Iran. The analysis included a total of 174,341 households’ five yearly data of 6 years starting from 1991 to 2017. Kakwani progressivity index (KPI) was used to measure the equity in OOP payment for each year and examine the households’ incidence of CHE at 20%, 30%, and 40% of their capacities to pay (CTP). The trend series regression analysis was used to examine the trend in the KPI and the incidence of the CHE over time. Results The findings indicated that the households’ expenditure on health out of their monthly budgets for the years 1991 and 2017 were 2.1% and 10.1%, respectively. The KPI for the OOP payment was negative for all 6-year observations (1991 = − 0.680; 1996 = − 0.608; 2001 = − 0.554; 2006 = − 0.265; 2011 = − 0.225, and 2017 = − 0.207), indicating that the OOP payments for healthcare are regressive and more concentrated among the socioeconomically disadvantaged households. There was a statistically significant (p = 0.003) increase in the KPI (i.e., decline in the regressivity) over time. The incidence of the CHE (1.12, 1.93, and 3.71%) in 1991 at the CTP levels of 20%, 30%, and 40% was lower than the incidence at the corresponding levels of CTP (5.26, 10.88, and 22.16) in 2017. The findings of the time-series regression indicated a statistically significant (p < 0.05) increase in the incidence of the CHE at the 20%, 30%, and 40% levels of the households’ CTP. Conclusions The current study demonstrated that OOP payment as a source of healthcare funding in Iran is inequitable. While the use of interventions such as the prepaid and publicly funded programs may contribute to the reduction of CHE and improvement of equity in healthcare financing, further inequality analyses in the incidence of the CHE among households and its main determinants can contribute to evidence-informed planning to reduce the CHE in the context.

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The Risk of Catastrophic Health Expenditures Due to Direct Non-Medical Costs in Patients: A Study of the Outpatients in Qazvin, Iran

International Journal of Health and Life Sciences ◽

10.5812/ijhls.106944 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Saeed Asefzadeh ◽

Bahman Ahadi Nezhad ◽

Saeed Norouzi

Keyword(s):

Health Expenditures ◽

Medical Costs ◽

Healthcare Services ◽

Disease Diagnosis ◽

Cross Sectional Survey ◽

Diagnostic Laboratory ◽

Cross Sectional ◽

Out Of Pocket Payments ◽

Catastrophic Health Expenditures ◽

Catastrophic Expenditures

Background: Out-of-pocket payment encompasses the costs that patients pay for healthcare services, which is an inefficient approach to healthcare financing as it may lead to poverty. Objectives: The present study aimed to determine the risk of catastrophic health expenditures due to non-medical costs in the outpatients in Qazvin, Iran. Methods: This cross-sectional survey was conducted on 341 outpatients referring to the internists of Velayat Hospital and Bu-Ali Sina Hospital in Qazvin. The required data were collected using a researcher-made questionnaire and the prescriptions of the patients. Out-of-pocket payments were defined as the direct medical and non-medical costs within one month. Results: The mean out-of-pocket payments of the patients in one month was 49.97 dollars, 75.8% of which covered direct medical cost (disease diagnosis and treatment), and 24.2% covered direct non-medical costs to receive health services. The highest out-of-pocket payments were for diagnostic/laboratory tests (50.3%), medications (21.5%), and transportation (18.2%). In addition, the exposure rate to catastrophic expenditures was estimated at 31%, and the patients with lower income had less exposure compared to those without incomes. Conclusions: According to the results, direct non-medical costs were associated with the increased out-of-pocket payments of the patients, which in turn led to the higher rates of catastrophic expenditures.

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What is associated with increased side effects and lower perceived efficacy following switching to a generic medicine? A New Zealand cross-sectional patient survey

BMJ Open ◽

10.1136/bmjopen-2018-023667 ◽

2018 ◽

Vol 8 (10) ◽

pp. e023667 ◽

Cited By ~ 9

Author(s):

Kate MacKrill ◽

Keith J Petrie

Keyword(s):

New Zealand ◽

Side Effects ◽

Generic Version ◽

Drug Efficacy ◽

Patient Survey ◽

Generic Medicine ◽

Cross Sectional Survey ◽

Online Questionnaire ◽

Cross Sectional ◽

Perceived Efficacy

ObjectiveFollowing a switch from either a generic or branded antidepressant (venlafaxine) to a new generic, we investigated the factors associated with a preference for branded medicines, side effects reported following switching and efficacy ratings of the new generic drug.DesignA cross-sectional survey of patients switched to a new generic.SettingPatients accessing venlafaxine information online from the New Zealand government pharmaceuticals funding website.Participants310 patients, comprising 205 originally on branded venlafaxine and 105 previously taking a generic version.Main outcome measuresAn online questionnaire assessing demographic factors, perceived sensitivity to medicines, trust in pharmaceutical agencies, sources of switch information, preference for branded medicine, new medicine perceptions, side effects and efficacy ratings.ResultsPreference for branded medicine was significantly stronger in older patients (OR=1.04, 95% CI 1.01 to 1.05), those taking branded venlafaxine (OR=2.02, 95% CI 1.13 to 3.64) and patients with a higher perceived sensitivity to medicine (OR=1.23, 95% CI 1.06 to 1.19). Different factors predicted side effects in those switching from the branded and those switching from the generic venlafaxine. Trust in pharmaceutical agencies and the number of side effects were significant predictors of efficacy ratings of the new generic in both patients switching from a branded and those switching from a generic version of venlafaxine.ConclusionsIn patients switching from a branded medicine and those already taking a generic, different demographic and psychological factors are associated with preference for branded medicine, side effect reporting and perceived efficacy of the new drug. When switching to new generic, there appears to be a close bidirectional relationship between the experience of side effects and perceived drug efficacy. Trust in pharmaceutical agencies impacts directly on perceived efficacy and increasing such trust could reduce the nocebo response following a generic switch.

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Satisfaction with botulinum toxin treatment in poststroke spasticity: Results from a cross-sectional patient survey

Annals of Physical and Rehabilitation Medicine ◽

10.1016/j.rehab.2013.07.1023 ◽

2013 ◽

Vol 56 ◽

pp. e399

Author(s):

D. Bensmail

Keyword(s):

Botulinum Toxin ◽

Patient Survey ◽

Cross Sectional ◽

Botulinum Toxin Treatment

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A cross-sectional study on global disparities in information experiences of patients with lymphoma/CLL.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18517 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18517-e18517

Author(s):

Olufunmilayo Bamigbola ◽

Natalie Dren ◽

Lorna Warwick

Keyword(s):

Side Effects ◽

Medical Information ◽

Information Source ◽

Treatment Options ◽

Information Provision ◽

Patient Advocacy ◽

Patient Survey ◽

Cross Sectional ◽

Treatment Side Effects ◽

First Choice

e18517 Background: Patient-centricity remains a cornerstone in the care of patients with lymphoma and CLL, as informed patients are consistently associated with better outcomes and experiences. This study uses the Lymphoma Coalition (LC) 2020 Global Patient Survey (GPS) on Lymphomas and CLL to describe the global differences in the top choices for medical information among patients with lymphoma, as well as differences in their understanding of this information relating to various aspects of their care. Methods: Globally, 9,179 patients from 89 countries took part in the LC 2020 GPS. The countries were grouped into regions, and the regions with greater than 200 patients were included in the analysis (Table). The demographics of the regions were examined, and descriptive analyses of questions relating to information source preferences, information provision at diagnosis (addressing treatment options; process and stages of care; managing treatment side effects), and corresponding levels of patient understanding were performed in IBM SPSS v27. Results: Doctors were the first choice for medical information for patients in each region (SA-82%, AS- 75%, EU-69%, OC-63%, NA-61%). In EU, NA and SA, websites were the most prevalent second and third choice for information (27% and 28%; 30% and 32%; 35% and 27%, respectively). In AS, patient advocacy organisations were the most prevalent second and third choices for information (32% and 40%, respectively), while in OC, the most prevalent second and third choices were nurses (27%) and patient advocacy groups (32%) respectively. Over a fifth of NA patients were not given information on the process and stages of care and how to manage side effects of treatment (21% and 29%, respectively). About a third of patients from SA (32%) reported not getting information on treatment options. Over half of OC patients reported being given information on and completely understanding the different treatment options (51%), processes and stages of care (53%) and how to manage treatment side-effects (58%). Patients from AS were the most prevalent in reporting across the three categories, that they were given information but did not understand it (10%, 7%, 5%, respectively). Conclusions: Globally, patients with lymphoma use various avenues to source the medical information they need, and they differ in their information experiences. Access to appropriate and adequate medical information remains an essential aspect of a successful patient experience and LC advocates that this information be contextual and accessible to all patients with lymphoma. [Table: see text]

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A decline in patient disclosure of heterosexuality in the English General Practice Patient Survey: a longitudinal analysis of cross-sectional data

Family Practice ◽

10.1093/fampra/cmaa033 ◽

2020 ◽

Vol 37 (5) ◽

pp. 661-667

Author(s):

Harry Cross ◽

Carrie D Llewellyn

Keyword(s):

Health Care ◽

General Practice ◽

Sexual Orientation ◽

Descriptive Analysis ◽

Patient Survey ◽

Cross Sectional ◽

Orientation Data ◽

Heterosexual Identity ◽

Health Care Experiences ◽

Practice Patient

Abstract Background Persistent health inequalities in relation to both health care experiences and health outcomes continue to exist among patients identifying with a marginalized sexual orientation (MSO). Objective To compare the patterns of sexual orientation disclosure within primary care in England over a 5-year period. Methods Descriptive analysis of cross-sectional, repeat measure, fully anonymized survey data of adults responding to the General Practice Patient Survey (GPPS) January 2012 to 2017. Participants from each year varied between 808 332 (2017) and 1 037 946 (2011/2012). Results The analysis samples comprised between 396 963 and 770 091 individuals with valid sexual orientation data depending on the year. For males, heterosexual disclosure decreased consistently from 92.3% to 91.2% from 2012 to 2017. Male patients reporting gay, bisexual and/or ‘other’ sexual orientations increased from 3.1% to 3.9%. For females, a larger reduction in heterosexual disclosure was recorded from 94% to 92.5%. Those reporting as lesbian, bisexual and/or ‘other’ increased from 1.82% to 2.68%, with the largest increase seen in the reporting of bisexuality, which nearly doubled from 2012 until 2017 (0.56–0.99%). Conclusion We found a year-on-year decline in patients reporting a heterosexual identity and an increase in the proportions of people reporting being either gay, bisexual, ‘other sexual orientation’ or preferring not to say. Heteronormative environments extend to health care settings, which may put increased stress on MSO individuals attending a GP practice. The introduction of environmental signs/symbols to show that a practice is inclusive of MSOs could reduce the potential stress experienced by patients.

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