The impacts of multiple healthcare reforms on catastrophic health spending for poor households in China

2021 ◽  
pp. 114271
Author(s):  
Kai Liu ◽  
Qian Zhang ◽  
Alex Jingwei He
Keyword(s):  
Health Spending ◽  
Catastrophic Health Spending ◽  
Poor Households ◽  
Healthcare Reforms

Abstract P140: High Poverty Among Patients With Noncommunicable Diseases in Rural Haiti

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Gene F Kwan ◽  
Benito Isaac ◽  
Lily Yan ◽  
Waking Jean-Baptiste ◽  
Densa Belony ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Low Income ◽  
Child Death ◽  
Health Spending ◽  
Low Income Countries ◽  
Noncommunicable Diseases ◽  
Major Barrier ◽  
Catastrophic Health Spending ◽  
Poverty Indicators ◽  
Clinic Visits

Background: Noncommunicable diseases (NCDs) are a major and growing cause of death and disability in low-income countries, and contribute a substantial portion of outpatient clinic visits. Poverty can be a major barrier to accessing healthcare in rural low-income countries. The objective of this study is to describe the demographics and socioeconomic status of patients attending an NCD clinic in rural Haiti, where poverty is highly prevalent. Methods: We analyzed routinely collected clinic data from adult patients in rural Haiti presenting to the NCD clinic at Hôpital Universitaire de Mirebalais. We collected data during routine initial clinic visits from July 2013 through October 2016. We performed descriptive statistics to assess patient demographics and socioeconomic status using available data. We evaluated poverty based on the Multidimensional Poverty Index by evaluating 9 indicators within three dimensions: health, education, and standard of living - we did not assess electricity. We assessed deprivation within each indicator. The “poorest” patients were defined as those deprived in 4 of the 9 poverty indicators. We also assessed measures of catastrophic health spending. Results: A total of 518 adults were included, with 72% (373/508) women. The mean overall age was 52.8 years (SD 14.7) and 21% (108/518) were 40 years old or younger. Of the patients, 32% had only hypertension, 18% had only diabetes, 32% had both diabetes and hypertension, 5% had heart failure, and 13% had no recorded diagnosis. 45% of patients travel more than 1 hour for clinic visits. Almost half (49%, 146/296) of adults sold belongings and 61% (178/292) borrowed money to pay for healthcare. Among the poverty measures, the top indicators with deprivation were cooking fuel with charcoal or wood (96%, 290/302), child death in household (70%, 169/243), and no household members completing primary school (25%, 83/324), lack of household assets (25%, 79/313), poor sanitation (19%, 59/304), dirt floor (16%, 50/304), and lack of improved drinking water (9%, 29/308). Of all patients, 21% (78/378) were among the poorest. Throughout Haiti, however, 55% of the population are among the poorest. There were more patients among the poorest living closer to the hospital (27%) than living farther away (10%). Interpretation: The great majority of patients were middle-aged women, with predominantly hypertension and/or diabetes. Socioeconomic deprivation was high among many poverty indicators and most patients experienced catastrophic health spending. At this clinic in rural Haiti, the proportion of patients presenting for care who are among the poorest is less than that overall in Haiti. Patients who travel far distances have less poverty. Health systems for chronic disease management in rural low-income countries must account for patient poverty.

scholarly journals Financial risk protection of Thailand’s universal health coverage: results from series of national household surveys between 1996 and 2015

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Viroj Tangcharoensathien ◽  
Kanjana Tisayaticom ◽  
Rapeepong Suphanchaimat ◽  
Vuthiphan Vongmongkol ◽  
Shaheda Viriyathorn ◽  
...  
Keyword(s):  
Universal Health Coverage ◽  
Financial Risk ◽  
Health Spending ◽  
Poverty Line ◽  
Health Coverage ◽  
Financial Risk Protection ◽  
Catastrophic Health Spending ◽  
Risk Protection ◽  
Universal Health ◽  
Benefits Package

Abstract Background Thailand, an upper-middle income country, has demonstrated exemplary outcomes of Universal Health Coverage (UHC). The country achieved full population coverage and a high level of financial risk protection since 2002, through implementing three public health insurance schemes. UHC has two explicit goals of improved access to health services and financial protection where use of these services does not create financial hardship. Prior studies in Thailand do not provide evidence of long-term UHC financial risk protection. This study assessed financial risk protection as measured by the incidence of catastrophic health spending and impoverishment in Thai households prior to and after UHC in 2002. Methods We used data from a 15-year series of annual national household socioeconomic surveys (SES) between 1996 and 2015, which were conducted by the National Statistic Office (NSO). The survey covered about 52,000 nationally representative households in each round. Descriptive statistics were used to assess the incidence of catastrophic payment as measured by the share of out-of-pocket payment (OOP) for health by households exceeding 10 and 25% of household total consumption expenditure, and the incidence of impoverishment as determined by the additional number of non-poor households falling below the national and international poverty lines after making health payments. Results Using the 10% threshold, the incidence of catastrophic spending dropped from 6.0% in 1996 to 2% in 2015. This incidence reduced more significantly when the 25% threshold was applied from 1.8 to 0.4% during the same period. The incidence of impoverishment against the national poverty line reduced considerably from 2.2% in 1996 to approximately 0.3% in 2015. When the international poverty line of US$ 3.1 per capita per day was applied, the incidence of impoverishment was 1.4 and 0.4% in 1996 and 2015 respectively; and when US$ 1.9 per day was applied, the incidence was negligibly low. Conclusion The significant decline in the incidence of catastrophic health spending and impoverishment was attributed to the deliberate design of Thailand’s UHC, which provides a comprehensive benefits package and zero co-payment at point of services. The well-founded healthcare delivery system and favourable benefits package concertedly support the achievement of UHC goals of access and financial risk protection.

scholarly journals Catastrophic health spending in Mexico and its determinants, 2002-2014

2019 ◽  
Vol 153 (7) ◽  
Author(s):  
Román Rodríguez-Aguilar ◽  
Gustavo Rivera-Peña
Keyword(s):  
Health Spending ◽  
Catastrophic Health Spending

scholarly journals Financial risk protection of Thailand’s Universal Health Coverage: results from series of national household surveys between 1996 and 2015

2020 ◽  
Author(s):  
Viroj Tangcharoensathien ◽  
Kanjana Tisayaticom ◽  
Rapeepong Suphanchaimat ◽  
Vuthiphan Vongmongkol ◽  
Shaheda Viriyathorn ◽  
...  
Keyword(s):  
Universal Health Coverage ◽  
Financial Risk ◽  
Health Spending ◽  
Poverty Line ◽  
Health Coverage ◽  
Financial Risk Protection ◽  
Catastrophic Health Spending ◽  
Out Of Pocket Payments ◽  
Risk Protection ◽  
Universal Health

Abstract Background: Thailand, an upper-middle income country, has demonstrated exemplary outcomes of Universal Health Coverage (UHC). The country achieved full population coverage and a high level of financial risk protection since 2002, through implementing three public health insurance schemes. UHC has two explicit goals of improved access to health services and financial protection where use of these services does not create financial hardship. Prior studies in Thailand do not however provide evidence of long-term UHC financial risk protection. This study assessed financial risk protection as measured by the incidence of catastrophic health spending and impoverishment in Thai households prior to and after UHC in 2002.Methods: We used data from a fifteen-year series of annual national household socioeconomic surveys between 1996 and 2015, which were conducted by the National Statistical Office. The survey covered about 52,000 nationally representative households in each round. Descriptive statistics were used to assess the incidence of catastrophic payment as measured by the share of out-of-pocket payments for health by households exceeding 10% and 25% of household total consumption expenditure, and the incidence of impoverishment as determined by the additional number of non-poor households falling below the national and international poverty lines after making health payments. Results: Using the 10% threshold, the incidence of catastrophic spending dropped from 6.0% in 1996 to 2% in 2015. This incidence reduced more significantly when the 25% threshold was applied from 1.8% to 0.4% during the same period. The incidence of impoverishment against the national poverty line reduced considerably from 2.2% in 1996 to approximately 0.3% in 2015. When the international poverty line of US$ 3.1 per capita per day was applied, the incidence of impoverishment was 1.4% and 0.4% in 1996 and 2015 respectively; and when US$ 1.9 per day was applied, the incidence was negligibly low. Conclusion: The significant decline in the incidence of catastrophic health spending and impoverishment was attributed to the deliberate design of Thailand’s UHC, which provides a comprehensive benefits package and zero co-payment at point of services. The well-founded healthcare delivery system and favourable benefit package concertedly support the achievement of UHC goals of access and financial risk protection.

Multi-Layered Catastrophic Health Spending of Inpatient Women by Broad Group of Diseases in India

2021 ◽  
Vol 30 ◽  
pp. 183-206
Author(s):  
Manali Swargiary ◽  
◽  
Hemkhothang Lhungdim ◽  
Mrinmoy Pratim Bharadwaz ◽  
◽  
...  
Keyword(s):  
Rural Areas ◽  
Economic Status ◽  
Health Spending ◽  
Binary Logistic Regression ◽  
National Sample ◽  
Sample Survey ◽  
Public Health Services ◽  
Indian Women ◽  
Catastrophic Health Spending ◽  
Out Of Pocket Payments

Healthcare for Indian women needs prioritizing, as they continue to face social and economic discrimination over their healthcare, often with high out-of-pocket payments. The study examines the amount inpatient women have to pay for treatment of major diseases, re-classified into four groups as infectious, reproductive, non-communicable diseases (NCDs), and disabilities & injuries, across the country to comprehend the extent of catastrophic health spending (CHS) they experienced. The study is based on India’s 75th round of the National Sample Survey (NSS), i.e., Household Social Consumption: Health (2017-2018), consisting of 26,938 inpatient women aged 12 and above from India's urban and rural areas. We examine the prevalence of the four categories of diseases by individual, household, community, and healthcare characteristics. Expenditure estimates were derived from cross-tabulation, followed by binary logistic regression to assess the association between covariates and inpatient expenditures for the diseases. Indian women are more likely to be hospitalized for infectious diseases (43%), but the burden of CHS (overall) is highest for disabilities and injuries (INR 24,414), followed by NCDs (INR 23,053). Duration of hospitalization and possession of health insurance by women indicate maximum variation with medical spending. Almost 97% of women have incurred out-of-pocket expenditure on hospitalization, from which we identify three layers of CHS. A substantial proportion of women (23 to 50%) experienced CHS, i.e., up to 0-10%, 11-30%, and >30%, which varies distinctively by place of residence and across the six regions. Covariates like age, economic status, and healthcare are highly significant and associated with disease-wise CHS thresholds. Women in India face divergent financial hardships for healthcare. Given the heterogeneity of morbidities and socio-economic characteristics, the need for women-sensitive public health services and interventions are evident.

Does remittance protect the household from catastrophic health expenditure in India

2020 ◽  
Vol 16 (4) ◽  
pp. 481-493
Author(s):  
Milan Das ◽  
Kaushalendra Kumar ◽  
Junaid Khan
Keyword(s):  
Health Expenditure ◽  
Health Care Expenditure ◽  
Health Spending ◽  
Binary Logistic Regression ◽  
Catastrophic Health Expenditure ◽  
Economic Research ◽  
National Council ◽  
Data Set ◽  
Content Type ◽  
Catastrophic Health Spending

Purpose The purpose of this paper is to examine the dynamic nature of the catastrophic health expenditure (CHE) on remittances receiving households between 2005 and 2012 in India. Design/methodology/approach The study adopted Xu’s (2005) definition of catastrophic health-care expenditure. And also used binary logistic regression to examine the effects of remittances being received on CHE in households across India. The data were drawn from the two rounds of the India Human Development Survey conducted by the University of Maryland, the USA, and the National Council of Applied Economic Research, New Delhi, India. Findings The results show that the percentage of households received remittances, and that the amount of remittances received has substantially increased during 2005 and 2012, though variation is evident by socioeconomic and demographic characteristics of the household. Apparently, the variation (percentage of households received remittances) is more pronounced for factors such as household size, number of 60+ elderly, sectors and by regions. Household’s catastrophic health spending and remittances being received show a statistically significant association. Households which received remittances during both the time showed the lowest likelihood (AOR:0.82; p-value < 0.10; 95% CI:0.64–1.03) to experience catastrophic health spending. Originality/value The paper identified the research gap to examine the occurrence of catastrophic health spending by remittances receiving status of the household using a novel panel data set.

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