The financial burden of health care felt by low-income families a decade ago may now affect middle-income families

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.

Download Full-text

Expansion in public health insurance for children lessens the financial burden of health care for low-income families

PsycEXTRA Dataset ◽

10.1037/e556152006-036 ◽

2006 ◽

Keyword(s):

Public Health ◽

Health Care ◽

Health Insurance ◽

Low Income ◽

Financial Burden ◽

Public Health Insurance ◽

Low Income Families

Download Full-text

Medical Debt and Catastrophic Health Expenditures among Middle- and Low-Income Families in China

10.21203/rs.2.17655/v1 ◽

2019 ◽

Author(s):

Jiajing Li ◽

Chen Jiao ◽

Lizheng Xu ◽

Stephen Nicholas ◽

Jian Wang

Keyword(s):

Low Income ◽

Concentration Index ◽

Financial Burden ◽

Medical Insurance ◽

Tobit Regression ◽

Middle Income ◽

Medical Debt ◽

Low Income Families ◽

Low And Middle Income

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 was obtained from the 2015 China Household Finance Survey and 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 a medical debt, averaging US$6278.25, or 0.56 times household yearly income; and 3.92% of low-income families had medical debts averaging US$5419.88, which was equivalent to 2.49 times 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 poor households deeper into poverty. While catastrophic health expenditure was the single most important factor in medial 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 basic medical insurance schemes to manage out-of-pocket medical expenses better and take account of pre-existing medical debt when addressing this problem.

Download Full-text

Breast Cancer in Low- and Middle-Income Countries: An Emerging and Challenging Epidemic

Journal of Oncology ◽

10.1155/2010/490631 ◽

2010 ◽

Vol 2010 ◽

pp. 1-5 ◽

Cited By ~ 32

Author(s):

Arafat Tfayli ◽

Sally Temraz ◽

Rachel Abou Mrad ◽

Ali Shamseddine

Keyword(s):

Breast Cancer ◽

Health Care ◽

Low Income ◽

Therapeutic Interventions ◽

Low Income Countries ◽

Middle Income ◽

Major Health ◽

Middle Income Countries ◽

Low And Middle Income

Breast cancer is a major health care problem that affects more than one million women yearly. While it is traditionally thought of as a disease of the industrialized world, around 45% of breast cancer cases and 55% of breast cancer deaths occur in low and middle income countries. Managing breast cancer in low income countries poses a different set of challenges including access to screening, stage at presentation, adequacy of management and availability of therapeutic interventions. In this paper, we will review the challenges faced in the management of breast cancer in low and middle income countries.

Download Full-text

PERCENTAGE OF UNINSURED CHILDREN HAS INCREASED

PEDIATRICS ◽

10.1542/peds.88.5.1051 ◽

1991 ◽

Vol 88 (5) ◽

pp. 1051-1051

Author(s):

STUDENT

Keyword(s):

Public Health ◽

United States ◽

Health Care ◽

Low Income ◽

Health Care Policy ◽

The United States ◽

Public Health Insurance ◽

Care Policy ◽

Low Income Families ◽

Uninsured Children

The proportion of children in the United States without private or public health insurance increased from roughly 13 percent to 18 percent between 1977 and 1987, according to a new study by the Agency for Health Care Policy and Research (AHCPR). The growth in the proportion of uninsured children in poor and low-income families over the decade was even more dramatic—it rose from 21 percent to 31 percent.

Download Full-text

A Randomized Controlled Trial of Prenatal Pediatric Visits for Urban, Low-income Families

PEDIATRICS ◽

10.1542/peds.98.6.1069 ◽

1996 ◽

Vol 98 (6) ◽

pp. 1069-1075

Author(s):

Janet R. Serwint ◽

Modena E. H. Wilson ◽

Judith W. Vogelhut ◽

John T. Repke ◽

Henry M. Seidel

Keyword(s):

Health Care ◽

Low Income ◽

Controlled Trial ◽

Intervention Group ◽

Care Utilization ◽

Control Group ◽

Health Maintenance ◽

Car Safety ◽

Low Income Families ◽

Safety Seat

Background. Prenatal pediatric visits have been recommended by the American Academy of Pediatrics to allow the pediatrician to counsel parents on infant care issues, establish a supportive relationship, and provide pediatric practice information to parents. We hypothesized that prenatal pediatric visits would have an impact on breastfeeding decisions, health care behaviors, health care utilization, and the doctor-patient relationship. Methods. We conducted a randomized controlled trial of prenatal pediatric visits for urban, low-income families to measure the impact on breastfeeding decisions, infant car safety seat use, circumcision, health maintenance, and emergency room visits and the pediatrician's perception that he/she would know the mother better. Pregnant women were recruited prenatally from the obstetrics clinic. Outcomes were measured by maternal interview prenatally and when the infant was 2 months old, in addition to review of the nursery record. Physicians were interviewed after the 2-month visit. Health care utilization was measured by chart review at 7 months. Results. A total of 156 pregnant women were enrolled and randomized, 81 to the intervention group and 75 to the control group. Of mothers who breastfed, 45% in the intervention group changed their mind in favor of breastfeeding after enrollment compared with 14% in the control group. Mothers in the intervention group compared with the control group were more likely to make fewer emergency room visits, 0.58 compared with 1.0. Pediatricians were more likely to think that they knew mothers in the intervention group well, 54% versus 29% in the control group, yet 67% of mothers in both groups agreed their pediatrician knew them well. There were no differences between groups in initiation or duration of breastfeeding at 30 or 60 days, infant car safety seat use, circumcision, or health maintenance visits. Conclusions. Prenatal pediatric visits have potential impact on a variety of health care outcomes. Among urban, low-income mothers, we found beneficial effects on breastfeeding decisions, a decrease in emergency department visits, and an initial impact on the doctor-patient relationship. We suggest urban practices actively promote prenatal pediatric visits.

Download Full-text

Barriers to Health Care Access for Low Income Families: A Review of Literature

Journal of Community Health Nursing ◽

10.1080/07370016.2018.1404832 ◽

2018 ◽

Vol 35 (1) ◽

pp. 28-37 ◽

Cited By ~ 14

Author(s):

Malerie Lazar ◽

Lisa Davenport

Keyword(s):

Health Care ◽

Low Income ◽

Health Care Access ◽

Review Of Literature ◽

Barriers To Health Care ◽

Care Access ◽

Low Income Families ◽

Barriers To Health

Download Full-text

HEALTH CARE FOR JUVENILE DELINQUENTS

PEDIATRICS ◽

10.1542/peds.52.3.434 ◽

1973 ◽

Vol 52 (3) ◽

pp. 434-435

Author(s):

Victor Eisner ◽

Robert I. Sholtz

Keyword(s):

Health Care ◽

Juvenile Delinquency ◽

Young People ◽

Low Income ◽

Juvenile Delinquents ◽

Juvenile Court ◽

National Council ◽

Health Supervision ◽

Low Income Families ◽

Detention Facilities

Pediatricians have long interested themselves in the health of juvenile delinquents. The Academy first appointed a Committee on Juvenile Delinquency in 1955. Although this Committee has changed its title to the Committee on Youth and has expanded its role to include other problems and concerns of young people, it still concerns itself with the health supervision of youth in detention facilities. It has now developed, with the endorsement of the National Council of Juvenile Court Judges, written standards for health care provided in juvenile court institutions.1 Juvenile delinquents come largely from low income families, and often from families with serious social problems.

Download Full-text