Treatment as insurance: HIV antiretroviral therapy offers financial risk protection in Malawi

2020 ◽  
Vol 35 (6) ◽  
pp. 676-683
Author(s):  
Sarah Dickerson ◽  
Victoria Baranov ◽  
Jacob Bor ◽  
Jeremy Barofsky
Keyword(s):  
Health Expenditure ◽  
Financial Risk ◽  
Health Expenditures ◽  
Catastrophic Health Expenditure ◽  
Hiv Treatment ◽  
Financial Risk Protection ◽  
Urban Households ◽  
Medical Spending ◽  
Risk Protection ◽  
The Impact

Abstract Many countries have expanded insurance programmes in an effort to achieve universal health coverage (UHC). We assess a complementary path toward financial risk protection: increased access to technologies that improve health and reduce the risk of large health expenditures. Malawi has provided free HIV treatment since 2004 with significant US Government support. We investigate the impact of treatment access on medical spending, capacity to pay and catastrophic health expenditures at the population level, exploiting the phased rollout of HIV treatment in a difference-in-differences design. We find that increased access to HIV treatment generated a 10% decline in medical spending for urban households, a 7% increase in capacity to pay for rural households and a 3-percentage point decrease in the likelihood of catastrophic health expenditure among urban households. These risk protection benefits are comparable to that found from broad-based insurance coverage in other contexts. Our findings show that targeted treatment programmes that provide free care for high burden causes of death can provide substantial financial risk protection against catastrophic health expenditure, while moving developing nations toward UHC.

scholarly journals Changes in Catastrophic Health Expenditures Depending on Health Policies in Turkey

2021 ◽  
Vol 8 ◽  
Author(s):  
Guvenc Kockaya ◽  
Gülpembe Oguzhan ◽  
Zafer Çalşkan
Keyword(s):  
Health Services ◽  
Health Expenditure ◽  
Positive Impact ◽  
Health Expenditures ◽  
Catastrophic Health Expenditure ◽  
Health Policies ◽  
World Health ◽  
Positive Health ◽  
Catastrophic Health Expenditures ◽  
The Impact

Without any financial protection out of pocket health expenses are essential both because their increase causes difficulties in accessing higher quality health services for households and more importantly because it complicates access to most basic health services. As a result of the Health Transformation Program in practice in the Turkish healthcare system since 2003, significant changes have been done in all layers of the health system. Turkish Statistics Institute (TurkStat) publishes the ratio of households that bear catastrophic health expenditures since 2002. According to TurkStat data, the ratio of households with catastrophic expenditure has fallen from 0.81% in 2002 to 0.17% in 2011 with the health transformation project. However, it has started to rise since 2012 and has reached 0.31% in 2014. This study aims to evaluate the expenditure items that may have caused the rise of the ratio of households with catastrophic health expenditures since 2012, which had previously dropped with the Health Transformation Program that has caused fundamental changes in health policies. Methodology and definitions presented in the article named “Distribution of health payments and catastrophic expenditures: Methodology” by Ke Xu published by the World Health Organization in 2005 have been used. Percentages of health expenditure items among the total expenditure of households with positive health expenditure and households with catastrophic health expenditure between 2007 and 2014 have been evaluated using descriptive analysis. Findings have been interpreted in light of the health policies in practice between 2007 and 2014. An overview of the impact of the health policies reveals that medicine expenditures have decreased both for household and public health expenditures. Despite the impact of policies on the pharmaceutical industry was criticized by the industry, the positive impact can be seen by the decrease in the spending on medicine for households spending on health. Hospital service with positive health expenditure is seen to decrease health expenditure. The reasons for the increase in households with catastrophic health expenditure need further research. As a result, the study strives to discuss the possible policy reasons for the observed effects.

scholarly journals Spatiotemporal variation and socioeconomic factors of financial hardships of out-of-pocket health expenditure in Pakistan

2021 ◽  
Vol 27 (10) ◽  
pp. 962-973
Author(s):  
Ashar Muhammad Malik ◽  
Iqbal Azam ◽  
Amir Khan ◽  
Faisal Rifaq ◽  
Kinza Chaudhary
Keyword(s):  
Socioeconomic Factors ◽  
Rural Areas ◽  
Health Expenditure ◽  
Financial Risk ◽  
National Level ◽  
Spatiotemporal Variation ◽  
Financial Risk Protection ◽  
Middle Income ◽  
Services Delivery ◽  
Risk Protection

Background: Financial hardships of out-of-pocket health expenditure (OPHE) is a growing concern for health policy makers in many low and middle-income countries. Spatiotemporal variation between Pakistan’s four provinces over 2001-2015 is discussed, which would help comparing existing health services delivery and financial risk protection plans. Aims: In this paper, we estimate financial hardship of OPHE in Pakistan. Methods: We use the data sets of the household integrated economic surveys 2001-02, 2005-06, 2010-11 and 2015-16. We estimate OPHE share in household total and non-subsistence expenditure, catastrophic headcount at the threshold of OPHE ≥ 10% of total expenditure or OPHE ≥ 25% of non-subsistence expenditure. We estimate impoverishment of OPHE using national poverty lines. Finally, we explore socioeconomic factors of financial hardships of OPHE. Results: Over the years, catastrophic headcount and impoverishment of OPHE had decreased at national level (–1.3% points) and in the provinces of Sindh (-7.8% points) and Khyber Pukhtoonkhawa (KPK), (–2.8% points). The province of KPK and the year 2005-06 witnessed the highest incidence of financial catastrophe (26.89% points) and impoverishment (4.8% points) of OPHE. Households in rural areas, in the middle and rich quintiles and those headed by a male were more likely to encounter financial catastrophe and impoverishment due to OPHE. Conclusion: Inter-provincial variation in financial hardships of OPHE provide aide to provincial level priority setting. The high impact of OPHE in the non-poor, in rural areas, and in KPK calls for enhanced targeting of financial risk protection plans.

scholarly journals What has been the progress in addressing financial risk in Uganda?  Analysis of catastrophe and impoverishment due to health payments

2020 ◽  
Author(s):  
Brendan Kwesiga ◽  
Tom Aliti ◽  
Pamela Nabukhonzo ◽  
Susan Najjuko ◽  
Peter Byawaka ◽  
...  
Keyword(s):  
Health Care ◽  
Health Services ◽  
Financial Risk ◽  
Poverty Line ◽  
Financial Risk Protection ◽  
Quality Health Care ◽  
Targeted Interventions ◽  
Out Of Pocket Payments ◽  
Risk Protection ◽  
The Impact

Abstract Background: Monitoring progress towards Universal Health Coverage (UHC) requires an assessment of progress in coverage of health services and protection of households from the impact of direct out-of-pocket payments (i.e. financial risk protection). Although Uganda has expressed aspirations for attaining UHC, out-of-pocket payments remain a major contributor to total health expenditure. This study aims to monitor progress in financial risk protection in Uganda. Methods: This study uses data from the Uganda National Household Surveys for 2005/06, 2009/10, 2012/13 and 2016/17. We measure financial risk protection using catastrophic health care payments and impoverishment indicators. Health care payments are catastrophic if they exceed a set threshold (i.e. 10% and 25%) of the total household consumption expenditure. Health payments are impoverishing if they push the household below the poverty line (the US$1.90/day and Uganda’s national poverty lines). A logistic regression model is used to assess the factors associated with household financial risk.Results: The results show that while progress has been made in reducing financial risk, this progress remains minimal, and there is still a risk of a reversal of this trend. We find that although catastrophic health payments at the 10% threshold decreased from 22.4% in 2005/06 to 13.8% in 2012/13, it increased to 14.2% in 2016/17. The percentage of Ugandans pushed below the national poverty line (US$1.90/day) has decreased from 5.2% in 2005/06 to 2.7% in 2016/17. The distribution of both catastrophic health payments and impoverishment varies across socio-economic status, location and residence. In addition, certain household characteristics (poverty, having a child below 5 years and an adult above 60 years) are more associated with the lack of financial risk protection. Conclusion: There is a need for targeted interventions to reduce OOP payments, especially among those most affected to increase financial risk protection. In the short-term, it is important to ensure that public health services are funded adequately to enable effective coverage with quality health care. In the medium-term, increased reliance on mandatory prepayment will reduce the burden of OOP health spending further.

scholarly journals Inequalities in the benefits of national health insurance on financial protection from out-of-pocket payments and access to health services: cross-sectional evidence from Ghana

2019 ◽  
Vol 34 (9) ◽  
pp. 694-705 ◽  
Author(s):  
Lucia Fiestas Navarrete ◽  
Simone Ghislandi ◽  
David Stuckler ◽  
Fabrizio Tediosi
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Health Expenditure ◽  
Financial Risk ◽  
Financial Protection ◽  
Medical Needs ◽  
Medical Spending ◽  
Out Of Pocket Payments ◽  
The Impact

Abstract A central pillar of universal health coverage (UHC) is to achieve financial protection from catastrophic health expenditure. There are concerns, however, that national health insurance programmes with premiums may not benefit impoverished groups. In 2003, Ghana became the first sub-Saharan African country to introduce a National Health Insurance Scheme (NHIS) with progressively structured premium charges. In this study, we test the impact of being insured on utilization and financial risk protection compared with no enrolment, using the 2012–13 Ghana Living Standards Survey (n = 72 372). Consistent with previous studies, we observed that participating in health insurance significantly decreased the probability of unmet medical needs by 15 percentage points (p.p.) and that of incurring catastrophic out-of-pocket (OOP) health payments by 7 p.p. relative to no enrolment in the NHIS. Households living outside a 1-h radius to the nearest hospital had lower reductions in financial risk from excess OOP medical spending relative to households living closer (−5 p.p. vs −9 p.p.). We also find evidence that in Ghana, the scheme was highly pro-poor. Once insured, the poorest 40% of households experienced significantly larger improvements in medical utilization (18 p.p. vs. 8 p.p.) and substantively larger reductions in catastrophic OOP health expenditure (−10 p.p. vs. −6 p.p.) compared with that of the richest households. However, health insurance did not benefit vulnerable persons equally from financial risk. Once insured, poor, low-educated and self-employed households living far from hospitals had significantly lower reductions in catastrophic OOP medical spending compared with their counterparts living closer. Taken together, we show that enrolment in the NHIS is associated with improved financial protection but less so among geographically remote vulnerable groups. Efforts to boost not just insurance uptake but also health service delivery may be needed as a supplement for insurance schemes to accelerate progress towards UHC.

scholarly journals Assessing the household economic burden of non-communicable diseases in India: evidence from repeated cross-sectional surveys

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Veenapani Rajeev Verma ◽  
Piyush Kumar ◽  
Umakant Dash
Keyword(s):  
Rural Areas ◽  
Financial Risk ◽  
Multinomial Logistic Regression ◽  
Poverty Line ◽  
Catastrophic Health Expenditure ◽  
Financial Risk Protection ◽  
Cross Sectional ◽  
Economic Determinants ◽  
Insurance Cover ◽  
Risk Protection

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.

scholarly journals Association of socioeconomic status with financial burden of disease among elderly patients with cardiovascular disease: evidence from the China Health and Retirement Longitudinal Survey

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e018703 ◽  
Author(s):  
Chunyan Li ◽  
Belinda-Rose Young ◽  
Weiyan Jian
Keyword(s):  
Socioeconomic Status ◽  
Low Income ◽  
Health Expenditure ◽  
Financial Risk ◽  
Financial Burden ◽  
Catastrophic Health Expenditure ◽  
Longitudinal Survey ◽  
Household Expenditure ◽  
Multilevel Regression ◽  
Financial Risk Protection

ObjectivesThe prevalence of cardiovascular diseases (CVD) within low-income and middle-income countries has reached epidemic proportions. However, the association between out-of-pocket (OOP) payment and socioeconomic status (SES) of patients with CVD is not well studied. We aimed to understand the financial burden among Chinese middle-aged and older patients with CVD, and whether there was an association with SES.SettingsA nationally representative survey—The China Health and Retirement Longitudinal Survey(CHARLS)—was conducted in 28 provinces of mainland China in 2011 and 2013.ParticipantsOf the over 18 000 CHARLS respondents, eligible participants were those aged 45 years and over who had been previously diagnosed with CVD.Outcome measuresFinancial burden was measured byindividualOOP payment andhouseholdcatastrophic health expenditure (CHE) occurrence (ie, the annual household health expenditure was 40% or more of the total non-food household expenditure). Multilevel regression models were used to explore the association between financial burden and SES.ResultsAmong CHARLS respondents, CVD prevalence increased from 14.7% in 2011 to 16.6% in 2013. Average annual CVD OOP payment increased from 5000 RMB (770 USD) to 6120 RMB (970 USD). Furthermore, CHE occurrence increased from 44.2% to 48.1%. Patients spent almost twice on outpatient as on inpatient services. Two of the three SES indicators (total household expenditure, occupation type) were found to be associated with CVD OOP payment amount, and the likelihood of CHE. Unemployed patients had a higher likelihood of CHE compared with agricultural workers. Rural-urban difference was associated with the likelihood of CHE in 2011 alone.ConclusionThe Chinese health system should use this health expenditure pattern among patients with CVD to create more equitable health insurance schemes that financially balance between outpatient and inpatient care, and provide better financial risk protection to patients with low SES.

scholarly journals What has been the progress in addressing financial risk in Uganda?  Analysis of catastrophe and impoverishment due to health payments

2020 ◽  
Author(s):  
Brendan Kwesiga ◽  
Tom Aliti ◽  
Pamela Nabukhonzo Kakande ◽  
Peter Byawaka ◽  
Susan Najjuko ◽  
...  
Keyword(s):  
Health Care ◽  
Health Services ◽  
Financial Risk ◽  
Poverty Line ◽  
Financial Risk Protection ◽  
Quality Health Care ◽  
Targeted Interventions ◽  
Out Of Pocket Payments ◽  
Risk Protection ◽  
The Impact

Abstract Background: Monitoring progress towards Universal Health Coverage (UHC) requires an assessment of progress in coverage of health services and protection of households from the impact of direct out-of-pocket payments (i.e. financial risk protection). Although Uganda has expressed aspirations for attaining UHC, out-of-pocket payments remain a major contributor to total health expenditure. This study aims to monitor progress in financial risk protection in Uganda. Methods: This study uses data from the Uganda National Household Surveys for 2005/06, 2009/10, 2012/13 and 2016/17. We measure financial risk protection using catastrophic health care payments and impoverishment indicators. Health care payments are catastrophic if they exceed a set threshold (i.e. 10% and 25%) of the total household consumption expenditure. Health payments are impoverishing if they push the household below the poverty line (the US$1.90/day and Uganda’s national poverty lines). A logistic regression model is used to assess the factors associated with household financial risk.Results: The results show that while progress has been made in reducing financial risk, this progress remains minimal, and there is still a risk of a reversal of this trend. We find that although catastrophic health payments at the 10% threshold decreased from 22.4% in 2005/06 to 13.8% in 2012/13, it increased to 14.2% in 2016/17. The percentage of Ugandans pushed below the poverty line (US$1.90/day) has decreased from 5.2% in 2005/06 to 2.7% in 2016/17. The distribution of both catastrophic health payments and impoverishment varies across socio-economic status, location and residence. In addition, certain household characteristics (poverty, having a child below 5 years and an adult above 60 years) are more associated with the lack of financial risk protection. Conclusion: There is a need for targeted interventions to reduce OOP payments, especially among those most affected to increase financial risk protection. In the short-term, it is important to ensure that public health services are funded adequately to enable effective coverage with quality health care. In the medium-term, mandatory prepayment through health insurance will be needed to reduce the burden of OOP health spending further.

scholarly journals Financial risk protection at the bedside: How Ethiopian physicians try to minimize out-of-pocket health expenditures

PLoS ONE ◽  
2019 ◽  
Vol 14 (2) ◽  
pp. e0212129 ◽  
Author(s):  
Ingrid Miljeteig ◽  
Frehiwot Berhane Defaye ◽  
Paul Wakim ◽  
Dawit Neema Desalegn ◽  
Yemane Berhane ◽  
...  
Keyword(s):  
Financial Risk ◽  
Health Expenditures ◽  
Financial Risk Protection ◽  
Risk Protection

scholarly journals Households forgoing healthcare as a measure of financial risk protection: an application to Liberia

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Jacopo Gabani ◽  
Lorna Guinness
Keyword(s):  
Health Expenditure ◽  
Financial Risk ◽  
Household Survey ◽  
Poverty Line ◽  
Healthcare Services ◽  
World Health ◽  
Health Shocks ◽  
Financial Risk Protection ◽  
Simple Method ◽  
Risk Protection

Abstract Introduction Access to Liberia’s health system is reliant on out-of-pocket (OOP) health expenditures which may prevent people from seeking care or result in catastrophic health expenditure (CHE). CHE and impoverishment due to OOP, which are used by the World Bank and World Health Organization as the sole measures of financial risk protection, are limited: they do not consider households who, following a health shock, do not incur expenditure because they cannot access the healthcare services they need (i.e., households forgoing healthcare (HFH) services). This paper attempts to overcome this limitation and improve financial risk protection by measuring HFH incidence and comparing it with CHE standard measures using household survey data from Liberia. Methods Data from the Liberia Household Income and Expenditure Survey 2014 were analysed. An OOP health expenditure is catastrophic when it exceeds a total or non-food household expenditure threshold. A CHE incidence curve, representing CHE incidence at different thresholds, was developed. To overcome CHE limitations, an HFH incidence measure was developed based on CHE, OOP and health shocks data: households incurring health shocks and having negligible OOP were considered to have forgone healthcare. HFH incidence was compared with standard CHE measures. Results CHE incidence and intensity levels depend on the threshold used. Using a 30% non-food expenditure threshold, CHE incidence is 2.1% (95% CI: 1.7–2.5%) and CHE intensity is 37.4% (95% CI: 22.7–52.0%). CHE incidence is approximately in line with other countries, while CHE intensity is higher than in other countries. CHE pushed 1.6% of households below the food poverty line in 2014. HFH incidence is approximately 4 times higher than CHE (8.0, 95% CI, 7.2–8.9%). Conclusion Lack of financial risk protection is a significant problem in Liberia and it may be underestimated by CHE: this study confirms that HFH incidence can complement CHE measures in providing a complete picture of financial risk protection and demonstrates a simple method that includes measures of healthcare forgone as part of standard CHE analyses. This paper provides a new methodology to measure HFH incidence and highlights the need to consider healthcare forgone in analyses of financial risk protection, as well as the need for further development of these measures.

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