Measuring Catastrophic Health Expenditures and its Inequality: Evidence from Iran’s Health Transformation Program

2019 ◽  
Vol 34 (4) ◽  
pp. 316-325 ◽  
Author(s):  
Vahid Yazdi-Feyzabadi ◽  
Mohammad Hossein Mehrolhassani ◽  
Ali Darvishi
Keyword(s):  
Rural Areas ◽  
Health Expenditure ◽  
Catastrophic Health Expenditure ◽  
Rural Populations ◽  
Financial Protection ◽  
Dominance Test ◽  
Cross Sectional ◽  
Poor Households ◽  
Before And After ◽  
Urban And Rural Areas

Abstract One of the important goals of Iran’s health transformation programme (HTP) is to improve financial protection for households against health expenditure. This study aimed to investigate the occurrence, intensity and inequality in distribution of catastrophic health expenditure (CHE) using the WHO and the World Bank (WB) methodologies with different thresholds in the years before and after HTP. We used data from seven annual national repeated cross-sectional surveys on households’ income and expenditures from 2011 to 2017. The intensity to CHE was calculated using overshoot and mean positive overshoot (MPO) indices. Finally, the inequality in distribution of exposure to CHE was calculated using the concentration index (CI), and the dominance test of concentration curves was used to inference about the significant changes in inequality of the years before and after HTP. The exposure rate to CHE in the total population and at 40% threshold of the WHO methodology changed from 1.99% in 2011 to 3.46% in 2017. Additionally, at 20% threshold of the WB methodology, it was changed from 5.14% to 8.68%. Overshoot and MPO indices increased on average based on two methodologies in urban and rural areas during seven years. The CIs for all the years show a negative value in both methodologies, indicating that CHE occurrence is higher among the poor households. In 2017, at 40% threshold of the WHO, the numerical values of the CIs were −0.15 and −0.14 in urban and rural populations, respectively. These values were −0.07 and −0.05 for the 20% threshold of WB, respectively. Results of dominance test showed no significant change in inequality for the years after than before HTP with two exceptions for total and rural populations based on the WB methodology. Generally, HTP had no considerable success in financial protection, requiring a review in actions to support pro-poor adaptation strategies.

scholarly journals Fairness in household financial contribution to the Iran’s healthcare system from 2008 to 2018

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Ali Darvishi ◽  
Mostafa Amini-Rarani ◽  
Mohammad Hossein Mehrolhassani ◽  
Vahid Yazdi-Feyzabadi
Keyword(s):  
Rural Areas ◽  
Total Sample ◽  
Rural Populations ◽  
Financial Protection ◽  
Cross Sectional ◽  
Financial Contribution ◽  
Recent Reform ◽  
Urban And Rural Areas ◽  
Contribution Index ◽  
Made In

Abstract Objective Enhancing financial protection in health is one of the main goals of Iran’s health transformation program (HTP), a recent reform conducted in early 2014. This study aimed to measure financial protection using the fair financial contribution index (FFCI) in urban and rural areas before (2008–2013) and after (2014–2018) the HTP implementation. Using a retrospective study on annual national cross-sectional surveys of households' income and expenditure, FFCI was measured. The total sample sizes for urban and rural areas from 2008 to 2018 were 207,980 and 212,249 households, respectively. Results The worst fair contributions to health expenditure in urban (FFCI = 0.684) and rural areas (FFCI = 0.530) were related to 2010 and 2009, respectively. Otherwise, the best fair contributions for urban (FFCI = 0.858) and rural (FFCI = 0.836) areas were made in 2011. Before the HTP implementation began, FFCI showed minor changes from 0.834 in 2008 to 0.833 in 2013. Following the HTP implementation, the FFCI values in urban and rural populations declined (worsened) from 0.842 to 0.836 and 0.816 to 0.809, respectively.On average more fair financial contributions had been made following five years after the HTP, especially in rural areas, but less than that expected in upstream documents (as determined 0.9).

scholarly journals Decomposing inequality in catastrophic health expenditure for self-reported hypertension household in Urban Shaanxi, China from 2008 to 2013: two waves’ cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e023033 ◽  
Author(s):  
Yafei Si ◽  
Zhongliang Zhou ◽  
Min Su ◽  
Xiao Wang ◽  
Xin Lan ◽  
...  
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Health Expenditure ◽  
Economic Status ◽  
Cross Sectional Study ◽  
Catastrophic Health Expenditure ◽  
Urban China ◽  
Shaanxi Province ◽  
Vulnerable Groups ◽  
Cross Sectional

ObjectiveDespite the latest wave of China’s healthcare reform initiated in 2009 has achieved unprecedented progress in rural areas, little is known for specific vulnerable groups’ catastrophic health expenditure (CHE) in urban China. This study aims to estimate the trend of incidence, intensity and inequality of CHE in hypertension households (households with one or more than one hypertension patient) in urban Shaanxi, China from 2008 to 2013.MethodsBased on the fourth and the fifth National Health Service Surveys of Shaanxi, we identified 460 and 1289 households with hypertension in 2008 and 2013, respectively for our analysis. We classified hypertension households into two groups: simplex households (with hypertension only) and mixed households (with hypertension plus other non-communicable diseases). CHE would be identified if out-of-pocket healthcare expenditure was equal to or higher than 40% of a household’s capacity to pay. Concentration index and its decomposition based on Probit regressions were employed to measure the income-related inequality of CHE.ResultsWe find that CHE occurred in 11.2% of the simplex households and 22.1% of the mixed households in 2008, and the 21.5% of the simplex households and the 46.9% of mixed households incurred CHE in 2013. Furthermore, there were strong pro-poor inequalities in CHE in the simplex households (−0.279 and −0.283) and mixed households (−0.362 and −0.262) both in 2008 and 2013. The majority of observed inequalities in CHE could be associated with household economic status, household head’s health status and having elderly members.ConclusionWe find a sharp increase of CHE occurrence and the sustained strong pro-poor inequalities for simplex and mixed households in urban Shaanxi Province of China from 2008 to 2013. Our study suggests that more concerns are needed for the vulnerable groups such as hypertension households in urban areas of China.

scholarly journals The Prevalence of Household Catastrophic Health Expenditure in Nigeria: A Rural-Urban Comparison

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Paul Oladapo Ajayi ◽  
◽  
Demilade Olusola Ibirongbe ◽  
Tope Michael Ipinnimo ◽  
Oluremi Olayinka Solomon ◽  
...  
Keyword(s):  
Urban Communities ◽  
Rural Areas ◽  
Urban Areas ◽  
Health Expenditure ◽  
Univariate Analysis ◽  
Sampling Technique ◽  
Catastrophic Health Expenditure ◽  
Cross Sectional ◽  
Rural And Urban ◽  
Household Heads

Background: Catastrophic health expenditure occurs when the burden of Out-of-pocket health expenditure has reached a certain level that a household must forego the expenditure on other basic needs of life to meet the health expenses of its member(s) of the household. Worldwide, over 44 million households suffer annually from financial catastrophe. This study intends to determine the prevalence of household catastrophic health expenditure amongst rural and urban communities in Ekiti, Nigeria. Methodology: This is a comparative cross-sectional study of households within selected rural and urban communities in Ekiti State, Nigeria. A pre-tested interviewer-administered semi-structured questionnaire was used to collect data over a period of 4 months from a sample of 1,000 household heads, using a multistage sampling technique. Data obtained were then entered using the SPSS version 20 and analysed with STATA 12. Two different methodologies were used to calculate household catastrophic health expenditure, with sensitivity analysis done. Univariate analysis were used to describe the population in relation to relevant variables. Result: The prevalence of household catastrophic health expenditure is high using the two methodological calculations. It was significantly higher in the rural areas, 18.5% than the urban areas, 12.8% (p=0.015) for first method; it was also higher in the rural areas, 8.3% compared to the urban areas, 2.5% (p<0.001) for the second method. Conclusion: Prevalence of household catastrophic health expenditure is high in Nigeria, but worse in the rural areas. It’s therefore vital to establish financial and social intervention mechanisms that can protect households from incurring catastrophic health expenditure.

scholarly journals Effects of Exposure to Risks on Household Vulnerability in Developing Countries: A New Evidence From Urban and Rural Areas of Nigeria

SAGE Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 215824402110022
Author(s):  
Peter Nwachukwu Mba ◽  
Emmanuel O. Nwosu ◽  
Anthony Orji
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Developing Economies ◽  
Sub Saharan Africa ◽  
Income Poverty ◽  
Poor Household ◽  
Cross Sectional ◽  
Poor Households ◽  
Household Vulnerability ◽  
Urban And Rural Areas

Exposure to risk may be seen as one of the many dimensions of poverty. Household exposure to risk consequent upon different types of shocks often leads to undesirable welfare outcomes. A shock can push an already income-poor household further into poverty or drive a non-poor household below the income poverty line. Risk appears to be one of the major challenges many households face in developing economies especially in the Sub-Saharan Africa. As a result, these issues have become central in the policy agenda not only in these countries but also in the international multilateral institutions. This study examines the exposure to risks in urban and rural areas and its effect on household vulnerability to poverty in Nigeria. The study applied the framework that computes vulnerability as expected poverty on the Nigeria General Household Survey for 2015 and the cross-sectional data and three-stage feasible generalized least squares analysis were employed. Findings show that exposure to risks such as job loss, business failure, harvest failure, livestock death, dwelling demolition, increase and decrease in input and output prices, and other similar risks significantly drive households into poverty but differ across households in rural and urban areas, both in characteristics and regions. These findings suggest that social safety nets should be designed to take care of not only the current poor households but also the non-poor households who are likely to be vulnerable in the future.

scholarly journals National and Provincial Estimates of Catastrophic Health Expenditure and its Determinants in Nepal

2021 ◽  
Vol 18 (4) ◽  
pp. 741-746
Author(s):  
Arjun Kumar Thapa ◽  
Achyut Raj Pandey
Keyword(s):  
Chronic Illness ◽  
Rural Areas ◽  
Health Expenditure ◽  
Household Head ◽  
Poverty Line ◽  
Catastrophic Health Expenditure ◽  
Living Standard ◽  
Cross Sectional ◽  
Provincial Level ◽  
The Government

Background: Despite various supply-side efforts, out of pocket expenditure occupies a considerable portion of healthcare financing in Nepal. With the recent process of federalization in country, there is additional scope for contextualized planning at provincial level to prevent catastrophic health expenditure among Nepalese households. In this context, this study intends to estimate the proportion of population facing catastrophic health expenditure at national and provincial level and identify the determinants of catastrophic health expenditure.Methods: This study involved analysis of Nepal Living Standard Survey III, which was a cross sectional study. Out of 5,988 households comprising 28,460 individuals, data from total of 7,911 individuals who reported having acute or chronic illness was extracted and analyzed in the study.Results: In the study, 11.11% of households had faced catastrophic health expenditure. Catastrophic health expenditure was found to be 11.3% in Province 1, 9.4% in Province 2, 10.7% in Bagmati Province, 10% in Gandaki Province, 11.7% in Lumbini Province, 13.3% in Karnali Province and 13.4% in Sudurpaschim Province. Household size, literacy status of household head, consumption quintile, urban or rural residence, type of illness and type of health facility visited were identified as determinants of catastrophic health expenditure.Conclusions: A tenth of households, most of whom lying below poverty line, residing in rural areas, suffering from chronic illness are facing catastrophic healthcare burden. The government needs to pursue its equity-oriented strategies preventing catastrophic health expenditure and impoverishment associated with it.Keywords: Catastrophic health expenditure; out of pocket payment; Nepal

scholarly journals The Prevalence of Household Catastrophic Health Expenditure in Nigeria: A Rural-Urban Comparison

2021 ◽  
Author(s):  
Paul Oladapo Ajayi ◽  
Demilade Olusola Ibirongbe ◽  
Tope Michael Ipinnimo ◽  
Oluremi Olayinka Solomon ◽  
Austin Idowu Ibikunle ◽  
...  
Keyword(s):  
Urban Communities ◽  
Rural Areas ◽  
Urban Areas ◽  
Health Expenditure ◽  
Univariate Analysis ◽  
Sampling Technique ◽  
Catastrophic Health Expenditure ◽  
Cross Sectional ◽  
Rural And Urban ◽  
Household Heads

Background: Catastrophic health expenditure occurs when the burden of Out-of-pocket health expenditure has reached a certain level that a household must forego the expenditure on other basic needs of life to meet the health expenses of its member(s) of the household. Worldwide, over 44 million households suffer annually from financial catastrophe. This study intends to determine the prevalence of household catastrophic health expenditure amongst rural and urban communities in Ekiti, Nigeria. Methodology: This is a comparative cross-sectional study of households within selected rural and urban communities in Ekiti State, Nigeria. A pre-tested interviewer-administered semi-structured questionnaire was used to collect data over a period of 4 months from a sample of 1,000 household heads, using a multistage sampling technique. Data obtained were then entered using the SPSS version 20 and analysed with STATA 12. Two different methodologies were used to calculate household catastrophic health expenditure, with sensitivity analysis done. Univariate analysis were used to describe the population in relation to relevant variables. Result: The prevalence of household catastrophic health expenditure is high using the two methodological calculations. It was significantly higher in the rural areas, 18.5% than the urban areas, 12.8% (p=0.015) for first method; it was also higher in the rural areas, 8.3% compared to the urban areas, 2.5% (p&lt;0.001) for the second method. Conclusion: Prevalence of household catastrophic health expenditure is high in Nigeria, but worse in the rural areas. It’s therefore vital to establish financial and social intervention mechanisms that can protect households from incurring catastrophic health expenditure.

scholarly journals Urban-rural differences in catastrophic health expenditure among households with chronic non-communicable disease patients : evidence from China Family Panel Studies

2020 ◽  
Author(s):  
Xianzhi Fu ◽  
Qi-wei Sun ◽  
Chang-qing Sun ◽  
Fei Xu ◽  
Jun-jian He
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Health Expenditure ◽  
Communicable Disease ◽  
Rural Households ◽  
Catastrophic Health Expenditure ◽  
System Reform ◽  
Cross Sectional ◽  
Urban Rural ◽  
Panel Studies

Abstract Background: The prevalence of chronic non-communicable diseases (NCDs) challenges the Chinese health system reform. Little is known for the differences in catastrophic health expenditure (CHE) between urban and rural households with NCD patients. This study aims to measure the differences above and quantify the contribution of each variable in explaining the urban-rural differences.Methods: The second and the fourth waves of the China Family Panel Studies (CFPS) data, conducted in 2012 and 2016, were employed in this cross-sectional study. The techniques of Fairlie nonlinear decomposition and Blinder-Oaxaca decomposition were employed to measure the contribution of each independent variable to the urban-rural differences.Results: The CHE incidence and intensity of households with NCD patients were significantly higher in rural areas than in urban areas. The explained disparity of CHE incidence increased from 3.15% in 2012 to 27.04% in 2016, and the corresponding values of CHE intensity rose from 21.30% in 2012 to 53.37% in 2016. The major contribution to the urban-rural differences in CHE was associated with household economic status, education level, health status and supplementary medical insurance (SMI).Conclusions: Compared with urban households with NCD patients, rural households with NCD patients have higher risk of incurring CHE and heavier economic burden of diseases. Policy interventions should give priority to decreasing the urban-rural disparity in observable characteristics.

scholarly journals Urban-rural differences in catastrophic health expenditure among households with chronic non-communicable disease patients: evidence from China Family Panel Studies

2020 ◽  
Author(s):  
Xian-zhi Fu ◽  
Qi-wei Sun ◽  
Chang-qing Sun ◽  
Fei Xu ◽  
Jun-jian He
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Health Expenditure ◽  
Communicable Disease ◽  
Rural Households ◽  
Catastrophic Health Expenditure ◽  
System Reform ◽  
Cross Sectional ◽  
Urban Rural ◽  
Panel Studies

Abstract BackgroundThe prevalence of chronic non-communicable diseases (NCDs) challenges the Chinese health system reform. Little is known for the differences in catastrophic health expenditure (CHE) between urban and rural households with NCD patients. This study aims to measure the differences above and quantify the contribution of each variable in explaining the urban-rural differences.MethodsThe second and the fourth waves of the China Family Panel Studies (CFPS) data, conducted in 2012 and 2016, were employed in this cross-sectional study. The techniques of Fairlie nonlinear decomposition and Blinder-Oaxaca decomposition were employed to measure the contribution of each independent variable to the urban-rural differences.ResultsThe CHE incidence and intensity of households with NCD patients were significantly higher in rural areas than in urban areas. The explained disparity of CHE incidence increased from 3.15% in 2012 to 27.04% in 2016, and the corresponding values of CHE intensity rose from 21.30% in 2012 to 53.37% in 2016. The major contribution to the urban-rural differences in CHE was associated with household economic status, education level, health status and supplementary medical insurance (SMI).ConclusionsCompared with urban households with NCD patients, rural households with NCD patients have higher risk of incurring CHE and heavier economic burden of diseases. Policy interventions should give priority to decreasing the urban-rural disparity in observable characteristics mentioned above.

scholarly journals The Prevalence and Awareness of Cardiovascular Diseases Risk Factors among the Lebanese Population: A Prospective Study Comparing Urban to Rural Populations

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Iqbal Fahs ◽  
Zainab Khalife ◽  
Diana Malaeb ◽  
Mohammad Iskandarani ◽  
Pascale Salameh
Keyword(s):  
Risk Factors ◽  
Rural Areas ◽  
Overweight And Obesity ◽  
Undiagnosed Diabetes ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Undiagnosed Hypertension ◽  
Lebanese Population ◽  
Urban And Rural Areas ◽  
A Prospective Study

Introduction. CVDs are largely driven by modifiable risk factors. This study sought to determine the awareness and prevalence of the modifiable CVDs risk factors among the Lebanese population.Methods. In a cross-sectional survey, 1000 participants aged ≥ 45 years were randomly selected from pharmacies and interviewed. The data was analyzed with SPSS version 21.0 software.Results. Differences between urban and rural areas include alcohol consumption (2.8% versus 1.7%;p=0.0001), cardioprotective vegetable servings (6.1% versus 2.3%;p=0.016), sedentary hours per day (18.6% versus 15.1%;p=0.002), and hypertension (38.5% versus 25.4%;p=0.001). The prevalence of overweight and obesity (77.3% versus 75.2%;p=0.468), smoking (39.3% versus 43.3%;p=0.232), diabetes (25.4% versus 21.4%;p=0.173), and dyslipidemia (25 versus 21.2%) was reported. Measurements revealed 19.3% of undiagnosed hypertension (12.4% versus 22.4%,p=0.001), 61.7% of hypertension (59.8% versus 62.6%;p=0.203), and 7.9% of undiagnosed diabetes (6.6% versus 8.6%;p=0.323). The declared awareness of CVDs risk factors was highest for smoking (91.5% versus 89.7%;p=0.339) and lowest for diabetes (54.4 versus 55.7%;p=0.692).Conclusion. This study has shown a high prevalence of modifiable CVDs risk factors in the Lebanese population ≥ 45 years, among which hypertension is the most prominent.

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