Economic burden and catastrophic health expenditure associated with COVID-19 hospitalisations in Kerala, South India

Introduction - Catastrophic health expenditure during COVID-19 hospitalization has altered the economic picture of households especially in low resource settings with high rates of COVID-19 infection. This study aimed to estimate the Out of Pocket (OOP) expenditure and the proportion of households that incurred catastrophic health expenditures due to COVID-19 hospitalisation in Kerala, South India. Materials and Methods - A cross-sectional study was conducted among a representative sample of 155 COVID-19 hospitalised patients in Kottayam district over four months, using a pretested interview schedule. The direct medical and non-medical costs incurred by the study participant during hospitalisation and the total monthly household expenditure were obtained from the respective COVID-19 affected households. Catastrophic health expenditure was defined as direct medical expenditure exceeding 40% of effective household income. Results - From the study, median and mean Out of Pocket (OOP) expenditures were obtained as USD 93.57 and USD 502.60 respectively. The study revealed that 49.7% of households had Catastrophic health expenditure, with 32.9% having incurred Distress financing. Multivariate analysis revealed being Below poverty line, hospitalisation in private healthcare facility and presence of co-morbid conditions as significant determinants of Catastrophic health expenditure. Conclusion - High levels of Catastrophic health expenditure and distress financing revealed by the study unveils major unaddressed challenges in the road to Universal health coverage.

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Inequity of healthcare access and use and catastrophic health spending in slum communities: a retrospective, cross-sectional survey in four countries

BMJ Global Health ◽

10.1136/bmjgh-2021-007265 ◽

2021 ◽

Vol 6 (11) ◽

pp. e007265

Author(s):

Keyword(s):

Health Expenditure ◽

Healthcare Access ◽

Health Spending ◽

Catastrophic Health Expenditure ◽

Small Scale ◽

Health Coverage ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Gini Coefficients ◽

Country Level

IntroductionTracking the progress of universal health coverage (UHC) is typically at a country level. However, country-averages may mask significant small-scale variation in indicators of access and use, which would have important implications for policy choice to achieve UHC.MethodsWe conducted a retrospective cross-sectional household and individual-level survey in seven slum sites across Nigeria, Kenya, Bangladesh and Pakistan. We estimated the adjusted association between household capacity to pay and report healthcare need, use and spending. Catastrophic health expenditure was estimated by five different methods.ResultsWe surveyed 7002 households and 6856 adults. Gini coefficients were wide, ranging from 0.32 to 0.48 across the seven sites. The total spend of the top 10% of households was 4–47 times more per month than the bottom 10%. Households with the highest budgets were: more likely to report needing care (highest vs lowest third of distribution of budgets: +1 to +31 percentage points (pp) across sites), to spend more on healthcare (2.0 to 6.4 times higher), have more inpatient and outpatient visits per year in five sites (1.0 to 3.0 times more frequently), spend more on drugs per visit (1.1 to 2.2 times higher) and were more likely to consult with a doctor (1.0 to 2.4 times higher odds). Better-off households were generally more likely to experience catastrophic health expenditure when calculated according to four methods (−1 to +12 pp), but much less likely using a normative method (−60 to −80 pp).ConclusionsSlums have a very high degree of inequality of household budget that translates into inequities in the access to and use of healthcare. Evaluation of UHC and healthcare access interventions targeting these areas should consider distributional effects, although the standard measures may be unreliable.

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Catastrophic Health Expenditure, Distress Financing and Impoverishment due to Out-of-Pocket Expenses for Healthcare among Patients with Chronic Liver Disease: A Cross-sectional Study among Hospitalized Patients in Bangladesh

10.31219/osf.io/svdkr ◽

2021 ◽

Author(s):

Mohammad Farhadul Haque ◽

ANM Shamsul Islam ◽

Samina Pervin ◽

Emily Akter ◽

Mahmudul Hasan

Keyword(s):

Liver Disease ◽

Chronic Liver Disease ◽

Health Expenditure ◽

Cross Sectional Study ◽

Catastrophic Health Expenditure ◽

Hospitalized Patients ◽

Chronic Liver ◽

Sectional Study ◽

Cross Sectional ◽

Distress Financing

Out-of-pocket (OOP) expenses for hospitalized patients with chronic liver disease (CLD) poses an economic challenge on affected household in the form of catastrophic health expenditure (CHE), distress financing and impoverishment. OOP Expenses data for hospitalized CLD patients from Bangladesh is scarce. This study aimed to estimate the OOP expenses and resulting CHE, distress financing and impoverishment among hospitalized patients with CLD. This cross-sectional study was conducted among conveniently selected 107 diagnosed CLD patients admitted at Bangabandhu Sheikh Mujib Medical University (BSMMU) and Dhaka Medical College Hospital (DMCH) aged 18 years and above. Data were collected from the respondents using a semi-structured questionnaire through face to face interview during discharge from hospital. Out of pocket expenditure for chronic liver disease in selected hospitals was Bangladeshi Taka (BDT) 19,262. Direct medical, direct non-medical and indirect cost was BDT 16,240; 2,165 and 1,510, respectively. Investigation cost and medicine cost contributed to 48.48% and 31.81% of the total OOP expenses, respectively. At 10% threshold level, 29% of the respondents were affected by CHE. 64.5% of the respondents were facing distress financing due to OOP expenses. Among the respondents, 1.9% slipped below the international poverty line of $1.90 (BDT 161.10, in 2019).There was statistically significant (p < 0.05) difference among the mean OOP expenses for different etiological types of chronic liver disease. The study concluded that it requires establishing a more accessible and affordable decentralized health care system for CLD treatment along with the implementation of financial risk protection.

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Mapping the Multidimensionality of Medical Care related Catastrophe on Households: A Study of Four Blocks in Birbhum District, West Bengal

10.21203/rs.3.rs-34272/v1 ◽

2020 ◽

Author(s):

Priyanka Dasgupta ◽

Subrata Mukherjee

Keyword(s):

Medical Care ◽

Healthcare Utilization ◽

Health Expenditure ◽

Negative Binomial ◽

West Bengal ◽

Catastrophic Health Expenditure ◽

Multidimensional Analysis ◽

Medical Expenditure ◽

Cross Sectional ◽

Multiple Indicators

Abstract Background Medical care related catastrophe is generally identified by healthcare expenses crossing a certain percentage of household’s resources (Wagstaff and van Doorslaer, 2003). This paper attempts to examine medical care related ‘catastrophe’ by going beyond the threshold-oriented approach of catastrophic medical expenditure and include multiple indicators which seeks to explore the catastrophe from a multidimensional perspective. Methods Drawing from multidimensional vulnerability to poverty approach (Alkire and Forster, 2008), we provide a measure which incorporates multiple indicators that might put households in medical care related catastrophic situation. Our study uses data from a cross-sectional household survey conducted by the Society for Health and Demographic Surveillance (SHDS) of the Government of West Bengal in 2012. Using negative binomial and logistic regression, the study also attempts to find the correlates of healthcare utilization, incurring catastrophic health expenditure for both 10 per cent of household consumption expenditure and 40 per cent of non-food expenditure as well as resorting to distress financing and availing low quality/ no care despite chronic illness. Results Estimates show that illness, presence of elderly members, hospitalization and outpatient visits increases the risk of incurring catastrophic health expenditure and healthcare utilization counts. In addition, households belonging to backward socio-religious categories and having members engaged as casual labourers face higher odds of distressed financing and availing informal/ no healthcare. In contrast to Wagstaff and van Doorslaer’s measure of catastrophic medical expenses, the multidimensional measure shows a lower medical care catastrophe for the upper economic classes and forward caste groups and vice versa which is more realistic and convincing. Conclusions The evidence generated from the multidimensional analysis presents a more convincing and reliable picture of vulnerability imparted due to health shocks as compared to identifying households with catastrophic medical expenditure by Wagstaff and van Doorslaer’s method. However, this study has its limitations as it has given equal weightage to all the dimensions and restricted itself to headcount measures. However, extension and refinement of this approach can provide more insightful findings.

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

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v18i4.2392 ◽

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

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Has Iran achieved the goal of reducing the prevalence of households faced with catastrophic health expenditure to 1%? The results of a national study

10.21203/rs.3.rs-847322/v1 ◽

2021 ◽

Author(s):

Bakhtiar Piroozi ◽

Hassan Mahmoodi ◽

Hossein Safari ◽

Amjad Mohamadi Bolbanabad ◽

Satar Rezaei ◽

...

Keyword(s):

Health Expenditure ◽

Economic Status ◽

Multivariate Regression Analysis ◽

Cross Sectional Study ◽

Catastrophic Health Expenditure ◽

World Health ◽

National Study ◽

Health Coverage ◽

World Health Survey ◽

Cross Sectional

Abstract Background Access to universal health coverage and reducing the prevalence of catastrophic health expenditure (CHE) to 1% are the commitments of the Islamic Republic of Iran. The aim of this study was to investigate the prevalence of households exposed to CHE. Methods This cross-sectional study was performed on 2000 households in five provinces of Iran in 2021. Data were collected through interviews using the World Health Survey questionnaire. Results Data from households whose health care costs were more than 40% of their capacity to pay were included in the group of households with CHE. Determinants of CHE were identified using multivariate regression analysis. 8.3% of households were exposed to CHE. The variables of being a female head of household, use of inpatient, outpatient, dental, and rehabilitation services, families with disabled members and low economic status of the households were significantly associated with increased odds of facing CHE. Conclusion In the final year of the sixth five-year development plan, Iran has not yet achieved its goal of "reducing the percentage of households exposed to CHE to 1%," and a high percentage of Iranian households still face CHE. Policymakers should pay attention to factors increasing the chance of facing CHE in designing interventions and this can help the goal of financial protection against health costs.

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Catastrophic health expenditure among industrial workers in a large-scale industry in Nepal, 2017: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2018-022002 ◽

2018 ◽

Vol 8 (11) ◽

pp. e022002

Author(s):

Prajjwal Pyakurel ◽

Jaya Prasad Tripathy ◽

Myo Minn Oo ◽

Bijay Acharya ◽

Ujjwal Pyakurel ◽

...

Keyword(s):

Outpatient Care ◽

Health Expenditure ◽

Large Scale ◽

Cross Sectional Study ◽

Catastrophic Health Expenditure ◽

Cost Of Care ◽

Industrial Workers ◽

Sectional Study ◽

Cross Sectional ◽

Distress Financing

ObjectivesThe study aimed at estimating out-of-pocket (OOP) expenditure, catastrophic health expenditure (CHE) and distress financing due to hospitalisation and outpatient care among industrial workers in Eastern Nepal.MethodsWe conducted a cross-sectional study involving industrial workers employed in a large-scale industry in Eastern Nepal. Those who were hospitalised in the last 1 year or availed outpatient care within the last 30 days were administered a structured questionnaire to estimate the cost of illness. CHE was defined as expenditure more than 20% of annual household income. Distress financing was defined as borrowing money/loan or selling assets to cope with OOP expenditure on health.ResultsOf 1824 workers eligible for the study, 1405 (77%) were screened, of which 85 (6%) were hospitalised last year; 223 (16%) attended outpatient department last month. The median (IQR) OOP expenditure from hospitalisation and outpatient care was US$124 (71–282) and US$36 (19–61), respectively. Among those hospitalised, the prevalence of CHE and distress financing was found to be 13% and 42%, respectively, and due to outpatient care was 0.4% and 42%, respectively. Drugs and diagnostics account for a large share of direct costs in both public and private sectors. More than 80% sought hospitalisation and outpatient care in a private sector.ConclusionIndustrial workers face significant financial risks due to ill health compared with the general population. Poor utilisation and higher cost of care in public health facilities warrant strengthening of public sector through increased government spending. The labour act 2014 of Nepal should be strictly adhered.

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Catastrophic Health Expenditure, Distress Financing and Impoverishment due to Out-of-Pocket Expenses for Healthcare among Patients with Chronic Liver Disease: A Cross-sectional Study among Hospitalized Patients in Bangladesh

Journal of Health and Medical Sciences ◽

10.31014/aior.1994.04.01.153 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Mohammad Farhadul Haque ◽

◽

ANM Shamsul Islam ◽

Samina Pervin ◽

Emily Akter ◽

...

Keyword(s):

Liver Disease ◽

Chronic Liver Disease ◽

Health Expenditure ◽

Cross Sectional Study ◽

Catastrophic Health Expenditure ◽

Hospitalized Patients ◽

Chronic Liver ◽

Sectional Study ◽

Cross Sectional ◽

Distress Financing

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Measuring the Direct Cost Burden of Illness in Burkina Faso

Research in Applied Economics ◽

10.5296/rae.v10i4.14078 ◽

2018 ◽

Vol 10 (4) ◽

pp. 60

Author(s):

Ousmane Traoré

Keyword(s):

Health Care ◽

Burkina Faso ◽

Direct Cost ◽

Health Expenditure ◽

Burden Of Illness ◽

Methodological Approach ◽

Catastrophic Health Expenditure ◽

Cost Burden ◽

Health Coverage ◽

Universal Health

In this article, we evaluate the direct cost burden of illness in Burkina Faso. The methodological approach predicts the normative health expenditure based on the population’s health risk factors and adjusts the income based on people’s asset portfolios, which are supposed to influence their ability to manage shocks, or their vulnerability to shocks like illness. Thus, using the National Institute for Statistics and Demography’s priority surveys database of 1996, our methodology leads to a better information on the distributions of income and health care spending across a subsample of 1022 treated individuals. Subsequently, the average of the direct cost burden of illness is 11.17%, and 50% of the population spend more than 10.52% of their adjusted income on normative health care. Otherwise, there is a difference of 66.84 of percentage points between the highest and lowest cost burdens. Overall, women face higher direct costs burden compared to men. Given the “catastrophic health expenditure” threshold conventionally set at 10% of income, to decrease these financial vulnerabilities and inequalities in Burkina Faso, one solution would be to achieve universal health coverage.

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On the Measurement of Financial Protection: An Assessment of the Usefulness of the Catastrophic Health Expenditure Indicator to Monitor Progress Towards Universal Health Coverage

Health Systems & Reform ◽

10.1080/23288604.2020.1744988 ◽

2020 ◽

Vol 6 (1) ◽

pp. e1744988 ◽

Cited By ~ 2

Author(s):

Karen A. Grépin ◽

Bridget R. Irwin ◽

Benjamin Sas Trakinsky

Keyword(s):

Universal Health Coverage ◽

Health Expenditure ◽

Catastrophic Health Expenditure ◽

Financial Protection ◽

Health Coverage ◽

Universal Health

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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 ◽

10.1136/bmjopen-2018-023033 ◽

2019 ◽

Vol 9 (5) ◽

pp. e023033 ◽

Cited By ~ 4

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.

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