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

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.

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

2021 ◽  
Author(s):  
Ronnie Thomas ◽  
Quincy Mariam Jacob ◽  
Sharon Raj Eliza ◽  
Malathi Mini ◽  
Jobinse Jose ◽  
...  
Keyword(s):  
Health Expenditure ◽  
South India ◽  
Study Participant ◽  
Poverty Line ◽  
Catastrophic Health Expenditure ◽  
Medical Expenditure ◽  
Health Coverage ◽  
Cross Sectional ◽  
Hospitalised Patients ◽  
Distress Financing

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.

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

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.

scholarly journals Predictors of catastrophic out-of-pocket health expenditure in rural Egypt: application of the heteroskedastic probit model

2021 ◽  
Vol 96 (1) ◽  
Author(s):  
Suzan Abdel-Rahman ◽  
Farouk Shoaeb ◽  
Mohamed Naguib Abdel Fattah ◽  
Mohamed R. Abonazel
Keyword(s):  
Private Sector ◽  
Rural Areas ◽  
Health Expenditure ◽  
Health Spending ◽  
Probit Model ◽  
Chronically Ill ◽  
Catastrophic Health Expenditure ◽  
Health Coverage ◽  
Household Heads ◽  
The Impact

Abstract Background Out-of-pocket (OOP) health expenditure is a pressing issue in Egypt and far exceeds half of Egypt’s total health spending, threatening the economic viability, and long-term sustainability of Egyptian households. Targeting households at risk of catastrophic health payments based on their characteristics is an obvious pathway to mitigate the impoverishing impacts of OOP health payments on livelihoods. This study was conducted to identify the risk factors of incurring catastrophic health payments hoping to formulate appropriate policies to protect households against financial catastrophes. Methods Using data derived from the Egyptian Household Income, Expenditure, and Consumption Survey (HIECS), a multiplicative heteroskedastic probit model is applied to account for heteroskedasticity and avoid biased and inconsistent estimates. Results Accounting for heteroskedasticity induces notable differences in marginal effects and demonstrates that the impact of some core variables is underestimated and insignificant and in the opposite direction in the homoscedastic probit model. Moreover, our results demonstrate the principal factors besides health status and socioeconomic characteristics responsible for incurring catastrophic health expenditure, such as the use of health services provided by the private sector, which has a dramatic effect on encountering catastrophic health payments. Conclusions The marked differences between estimates of probit and heteroskedastic probit models emphasize the importance of investigating homoscedasticity assumption to avoid policies based on incorrect evidence. Many policies can be built upon our findings, such as enhancing the role of social health insurances in rural areas, expanding health coverage for poor households and chronically ill household heads, and providing adequate financial coverage for households with a high proportion of elderly, sick members, and females. Also, there is an urgent need to limit OOP health payments absorbed by private sector to achieve an acceptable level of fair financing.

scholarly journals Achieving SDG 3.8.2: Financial Protection Against Catastrophic Health Expenditure in Malaysia

2020 ◽  
Author(s):  
Surianti Sukeri ◽  
Muaz Sayuti
Keyword(s):  
At Risk ◽  
Universal Health Coverage ◽  
Health Expenditure ◽  
Health Spending ◽  
Safety Net ◽  
Catastrophic Health Expenditure ◽  
P Value ◽  
Financial Protection ◽  
Health Coverage ◽  
Universal Health

Abstract Background: The Sustainable Development Goal (SDG) 3.8.2 is one of the two indicators to monitor a country's progress towards universal health coverage. It concerns the financial protection against catastrophic spending on health based on the budget share approach. The purpose of this study is twofold: 1) to measure SDG 3.8.2 on the proportion of households with catastrophic health expenditure (CHE), and 2) to determine households at risk of CHEMethods: A cross-sectional study was conducted using secondary data from the 2015/2016 Household Expenditure Survey. The inclusion criterion was Malaysian households with some health spending in the past 12 months before the date of the survey. The World Health Organization method of calculating CHE was applied in the calculation, and a threshold of 10% out-of-pocket health spending from total household expenditures was used to determine CHE. Data were analysed descriptively, and multiple logistic regression was used to determine factors associated with CHE.Results: A total of 13015 households were involved in the study. The proportion of CHE was 2.8%. Four associated factors that were statistically significant were female-headed household (Adjusted OR 1.6; CI 1.25, 2.03; p-value <0.001), household that lived in rural area (Adjusted OR 1.29; 95% CI 1.04, 1.61; p-value =0.022), small household size (Adjusted OR 2.4; 95% CI 1.81, 3.18; p-value <0.001) and head of household aged below 60 years old (Adjusted OR2.34; 95% CI 1.81, 3.18; p-value <0.001).Conclusions: The low proportion of CHE revealed that Malaysia is on the right track towards achieving SDG 3.8 on universal health coverage status by 2030. However there is an increasing trend in the proportion of CHE. Households at risk of CHE require financial protection to afford healthcare and safety net measures to prevent from spiralling further into the vicious cycle of illness and poverty.

scholarly journals Catastrophic Household Expenditure for Healthcare in Turkey: Clustering Analysis of Categorical Data

Data ◽  
2019 ◽  
Vol 4 (3) ◽  
pp. 112
Author(s):  
Onur Dogan ◽  
Gizem Kaya ◽  
Aycan Kaya ◽  
Hidayet Beyhan
Keyword(s):  
Health Expenditure ◽  
National Income ◽  
Health Spending ◽  
Health Problems ◽  
Catastrophic Health Expenditure ◽  
Catastrophic Expenditure ◽  
Household Level ◽  
Expenditure Rate ◽  
Type Property ◽  
Similarity And Difference

The amount of health expenditure at the household level is one of the most basic indicators of development in countries. In many countries, health expenditure increases relative to national income. If out-of-pocket health spending is higher than the income or too high, this indicates an economical alarm that causes a lower life standard, called catastrophic health expenditure. Catastrophic expenditure may be affected by many factors such as household type, property status, smoking and drinking alcohol habits, being active in sports, and having private health insurance. The study aims to investigate households with respect to catastrophic health expenditure by the clustering method. Clustering enables one to see the main similarity and difference between the groups. The results show that there are significant and interesting differences between the five groups. C4 households earn more but spend less money on health problems by the rate of 3.10% because people who do physical exercises regularly have fewer health problems. A household with a family with one adult, landlord and three people in total (mother or father and two children) in the cluster C5 earns much money and spends large amounts for health expenses than other clusters. C1 households with elementary families with three children, and who do not pay rent although they are not landlords have the highest catastrophic health expenditure. Households in C3 have a rate of 3.83% health expenditure rate on average, which is higher than other clusters. Households in the cluster C2 make the most catastrophic health expenditure.

scholarly journals Measuring the Direct Cost Burden of Illness in Burkina Faso

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.

scholarly journals A call for harmonization of European kidney care: dialysis reimbursement and distribution of kidney replacement therapies

2020 ◽  
Vol 35 (6) ◽  
pp. 979-986 ◽  
Author(s):  
Arjan van der Tol ◽  
Vianda S Stel ◽  
Kitty J Jager ◽  
Norbert Lameire ◽  
Rachael L Morton ◽  
...  
Keyword(s):  
Public Health ◽  
Health Expenditure ◽  
European Countries ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Public Health Expenditure ◽  
Home Dialysis ◽  
Kidney Replacement Therapy ◽  
The Cost ◽  
The Impact

Abstract Background We compare reimbursement for haemodialysis (HD) and peritoneal dialysis (PD) in European countries to assess the impact on government healthcare budgets. We discuss strategies to reduce costs by promoting sustainable dialysis and kidney transplantation. Methods This was a cross-sectional survey among nephrologists conducted online July–December 2016. European countries were categorized by tertiles of gross domestic product per capita (GDP). Reimbursement data were matched to kidney replacement therapy (KRT) data. Results The prevalence per million population of patients being treated with long-term dialysis was not significantly different across tertiles of GDP (P = 0.22). The percentage of PD increased with GDP across tertiles (4.9, 8.2, 13.4%; P &lt; 0.001). The HD-to-PD reimbursement ratio was higher in countries with the highest tertile of GDP (0.7, 1.0 versus 1.7; P = 0.007). Home HD was mainly reimbursed in countries with the highest tertile of GDP (15, 15 versus 69%; P = 0.005). The percentage of public health expenditure for reimbursement of dialysis decreased across tertiles of GDP (3.3, 1.5, 0.7%; P &lt; 0.001). Transplantation as a proportion of all KRT increased across tertiles of GDP (18.5, 39.5, 56.0%; P &lt; 0.001). Conclusions In Europe, dialysis has a disproportionately high impact on public health expenditure, especially in countries with a lower GDP. In these countries, the cost difference between PD and HD is smaller, and home dialysis and transplantation are less frequently provided than in countries with a higher GDP. In-depth evaluation and analysis of influential economic and political measures are needed to steer optimized reimbursement strategies for KRT.

scholarly journals Nurses' knowledge of universal health coverage for inclusive and sustainable elderly care services

2016 ◽  
Vol 24 (0) ◽  
Author(s):  
Fabian Ling Ngai Tung ◽  
Vincent Chun Man Yan ◽  
Winnie Ling Yin Tai ◽  
Jing Han Chen ◽  
Joanne Wai-yee Chung ◽  
...  
Keyword(s):  
Universal Health Coverage ◽  
Elderly Care ◽  
Healthcare Policy ◽  
Health Coverage ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Care Services ◽  
Universal Health ◽  
Nurses Knowledge

Objectives: to explore nurses' knowledge of universal health coverage (UHC) for inclusive and sustainable development of elderly care services. Method: this was a cross-sectional survey. A convenience sample of 326 currently practicing enrolled nurses (EN) or registered nurses (RN) was recruited. Respondents completed a questionnaire which was based on the implementation strategies advocated by the WHO Global Forum for Governmental Chief Nursing Officers and Midwives (GCNOMs). Questions covered the government initiative, healthcare financing policy, human resources policy, and the respondents' perception of importance and contribution of nurses in achieving UHC in elderly care services. Results: the knowledge of nurses about UHC in elderly care services was fairly satisfactory. Nurses in both clinical practice and management perceived themselves as having more contribution and importance than those in education. They were relatively indifferent to healthcare policy and politics. Conclusion: the survey uncovered a considerable knowledge gap in nurses' knowledge of UHC in elderly care services, and shed light on the need for nurses to be more attuned to healthcare policy. The educational curriculum for nurses should be strengthened to include studies in public policy and advocacy. Nurses can make a difference through their participation in the development and implementation of UHC in healthcare services.

scholarly journals Assessing the quality of primary healthcare in seven Chinese provinces with unannounced standardised patients: protocol of a cross-sectional survey

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e023997 ◽  
Author(s):  
Dong Roman Xu ◽  
Mengyao Hu ◽  
Wenjun He ◽  
Jing Liao ◽  
Yiyuan Cai ◽  
...  
Keyword(s):  
Primary Healthcare ◽  
Rating Scale ◽  
Physical Symptoms ◽  
Health Coverage ◽  
Cross Sectional Survey ◽  
Real Patient ◽  
Cross Sectional ◽  
Patient Rating ◽  
Standardised Patients ◽  
Real Practice

IntroductionPrimary healthcare (PHC) serves as the cornerstone for the attainment of universal health coverage (UHC). Efforts to promote UHC should focus on the expansion of access and on healthcare quality. However, robust quality evidence has remained scarce in China. Common quality assessment methods such as chart abstraction, patient rating and clinical vignette use indirect information that may not represent real practice. This study will send standardised patients (SP or healthy person trained to consistently simulate the medical history, physical symptoms and emotional characteristics of a real patient) unannounced to PHC providers to collect quality information and represent real practice.Methods and analysis1981 SP–clinician visits will be made to a random sample of PHC providers across seven provinces in China. SP cases will be developed for 10 tracer conditions in PHC. Each case will include a standard script for the SP to use and a quality checklist that the SP will complete after the clinical visit to indicate diagnostic and treatment activities performed by the clinician. Patient-centredness will be assessed according to the Patient Perception of Patient-Centeredness Rating Scale by the SP. SP cases and the checklist will be developed through a standard protocol and assessed for content, face and criterion validity, and test–retest and inter-rater reliability before its full use. Various descriptive analyses will be performed for the survey results, such as a tabulation of quality scores across geographies and provider types.Ethics and disseminationThis study has been reviewed and approved by the Institutional Review Board of the School of Public Health of Sun Yat-sen University (#SYSU 2017-011). Results will be actively disseminated through print and social media, and SP tools will be made available for other researchers.

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