Extent and determinants of catastrophic health expenditure for tuberculosis care in Chongqing municipality, China: a cross-sectional study

ObjectiveTo investigate the extent and associations of patient/diagnostic delay and other potential factors with catastrophic health expenditure (CHE) for tuberculosis (TB) care in Chongqing municipality, China.DesignA cross-sectional study.SettingFour counties of Chongqing municipality, China.ParticipantsA total of 1199 patients with active pulmonary TB beyond 16 years and without mental disorders were consecutively recruited in the four counties’ designated TB medical institutions.Outcome measuresThe incidence and intensity of CHE for TB care were described. The association between patients’ ‘sociodemographic and clinical characteristics such as patient delay, diagnostic delay, forms of TB, health insurance status and hospitalisation and CHE were analysed using univariate and multivariate logistic regression.ResultsThe incidence of CHE was 52.8% and out-of-pocket (OOP) payments were 93% of the total costs for TB care. Compared with patients without delay, the incidence and intensity of CHE were higher in patients who had patient delay or diagnostic delay. Patients who experienced patient delay or diagnostic delay, who was a male, elderly (≥60 years), an inhabitant, a peasant, divorced/widow, the New Cooperative Medical Scheme membership had greater risks of incurring CHE for TB care. Having a higher educational level appeared to be a protective factor. However, hospitalisation was not associated with CHE after controlling for other variables.ConclusionThe incidence and intensity of CHE for TB care are high, which provides baseline data about catastrophic costs that TB-related households faced in Chongqing of China. Variety of determinants of CHE implicate that it is essential to take effective measures to promote early seeking care and early diagnosis, improve the actual reimbursement rates of health insurance, especially for outpatients, and need more fine-tuned interventions such as precise poverty alleviation to reduce catastrophic costs of the vulnerable population.

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The effect of community based health insurance on catastrophic health expenditure in Northeast Ethiopia: A cross sectional study

PLoS ONE ◽

10.1371/journal.pone.0205972 ◽

2018 ◽

Vol 13 (10) ◽

pp. e0205972 ◽

Cited By ~ 8

Author(s):

Asnakew Molla Mekonen ◽

Measho Gebreslassie Gebregziabher ◽

Alemayehu Shimeka Teferra

Keyword(s):

Health Insurance ◽

Health Expenditure ◽

Cross Sectional Study ◽

Catastrophic Health Expenditure ◽

Sectional Study ◽

Community Based ◽

Cross Sectional ◽

Community Based Health Insurance ◽

Northeast Ethiopia

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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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Health seeking behaviour in pulmonary tuberculosis: a cross sectional study

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20181206 ◽

2018 ◽

Vol 5 (4) ◽

pp. 1346 ◽

Cited By ~ 2

Author(s):

Jebamalar J. ◽

Priya Senthilkumar ◽

Mary Ramola

Keyword(s):

Pulmonary Tuberculosis ◽

Diagnostic Delay ◽

Cross Sectional Study ◽

Patient Delay ◽

Diagnosis And Treatment ◽

Sectional Study ◽

Health Seeking Behaviour ◽

Health Seeking ◽

Cross Sectional ◽

Tuberculosis Patients

Background: Health seeking behaviour has been identified as a complex and dynamic process which influences disease burden of tuberculosis. The present study aimed to study health seeking behaviour among pulmonary tuberculosis patients in a metropolitan city and to assess diagnostic and treatment delays and their determinants.Methods: A cross sectional study was conducted among newly diagnosed pulmonary tuberculosis patients registered for intensive phase of Category 1 ATT during the study period in Zone VIII of Chennai Corporation. The sample size was 197. The study was conducted over a period of one year from September 2015 to August 2016. A standardized WHO interview schedule on diagnostic delay was used for the study.Results: Patients sought healthcare for more severe symptoms like hemoptysis (delay of 38 days) earlier than for cough (delay o- 8 days). Other reasons for delay in seeking care were hope of self-resolution, financial constraints, fear of what the diagnosis would be, incompatible timings etcetera. The total mean delay from onset of symptoms till start of treatment was around 47 days, out of which the patient delay was 42 days. Factors significantly associated with delay included smoking, age more than 35 years and not approaching healthcare facilities first.Conclusions: An unacceptably high patient delay is the major contributor to total delay in the diagnosis and treatment of pulmonary tuberculosis patients. There is increased odds of delay among smokers compared to those who have never smoked. So smokers may be added to the high risk group for suspicion of tuberculosis for fast tracking of diagnosis and treatment. Furthermore, methods to curb over the counter medications should be explored.

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Association between livelihood capital and catastrophic health expenditure among patients with critical illness: a cross-sectional study in rural Shandong, China

BMJ Open ◽

10.1136/bmjopen-2021-051234 ◽

2021 ◽

Vol 11 (10) ◽

pp. e051234

Author(s):

Xin Che ◽

Jiajia Li ◽

Wenhao Fu ◽

Feng Fang

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Health Expenditure ◽

Natural Capital ◽

Cross Sectional Study ◽

Catastrophic Health Expenditure ◽

Secondary Outcome ◽

Sectional Study ◽

Cross Sectional ◽

Out Of Pocket Payments

ObjectiveThe objective of this study is to examine the association between livelihood capital and catastrophic health expenditure (CHE).DesignBetween July and August 2019, a cross-sectional study was conducted in critically ill patients.SettingShandong, China.Participants1041 households with critically ill patients from 77 villages.Primary and secondary outcome measuresWe defined expenditure as being catastrophic if a household’s out-of-pocket payments were greater than or equal to 40% of their capacity to pay. Using the sustainable livelihoods framework, this study explored the associations between CHE and the various forms of livelihood capital—inclusive of human capital, natural capital, physical capital, financial capital and social capital. χ2 tests, t-tests, Wilcoxon tests and binary logistic regression analysis were performed to examine these associations.ResultsThe incidence of CHE among households with critically ill patients was 76.37% in this study. Better livelihood capital was significantly associated with lower incidence of CHE. After controlling for confounding factors, households with healthier patients (OR 0.47, 95% CI 0.23 to 0.96), more real estate ownership (OR 0.35, 95% CI 0.19 to 0.67) and better economic status (OR 0.33, 95% CI 0.18 to 0.62) were associated with a reduction in the occurrence of CHE.ConclusionsLivelihood capital was significantly associated with CHE in rural families with critically ill patients. This association suggests that, in addition to providing health insurance to the critically ill, more attention should be paid to their ability to create and preserve livelihood capital.

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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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Determinants of Out-of-Pocket and Catastrophic Health Expenditure: A Cross-sectional Study

British Journal of Medicine and Medical Research ◽

10.9734/bjmmr/2016/21470 ◽

2016 ◽

Vol 11 (8) ◽

pp. 1-11 ◽

Cited By ~ 2

Author(s):

Rajesh Sinha ◽

Keya Chatterjee ◽

Nirmala Nair ◽

Prasanta Tripathy

Keyword(s):

Health Expenditure ◽

Cross Sectional Study ◽

Catastrophic Health Expenditure ◽

Sectional Study ◽

Cross Sectional

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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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The Association of Social Support and Symptomatic Remission among Community-Dwelling Schizophrenia Patients: A Cross-Sectional Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18083977 ◽

2021 ◽

Vol 18 (8) ◽

pp. 3977

Author(s):

Chi-Hsuan Fan ◽

Shih-Chieh Hsu ◽

Fei-Hsiu Hsiao ◽

Chia-Ming Chang ◽

Chia-Yih Liu ◽

...

Keyword(s):

Social Support ◽

Protective Factor ◽

Cross Sectional Study ◽

Community Dwelling ◽

Psychotic Symptoms ◽

Sectional Study ◽

Cross Sectional ◽

Remission Status ◽

Remission Rates ◽

Symptomatic Remission

Schizophrenia is a mental disease that often leads to chronicity. Social support could reduce the severity of psychotic symptoms; therefore, its influence on remission should be examined. This study investigated the remission rates in community-dwelling schizophrenia patients and examined the association between social support and remission status. A cross-sectional study was conducted in 129 schizophrenia patients in Taiwan. Remission rates were evaluated, and the level of social support, clinical characteristics, sociodemographic variables, and healthy lifestyle status were compared between the remission and nonremission groups. The association between social support and remission was analyzed after adjusting for confounding factors. The mean illness duration is 12.9 years. More than 95% of the participants lived with their families, 63% were unemployed, and 43% achieved remission. Higher social support was observed in the remission group, and a significant correlation was observed between family domain of social support and remission status. Family support was a protective factor of symptomatic remission in community-dwelling schizophrenia patients in Taiwan. The results reflect the effects of a family-centered culture on patients during illness. Consequently, reinforcing family relationships and the capacity of families to manage the symptoms of patients and providing support to families are recommended.

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Prevalence of gout and asymptomatic hyperuricemia in the pediatric population: a cross-sectional study of a Japanese health insurance database

BMC Pediatrics ◽

10.1186/s12887-020-02379-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Shuichi Ito ◽

Tomoko Torii ◽

Akihiro Nakajima ◽

Takeshi Iijima ◽

Hiroshi Murano ◽

...

Keyword(s):

Uric Acid ◽

Health Insurance ◽

Pediatric Population ◽

Gouty Arthritis ◽

Cross Sectional Study ◽

Sectional Study ◽

Insurance Claims ◽

Cross Sectional ◽

Total Prevalence ◽

Health Insurance Claims

Abstract Background Although gout is rare in children, chronic sustained hyperuricemia can lead to monosodium urate deposits progressing to gout, just as in adults. This study assessed prevalence and characteristics of gout and asymptomatic hyperuricemia, and incidence of gouty arthritis in the pediatric population, using data from Japanese health insurance claims. The diagnosis and treatment of pediatric gout and hyperuricemia were analyzed, and specific characteristics of those patients were assessed. Since Japanese guidelines recommend treatment with uric acid lowering drugs for asymptomatic hyperuricemia as well as for gout, these data were also used to investigate the real-world use of uric acid lowering drugs in a pediatric population. Methods This cross-sectional study was based on a 2016–2017 Japanese health insurance claims database, one of the largest epidemiology claims databases available in Japan, which included 356,790 males and 339,487 females 0–18 years of age. Outcomes were measured for prevalence, patient characteristics, treatment with uric acid lowering drugs for gout and asymptomatic hyperuricemia, and prevalence and incidence of gouty arthritis. Because uric acid can be elevated by some forms of chemotherapy, data from patients under treatment for malignancies were excluded from consideration. Results Total prevalence of gout and asymptomatic hyperuricemia in 0–18 year-olds was 0.040% (276/696,277 patients), with gout prevalence at 0.007% (48/696,277) and asymptomatic hyperuricemia at 0.033% (228/696,277). Prevalence of gout and asymptomatic hyperuricemia was highest in adolescent males, at 0.135% (176/130,823). The most common comorbidities for gout and asymptomatic hyperuricemia were metabolic syndrome at 42.8% (118/276) and kidney disease at 34.8% (96/276). Of the patients diagnosed with gout or asymptomatic hyperuricemia, 35.1% (97/276) were treated with uric acid lowering drugs. Gouty arthritis developed in 43.8% (21/48) of gout patients during the study, at an incidence of 0.65 flares/person-year. Conclusions Even the pediatric population could be affected by asymptomatic hyperuricemia, gout, and gouty arthritis, and uric acid lowering drugs are being used in this population even though those drugs have not been approved for pediatric indications. Such off-label use may indicate a potential need for therapeutic agents in this population. Trial registration UMIN000036029.

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