Health service use, out-of-pocket payments and catastrophic health expenditure among older people in India: The WHO Study on global AGEing and adult health (SAGE)

2015 ◽  
Vol 69 (5) ◽  
pp. 489-494 ◽  
Author(s):  
Ethel Mary Brinda ◽  
Paul Kowal ◽  
Jørn Attermann ◽  
Ulrika Enemark
Keyword(s):  
Health Service ◽  
Older People ◽  
Health Expenditure ◽  
Service Use ◽  
Catastrophic Health Expenditure ◽  
Health Service Use ◽  
Adult Health ◽  
Out Of Pocket Payments ◽  
Global Ageing

scholarly journals Impact of non-communicable disease multimorbidity on health service use, catastrophic health expenditure and productivity loss in Indonesia: a population-based panel data analysis study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e041870
Author(s):  
Tiara Marthias ◽  
Kanya Anindya ◽  
Nawi Ng ◽  
Barbara McPake ◽  
Rifat Atun ◽  
...  
Keyword(s):  
Panel Data ◽  
Health Service ◽  
Low Income ◽  
Health Expenditure ◽  
Service Use ◽  
Financial Burden ◽  
Panel Data Analysis ◽  
Productivity Loss ◽  
Catastrophic Health Expenditure ◽  
Health Service Use

ObjectivesTo examine non-communicable diseases (NCDs) multimorbidity level and its relation to households’ socioeconomic characteristics, health service use, catastrophic health expenditures and productivity loss.DesignThis study used panel data of the Indonesian Family Life Survey conducted in 2007 (Wave 4) and 2014 (Wave 5).SettingThe original sampling frame was based on 13 out of 27 provinces in 1993, representing 83% of the Indonesian population.ParticipantsWe included respondents aged 50 years and above in 2007, excluding those who did not participate in both Waves 4 and 5. The total number of participants in this study are 3678 respondents.Primary outcome measuresWe examined three main outcomes; health service use (outpatient and inpatient care), financial burden (catastrophic health expenditure) and productivity loss (labour participation, days primary activity missed, days confined in bed). We applied multilevel mixed-effects regression models to assess the associations between NCD multimorbidity and outcome variables,ResultsWomen were more likely to have NCD multimorbidity than men and the prevalence of NCD multimorbidity increased with higher socioeconomic status. NCD multimorbidity was associated with a higher number of outpatient visits (compared with those without NCD, incidence rate ratio (IRR) 4.25, 95% CI 3.33 to 5.42 for individuals with >3 NCDs) and inpatient visits (IRR 3.68, 95% CI 2.21 to 6.12 for individuals with >3 NCDs). NCD multimorbidity was also associated with a greater likelihood of experiencing catastrophic health expenditure (for >3 NCDs, adjusted OR (aOR) 1.69, 95% CI 1.02 to 2.81) and lower participation in the labour force (aOR 0.23, 95% CI 0.16 to 0.33) compared with no NCD.ConclusionsNCD multimorbidity is associated with substantial direct and indirect costs to individuals, households and the wider society. Our study highlights the importance of preparing health systems for addressing the burden of multimorbidity in low-income and middle-income countries.

scholarly journals Socioeconomic Disparities in Cancer Treatment, Service Utilization and Catastrophic Health Expenditure in China: A Cross-Sectional Analysis

2020 ◽  
Vol 17 (4) ◽  
pp. 1327 ◽  
Author(s):  
Yang Zhao ◽  
Lin Zhang ◽  
Yu Fu ◽  
Minyu Wang ◽  
Luwen Zhang
Keyword(s):  
Health Service ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Service Utilization ◽  
Health Expenditure ◽  
Health Service Utilization ◽  
Service Use ◽  
Catastrophic Health Expenditure ◽  
Socioeconomic Disparities ◽  
Health Service Use

Background: This study aims (1) to assess socioeconomic disparities in healthcare use and catastrophic health expenditure (CHE) among cancer patients in China, which is defined as the point at which annual household health payments exceeded 40% of non-food household consumption expenditure, and (2) to examine the association of different treatments for cancers with health service utilization and CHE. Methods: We used nationally representative data from the China Health and Retirement Longitudinal Study in 2015 with 17,018 participants in which 381 with doctor-diagnosed cancer. The main treatments for cancer included the Chinese traditional medicine (TCM), western modern medicine (refers to taking western modern medications excluding TCM and other treatments for cancers), surgery, and radiation/chemotherapy. Concentration curve was used to assess economic-related disparities in healthcare and CHE. Multivariate regression models were used to examine the impact of the cancer treatment on health service use and incidence of CHE. Results: The main cancer treatments and health service use were more concentrated among the rich patients than among the poor patients in 2015. There was a positive association between the treatment of cancer and outpatient visit (Adjusted Odds Ratio (AOR) = 2.492, 95% CI = 1.506, 4.125), inpatient visit (AOR = 1.817, 95% CI = 1.098, 3.007), as well as CHE (AOR = 2.744, 95% CI = 1.578, 4.772). All cancer therapies except for medication treatments were associated with a higher incidence of CHE, particularly the surgery therapy (AOR = 6.05, 95% CI = 3.393, 27.866) in urban areas. Conclusion: Disparities in treatment and health service utilization among Chinese cancer patients was largely determined by financial capability. The current insurance schemes are insufficient to address these disparities. A comprehensive health insurance policy of expanding the current benefits packages and strengthening the Public Medical Assistance System, are essential for Chinese adults with cancer.

Vulnerable Older People in the Community: Relationship Between the Vulnerable Elders Survey and Health Service Use

2008 ◽  
Vol 56 (1) ◽  
pp. 8-15 ◽  
Author(s):  
Hannah M. McGee ◽  
Ann O'Hanlon ◽  
Maja Barker ◽  
Anne Hickey ◽  
Anthony Montgomery ◽  
...  
Keyword(s):  
Health Service ◽  
Older People ◽  
Service Use ◽  
Health Service Use ◽  
Community Relationship

scholarly journals Evidence assessment and narrative synthesis of the key characteristics of older people living in service-integrated housing facilities, and their ‘accommodation journey’

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Juliana Thompson ◽  
Michael Hill ◽  
Lesley Bainbridge ◽  
Daniel Cowie ◽  
Emma Flewers
Keyword(s):  
Health Service ◽  
Older People ◽  
Workforce Development ◽  
Service Use ◽  
Well Being ◽  
Health Service Use ◽  
Narrative Synthesis ◽  
Care Needs ◽  
Content Type ◽  
Key Characteristics

Purpose This paper aims to provide an evidence assessment and narrative synthesis of literature regarding the key characteristics of older people living in service-integrated housing (SIH) facilities and their “accommodation journey”. Design/methodology/approach A rapid evidence assessment was conducted: 22 research publications met the inclusion criteria and were analysed using narrative synthesis. Findings The quality of studies in this area is low, but consistency across components of the results of studies included in the review is apparent. Results suggest key characteristics of older people that drive moves into SIH are a decline in health, increased dependency, increased health service use and carer burden. Suggested key characteristics of SIH residents are high levels of health problems, dependency and health service use, but high self-reported health and well-being. Results indicate that the key driver for older people leaving SIH is a lack of workforce competency to manage further declines in health and dependency status. Research limitations/implications Current policy may not realise or account for the complex health and care needs of SIH residents. Investment into integrated care, robust community health services and workforce development to facilitate a comprehensive assessment approach may be required to support residents to remain in SIH and live well. Further longitudinal studies are required to map the progression of SIH residents’ health status in detail over time to provide an understanding of preventative and enablement support, development of care pathways and workforce planning and development requirements. Originality/value This evidence assessment is the first to consider the accommodation journey of older people residing in SIH.

scholarly journals Common elements of service delivery models that optimise quality of life and health service use among older people with advanced progressive conditions: a tertiary systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e048417
Author(s):  
Joanne Bayly ◽  
Anna E Bone ◽  
Clare Ellis-Smith ◽  
India Tunnard ◽  
Shuja Yaqub ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Health Service ◽  
Older People ◽  
Low Income ◽  
Service Use ◽  
Functional Decline ◽  
Low Income Countries ◽  
Health Service Use

IntroductionHealth and social care services worldwide need to support ageing populations to live well with advanced progressive conditions while adapting to functional decline and finitude. We aimed to identify and map common elements of effective geriatric and palliative care services and consider their scalability and generalisability to high, middle and low-income countries.MethodsTertiary systematic review (Cochrane Database of Systematic Reviews, CINAHL, Embase, January 2000–October 2019) of studies in geriatric or palliative care that demonstrated improved quality of life and/or health service use outcomes among older people with advanced progressive conditions. Using frameworks for health system analysis, service elements were identified. We used a staged, iterative process to develop a ‘common components’ logic model and consulted experts in geriatric or palliative care from high, middle and low-income countries on its scalability.Results78 studies (59 geriatric and 19 palliative) spanning all WHO regions were included. Data were available from 17 739 participants. Nearly half the studies recruited patients with heart failure (n=36) and one-third recruited patients with mixed diagnoses (n=26). Common service elements (≥80% of studies) included collaborative working, ongoing assessment, active patient participation, patient/family education and patient self-management. Effective services incorporated patient engagement, patient goal-driven care and the centrality of patient needs. Stakeholders (n=20) emphasised that wider implementation of such services would require access to skilled, multidisciplinary teams with sufficient resource to meet patients’ needs. Identified barriers to scalability included the political and societal will to invest in and prioritise palliative and geriatric care for older people, alongside geographical and socioeconomic factors.ConclusionOur logic model combines elements of effective services to achieve optimal quality of life and health service use among older people with advanced progressive conditions. The model transcends current best practice in geriatric and palliative care and applies across the care continuum, from prevention of functional decline to end-of-life care.PROSPERO registration numberCRD42020150252.

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