scholarly journals Measurement and determinants of catastrophic health expenditure among elderly households in China using longitudinal data from the CHARLS

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Shiai Liu ◽  
Peter C. Coyte ◽  
Mingqi Fu ◽  
Qilin Zhang
Keyword(s):  
Logistic Regression ◽  
Health Expenditure ◽  
Chronic Health Condition ◽  
Catastrophic Health Expenditure ◽  
Health Condition ◽  
Gradual Improvement ◽  
Services Utilization ◽  
Food Expenditure ◽  
Key Policy ◽  
Elderly Households

Abstract Background Catastrophic health expenditure (CHE) among the Chinese elderly warrants attention. However, the incidence, intensity and determinants of CHE have not been fully investigated. This study explores the incidence, intensity and determinants of CHE among elderly Chinese citizens, i.e., those aged 60 years or older. Methods Data were obtained from three waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011, 2013 and 2015. The cut-off points used in this study for CHE were 10% of the total expenditures and 40% of non-food expenditure. Under the guidance of Andersen’s model of health services utilization, this study used logistic regression analysis to explore the determinants of CHE. Results The incidence of CHE defined as more than 40% of non-food expenditure rose over the study period, 2011–2015, from 20.86% (95% CI: 19.35 to 22.37%) to 31.00% (95% CI: 29.28 to 32.72%). The intensity of CHE also increased. The overshoot (O) based on non-food expenditure rose from 3.12% (95% CI: 2.71 to 3.53%) to 8.75% (95% CI: 8.14 to 9.36%), while the mean positive overshoot (MPO) rose from 14.96% (95% CI: 12.99 to 16.92%) to 28.23% (95% CI: 26.26 to 30.19%). Thus, the problem of CEH was even more serious in 2015 than in 2011. Logistic regression revealed that households were more likely to face CHE if they had a spouse as a household member, reported an inpatient event in the last year, reported an outpatient visit in the last month, were disabled, were members of a poor expenditure quartile, lived in the middle and western zones or resided in an urban area. In contrast, CEH was not significantly affected by respondents being older than 75 years or having a chronic health condition, by household size or by insurance type. Conclusions Key policy recommendations include the gradual improvement of medical assistance and the expansion of the use of health insurance to reduce household liability for health expenditures.

scholarly journals Measurement and determinants of catastrophic health expenditure among the elderly households in China using longitudinal data from the CHARLS

2020 ◽  
Author(s):  
Shiai Liu ◽  
Peter Christopher Coyte ◽  
Mingqi Fu ◽  
Qilin Zhang
Keyword(s):  
Logistic Regression ◽  
Health Expenditure ◽  
The Elderly ◽  
Chronic Health Condition ◽  
Catastrophic Health Expenditure ◽  
Health Condition ◽  
Gradual Improvement ◽  
Food Expenditure ◽  
Key Policy ◽  
Elderly Households

Abstract Background: Catastrophic health expenditure (CHE) among the Chinese elderly warrants attention. However, the incidence, intensity and determinants of CHE have not been fully investigated. This study explores the incidence, intensity and determinants of CHE among elderly Chinese citizens, i.e., those aged 60 years or older.Methods: Data were obtained from three waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011, 2013 and 2015. The cut-off points used in this study for CHE were 10% of the total expenditures and 40% of non-food expenditure. Under the guidance of Andersen’s model of health services utilization, this study used logistic regression analysis to explore the determinants of CHE.Results: The incidence of CHE defined as more than 40% of non-food expenditure rose over the study period, 2011-2015, from 20.86% (95% CI: 19.35% to 22.37%) to 31.00% (95% CI: 29.28% to 32.72%). The intensity of CHE also increased. The overshoot (O) based on non-food expenditure rose from 3.12% (95% CI: 2.71% to 3.53%) to 8.75% (95% CI: 8.14% to 9.36%), while the mean positive overshoot (MPO) rose from 14.96% (95% CI: 12.99% to 16.92%) to 28.23% (95% CI: 26.26% to 30.19%). Thus, the problem of CEH was even more serious in 2015 than in 2011. Logistic regression revealed that households were more likely to face CHE if they had a spouse as a household member, reported an inpatient event in the last year, reported an outpatient visit in the last month, were disabled, were members of a poor expenditure quartile, lived in the middle and western zones or resided in an urban area. In contrast, CEH was not significantly affected by respondents being older than 75 years or having a chronic health condition, by household size or by insurance type.Conclusions: Key policy recommendations include the gradual improvement of medical assistance and the expansion of the use of health insurance to reduce household liability for health expenditures.Trial Registration: None.

scholarly journals Measurement and determinants of catastrophic health expenditures among the elderly in China using longitudinal data from the CHARLS

2020 ◽  
Author(s):  
Shiai Liu ◽  
Peter Christopher Coyte ◽  
Mingqi Fu ◽  
Qilin Zhang
Keyword(s):  
Logistic Regression ◽  
Health Expenditures ◽  
The Elderly ◽  
Chronic Health Condition ◽  
Health Condition ◽  
Andersen Model ◽  
Food Expenditures ◽  
Catastrophic Health Expenditures ◽  
Food Expenditure ◽  
Key Policy

Abstract Introduction: Catastrophic health expenditures (CHE) among Chinese elderly is an issue worthy of attention. However, the incidence, intensity and determinants of CHE have not been fully investigated by previous studies. This study explores the incidence, intensity and determinants of CHE among elderly Chinese citizens, i.e. those aged 60 years or older.Methods: Data were obtained from three waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011, 2013 and 2015. Cutoff points used in this study for catastrophic health expenditures were 10% of the total expenditures and 40% of non-food expenditures. Under the guidance of the Andersen model of health services utilization, this study used the logistic regression analysis to explore the determinants of catastrophic health expenditures.Results: The incidence of catastrophic health expenditures rose over the study period, 2011-2015, from 20.86% (95% CI: 19.35% to 22.37%) to 31.00% (95% CI: 29.28% to 32.72%) with 40% non-food expenditure. The intensity of CHE had also increased. The Overshoot(O) rose from from 3.12% (95% CI: 2.71% to 3.53%) to 8.75% (95% CI: 8.14% to 9.36%) with 40% non-food expenditure, while the mean positive overshoot (MPO) rose from 14.96% (95% CI: 12.99% to 16.92%) to 28.23% (95% CI: 26.26% to 30.19%), which means that the problem of catastrophic health expenditures was even more serious in 2015 than in 2011. Logistic regression revealed that households were more likely to face CHE if they: had a spouse as a household member, reported an inpatient event in the last year, reported an outpatient visit in the last month, are disabled; are members of a poor expenditure quartile, are located in the middle and western zones and reside in an Urban area. In contrast, catastrophic health expenditures were not significantly affected by age above 75 years, household size, having a chronic health condition or insurance type.Conclusion: Key policy recommendations include efforts to gradually improve medical assistance and to expand the use of health insurance to reduce household liability exposure for health expenditures.

scholarly journals Measurement and determinants of financial protection in health in Afghanistan

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ilker Dastan ◽  
Asiyeh Abbasi ◽  
Chokri Arfa ◽  
Mir Najmuddin Hashimi ◽  
Said Mohammad Karim Alawi
Keyword(s):  
Logistic Regression ◽  
Health Services ◽  
Health Expenditure ◽  
Health Financing ◽  
Catastrophic Health Expenditure ◽  
Financial Hardship ◽  
High Rate ◽  
Financing System ◽  
Total Consumption ◽  
Female Head

Abstract Background Out of pocket (OOP) payments for health are significant health financing challenges in Afghanistan as it is a source of incurrence of catastrophic health expenditure (CHE) and impoverishment. Measuring and understanding the drivers and impacts of this financial health hardship is an economic and public health priority, particularly in the time of COVID-19. This is the first study that measures the financial hardship and determines associated factors in Afghanistan. Methods Afghanistan Living Conditions Survey data for 2016–2017 was used for this study. We calculated incidence and intensity of catastrophic health expenditure by using different thresholds ranging from 5 to 40% of total and nonfood consumption and subsequent impoverishment due to OOPs. Logistic regression was used to assess the degree to which Afghan households are protected from the catastrophic household expenditure. Results Results revealed that 32% of the population in Afghanistan incurred catastrophic health expenditure (as 10% of total consumption) and when healthcare payments are netted out of household consumption, the Afghan population live in extreme poverty ($1.9 in 2011 PPP), increased from 29 to 36%. Based on our findings from logistic regression in Afghanistan, having an educated head or being employed are protective factors from financial hardship while having a female head, an elderly member, a disabled, or a sick member are the risk factors of facing catastrophic health expenditure. Moreover, the people living in rural/nomadic areas or facing an economic shock are more likely to face catastrophic health expenditure and hence to be impoverished due to direct OOPs on health. Conclusions The high rate of poverty and catastrophic health expenditure in Afghanistan emphasizes the need to strengthen the health financing system. Although Afghanistan has made great efforts to support households against health expenditure burden during the pandemic, households are at higher risk of poverty and financial hardship due to OOPs. Therefore, there is need for more financial and supportive response policies by providing a better and easier access to primary health services, extending to all entitlement to health services particularly in the public sector, eliminating user fees for COVID-19 health services and suspending fees for other essential health services, expanding coverage of income support, and strengthening the overall health financing system.

scholarly journals Health services utilization and out-of-pocket (OOP) expenditures in public and private facilities in Pakistan: An empirical analysis of the 2013-14 OOP Health Expenditure Survey

2021 ◽  
Author(s):  
Faraz Khalid ◽  
Wajeeha Raza ◽  
David R. Hotchkiss ◽  
Rieza H. Soelaeman
Keyword(s):  
Logistic Regression ◽  
Health Services ◽  
Private Sector ◽  
Health Expenditure ◽  
Health Services Utilization ◽  
Private Provider ◽  
Care Utilization ◽  
Public And Private ◽  
Services Utilization ◽  
Expenditure Survey

Abstract Background As low- and middle-income countries progress toward Universal Health Coverage, there is an increasing focus on measuring out-of-pocket (OOP) expenditure and health services utilization within countries. While there have been several reforms to improve health services coverage and financial protection in Pakistan, there is limited empirical research comparing OOP expenditure and health services utilization between public and private facilities and exploring their determinants, a knowledge gap addressed in this study. Methods We used data from 2013-14 OOP Health Expenditure Survey, a population-based household survey carried out for Pakistan’s National Health Accounts. The analysis included 7,969 encounters from 4,293 households. We conducted bivariate analyses to describe patterns of care utilization, estimated annualized expenditures by type and sector of care, and assessed expenditure composition. We used multivariable logistic regression modeling to identify factors associated with sector of care and generalized linear model (GLM) with log link and gamma distribution to identify determinants of OOP expenditures stratified by type of care (inpatient and outpatient). Results Most encounters (82.5%) were in the private sector and were for outpatient visits (85%). Several public-private differences were observed in annualized expenditures and expenditure components. Logistic regression results indicate males, wealthier individuals, Punjab and Sindh residents, and those in smaller households were more likely to access private outpatient care. In the inpatient model, rural residents were more likely to use a private provider, while Khyber Pakhtunkhwa residents were less likely to use private care. GLM results indicate private sector inpatient expenditures were approximately PKR 6,660 (USD 61.8) higher than public sector expenditures, but no public-private differences were observed for outpatient expenditures. Several demographic factors were significantly associated with outpatient and inpatient expenditures. Of note, expenditures increased with increasing wealth, decreased with increasing household size, and differed by province and region. Conclusions This is the first study comprehensively investigating how healthcare utilization and OOP expenditures vary by sector, type of care, and socio-economic characteristics in Pakistan. The findings are expected to be particularly useful for the next phase of social health protection programs and supply side reforms, as they highlight sub-populations with higher OOP and private sector utilization.

scholarly journals Out-of-Pocket and Catastrophic Expenditure of Neonatal Health Care in Kaski District, Nepal

2018 ◽  
pp. 1-21
Author(s):  
Chiranjivi Adhikari ◽  
Bishnu Prasad Sharma ◽  
Sudarshan Subedi
Keyword(s):  
Health Care ◽  
Health Expenditure ◽  
Catastrophic Health Expenditure ◽  
Neonatal Health ◽  
Major Barrier ◽  
Face To Face ◽  
Food Expenditures ◽  
Food Expenditure ◽  
Eye Infection ◽  
Economic Journal

Neonatal mortality is the prime indicator that contributes to child mortality. The out-of-pocket (OOP) expenditure for treatment remains a major barrier in treatment. The study aimed to calculate OOP of neonatal health care in Kaski district of Nepal. A total of 450 mothers (226 from rural and 224 from urban), having infants aged six months or less or the infants died within last six months, were interviewed face-to-face retrospectively for neonate period. Firstly, six out of 33 urban and ten out of 43 rural clusters were randomly selected from Kaski district and secondly, within each cluster, HHs were selected using EPI method as described by WHO. The mean out-of-pocket expenditure (OOP) of neonatal health care was NRs. 4,322 which was 2.7 percent of total non-food expenditure.  Three percent HHs suffered catastrophic health expenditure due to neonatal OOP. It reached five percent when housing/rental cost was excluded from non-food expenditures. HHs with cases of ARI, diarrhea, and others such as Neonatal Tetanus (NT), constipation, eye infection, preterm, meconium engulf and allergy differed significantly from the HHs with cases of jaundice and fever at all three thresholds of catastrophic health expenditure.  OOP also differed significantly according to the levels of health facilities. Economic Journal of Development Issues Vol. 21 & 22 No. 1-2 (2016) Combined Issue, Page: 1-21 

scholarly journals Health services utilization and out-of-pocket (OOP) expenditures in public and private facilities in Pakistan: an empirical analysis of the 2013–14 OOP health expenditure survey

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
F. Khalid ◽  
W. Raza ◽  
D. R. Hotchkiss ◽  
R. H. Soelaeman
Keyword(s):  
Logistic Regression ◽  
Health Services ◽  
Private Sector ◽  
Health Expenditure ◽  
Health Services Utilization ◽  
Private Provider ◽  
Care Utilization ◽  
Public And Private ◽  
Services Utilization ◽  
Expenditure Survey

Abstract Background As low- and middle-income countries progress toward Universal Health Coverage, there is an increasing focus on measuring out-of-pocket (OOP) expenditure and health services utilization within countries. While there have been several reforms to improve health services coverage and financial protection in Pakistan, there is limited empirical research comparing OOP expenditure and health services utilization between public and private facilities and exploring their determinants, a knowledge gap addressed in this study. Methods We used data from 2013 to 14 OOP Health Expenditure Survey, a population-based household survey carried out for Pakistan’s National Health Accounts. The analysis included 7969 encounters from 4293 households. We conducted bivariate analyses to describe patterns of care utilization, estimated annualized expenditures by type and sector of care, and assessed expenditure composition. We used multivariable logistic regression modeling to identify factors associated with sector of care and generalized linear model (GLM) with log link and gamma distribution to identify determinants of OOP expenditures stratified by type of care (inpatient and outpatient). Results Most encounters (82.5%) were in the private sector and were for outpatient visits (85%). Several public-private differences were observed in annualized expenditures and expenditure components. Logistic regression results indicate males, wealthier individuals, Punjab and Sindh residents, and those in smaller households were more likely to access private outpatient care. In the inpatient model, rural residents were more likely to use a private provider, while Khyber Pakhtunkhwa residents were less likely to use private care. GLM results indicate private sector inpatient expenditures were approximately PKR 6660 (USD 61.8) higher than public sector expenditures, but no public-private differences were observed for outpatient expenditures. Several demographic factors were significantly associated with outpatient and inpatient expenditures. Of note, expenditures increased with increasing wealth, decreased with increasing household size, and differed by province and region. Conclusions This is the first study comprehensively investigating how healthcare utilization and OOP expenditures vary by sector, type of care, and socio-economic characteristics in Pakistan. The findings are expected to be particularly useful for the next phase of social health protection programs and supply side reforms, as they highlight sub-populations with higher OOP and private sector utilization.

Does choice of health care facility matter? Assessing out-of-pocket expenditure and catastrophic spending on emergency obstetric care in India

2020 ◽  
pp. 1-16
Author(s):  
Jalandhar Pradhan ◽  
Sasmita Behera
Keyword(s):  
Public Health ◽  
Health Care ◽  
Logistic Regression ◽  
Maternal Mortality ◽  
Health Expenditure ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Catastrophic Health Expenditure ◽  
Health Care Facilities ◽  
Care Facilities

Abstract The key recommendation of the Child Survival and Safe Motherhood programme was the provision of Emergency Obstetric Care (EmOC) for the prevention of maternal mortality, especially in developing countries like India. The objectives of this paper were three-fold: to examine the socioeconomic differentials in mean out-of-pocket expenditure on EmOC in public and private health care facilities in India; to evaluate the catastrophic health expenditure of households at the threshold levels of 5% and 10%; and finally, to assess the effects of various socioeconomic and demographic covariates on the levels of catastrophic health expenditure on EmOC. Data were extracted from the 71st round of the National Sample Survey Office (NSSO) survey conducted in India between January and June 2014. A stratified multi-stage sampling design was followed to conduct the survey. The information was collected from 65,932 households (rural: 36,480; urban: 29,452) and 33,104 individuals across various states and union territories in India. However, the present study had taken only 1653 sample women who availed EmOC care during the last one year preceding the survey date. Binary logistic regression was applied. Large differences in out-of-pocket expenditure on EmOC were found between private and public health care facilities. Mean annual out-of-pocket expenditure by women in private hospitals was INR 23,309 (US$367), which was about 6 times higher than in public hospitals, where mean spending was INR 3651 (US$58). Furthermore, logistic regression analysis showed a significant association between household socioeconomic status and level of catastrophic health expenditure on EmOC. The odds of catastrophic health expenditure in public health facilities among women from the North region were higher than among those from the Central, South and West regions. Age and level of education significantly influenced the mean level of catastrophic health expenditure. Access to good-quality obstetric care is key to reducing the maternal mortality rate and child deaths, and thus achieving Sustainable Development Goal 3. There is an urgent need for policy interventions to reduce the financial burden of households in accessing obstetric care in India.

scholarly journals Determinants of Catastrophic Health Expenditure (CHE): An Indonesian Family Life Survey (IFLS) 2007 & 2014

2021 ◽  
Vol 24 (1) ◽  
pp. 156
Author(s):  
Afanin Husna ◽  
Ni Made Sukartini
Keyword(s):  
Health Expenditure ◽  
Occupational Status ◽  
Basic Needs ◽  
Catastrophic Health Expenditure ◽  
Household Economy ◽  
Ols Regression ◽  
Section Data ◽  
Food Expenditure ◽  
Household Heads ◽  
The Impact

This study aims at finding and analyzing the determinants of catastrophic health expenditure (CHE) and its impact on the household economy in Indonesia, using pooled cross section data from IFLS 2007 and 2014. The study used binary logit regression for analyzing the determinants of CHE and OLS regression to see the impact of CHE on household economy. It was found that the occupational status of the head of household, size of the household, age, ownership of insurance, visits to health centers, location of residence, and the interaction variable of educated household heads with chronic disease affect the occurrences of CHE with various threshold. The OLS regression results found that households who experienced CHE with a threshold of 10% and 40% made a reduction in their basic needs (food expenditure). It implies that households that experienced CHE also experienced economic shocks and they are eventually forced to reduce their basic needs (food expenditure) to meet health needs.

Sign in / Sign up

Export Citation Format

Share Document