scholarly journals Addressing data and methodological limitations in estimating catastrophic health spending and impoverishment in India, 2004–18

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Sanjay K. Mohanty ◽  
Laxmi Kant Dwivedi
Keyword(s):  
Health Spending ◽  
National Sample ◽  
Catastrophic Health Expenditure ◽  
Outpatient Services ◽  
Policy Makers ◽  
Catastrophic Health Spending ◽  
Access To Health ◽  
Food Expenditure ◽  
Using Data ◽  
Concentration Curves

Abstract Background Estimates of catastrophic health expenditure (CHE) are counterintuitive to researchers, policy makers, and developmental partners due to data and methodological limitation. While inferences drawn from use of capacity-to-pay (CTP) and budget share (BS) approaches are inconsistent, the non-availability of data on food expenditure in the health survey in India is an added limitation. Methods Using data from the health and consumption surveys of National Sample Surveys over 14 years, we have overcome these limitations and estimated the incidence and intensity of CHE and impoverishment using the CTP approach. Results The incidence of CHE for health services in India was 12.5% in 2004, 13.4% in 2014 and 9.1% by 2018. Among those households incurring CHE, they spent 1.25 times of their capacity to pay in 2004 (intensity of CHE), 1.71 times in 2014 and 1.31 times by 2018. The impoverishment due to health spending was 4.8% in 2004, 5.1% in 2014 and 3.3% in 2018. The state variations in incidence and intensity of CHE and incidence of impoverishment is large. The concentration index (CI) of CHE was − 0.16 in 2004, − 0.18 in 2014 and − 0.22 in 2018 suggesting increasing inequality over time. The concentration curves based on CTP approach suggests that the CHE was concentrated among poor. The odds of incurring CHE were lowest among the richest households [OR 0.22; 95% CI: 0.21, 0.24], households with elderly members [OR 1.20; 95% CI:1.12, 1.18] and households using both inpatient and outpatient services [OR 2.80, 95% CI 2.66, 2.95]. Access to health insurance reduced the chance of CHE and impoverishment among the richest households. The pattern of impoverishment was similar to that of CHE. Conclusion In the last 14 years, the CHE and impoverishment in India has declined while inequality in CHE has increased.

scholarly journals Addressing Data and Methodological Limitations in Estimating Catastrophic Health Spending and Impoverishment in India, 2004-18

2021 ◽  
Author(s):  
Sanjay Mohanty ◽  
Laxmikant Dwivedi
Keyword(s):  
Health Spending ◽  
National Sample ◽  
Catastrophic Health Expenditure ◽  
Outpatient Services ◽  
Middle Income ◽  
Policy Makers ◽  
Middle Income Countries ◽  
Catastrophic Health Spending ◽  
Food Expenditure ◽  
Using Data

Abstract Background Estimates of catastrophic health expenditure (CHE) are counterintuitive to researchers, policy makers, and developmental partners due to data and methodological limitation. While inferences drawn from use of capacity-to-pay (CTP) and budget share (BS) approaches are inconsistent, the non-availability of data on food expenditure in the health survey in India is an added limitation. Methods Using data from the health and consumption surveys of National Sample Surveys over 14 years, we have overcome these limitations and estimated the incidence and intensity of CHE and impoverishment using the CTP approach. Results The incidence of CHE for health services in India was 12.5% in 2004, 13.4% in 2014 and 9.1% by 2018. Among those households incurring CHE, they spent 1.25 times of their capacity to pay in 2004 (intensity of CHE), 1.71 times in 2014 and 1.31 times by 2018. The impoverishment due to health spending was 4.8% in 2004, 5.1% in 2014 and 3.3% in 2018. The state variations in incidence and intensity of CHE and incidence of impoverishment is large. The concentration index (CI) of CHE was -0.16 in 2004, -0.18 in 2014 and -0.22 in 2018 suggesting increasing inequality over time. The concentration curves based on CTP approach suggests that the CHE was concentrated among poor. The odds of incurring CHE were lowest among the richest households [OR 0.22; 95% CI: 0.21, 0.24], households with elderly members [OR 1.20; 95% CI:1.12, 1.18] and households using both inpatient and outpatient services [OR 2.80, 95% CI 2.66, 2.95]. Access to health insurance reduced the chance of CHE and impoverishment among the richest households. The pattern of impoverishment was similar to that of CHE. Conclusion In the last 14 years, the CHE and impoverishment in India has declined while inequality in CHE has increased. We recommend the CTP approach when estimating CHE and impoverishment in low and middle-income countries.

scholarly journals Addressing Data and Methodological Limitations in Estimating Catastrophic Health Spending and Impoverishment in India, 2004-18

2020 ◽  
Author(s):  
Sanjay Mohanty ◽  
Laxmikant Dwivedi
Keyword(s):  
Health Spending ◽  
National Sample ◽  
Catastrophic Health Expenditure ◽  
Outpatient Services ◽  
Middle Income ◽  
Policy Makers ◽  
Middle Income Countries ◽  
Catastrophic Health Spending ◽  
Food Expenditure ◽  
Using Data

Abstract BackgroundEstimates of catastrophic health expenditure (CHE) are counterintuitive to researchers, policy makers, and developmental partners due to data and methodological limitation. While inferences drawn from use of capacity-to-pay (CTP) and budget share (BS) approaches are inconsistent, the non-availability of data on food expenditure in the health survey in India is an added limitation. MethodsUsing data from the health and consumption surveys of National Sample Surveys over 15 years, we have overcome these limitations and estimated the incidence and intensity of CHE and impoverishment using the CTP approach. ResultsThe incidence of CHE for health services in India has declined from 12.5% in 2004 to 9.1% by 2018 and that of intensity of CHE has increased from 1.25 to 1.31 during the same period. The impoverishment due to health spending was 4.8% in 2004, 5.1% in 2014 and 3.3% in 2018. The state variations in incidence and intensity of CHE and incidence of impoverishment is large. The odds of incurring CHE were lowest among the richest households [OR 0.22; 95% CI: 0.21,0.24], households with elderly members [OR 1.20; 95% CI :1.12,1.18] and households using both inpatient and outpatient services [OR 2.80, 95% CI 2.66, 2.95]. Access to health insurance reduced the chance of CHE and impoverishment among the richest households. The pattern of impoverishment was similar to that of CHE. ConclusionWe recommend the CTP approach when estimating CHE and impoverishment in low and middle-income countries.

Multi-Layered Catastrophic Health Spending of Inpatient Women by Broad Group of Diseases in India

2021 ◽  
Vol 30 ◽  
pp. 183-206
Author(s):  
Manali Swargiary ◽  
◽  
Hemkhothang Lhungdim ◽  
Mrinmoy Pratim Bharadwaz ◽  
◽  
...  
Keyword(s):  
Rural Areas ◽  
Economic Status ◽  
Health Spending ◽  
Binary Logistic Regression ◽  
National Sample ◽  
Sample Survey ◽  
Public Health Services ◽  
Indian Women ◽  
Catastrophic Health Spending ◽  
Out Of Pocket Payments

Healthcare for Indian women needs prioritizing, as they continue to face social and economic discrimination over their healthcare, often with high out-of-pocket payments. The study examines the amount inpatient women have to pay for treatment of major diseases, re-classified into four groups as infectious, reproductive, non-communicable diseases (NCDs), and disabilities & injuries, across the country to comprehend the extent of catastrophic health spending (CHS) they experienced. The study is based on India’s 75th round of the National Sample Survey (NSS), i.e., Household Social Consumption: Health (2017-2018), consisting of 26,938 inpatient women aged 12 and above from India's urban and rural areas. We examine the prevalence of the four categories of diseases by individual, household, community, and healthcare characteristics. Expenditure estimates were derived from cross-tabulation, followed by binary logistic regression to assess the association between covariates and inpatient expenditures for the diseases. Indian women are more likely to be hospitalized for infectious diseases (43%), but the burden of CHS (overall) is highest for disabilities and injuries (INR 24,414), followed by NCDs (INR 23,053). Duration of hospitalization and possession of health insurance by women indicate maximum variation with medical spending. Almost 97% of women have incurred out-of-pocket expenditure on hospitalization, from which we identify three layers of CHS. A substantial proportion of women (23 to 50%) experienced CHS, i.e., up to 0-10%, 11-30%, and >30%, which varies distinctively by place of residence and across the six regions. Covariates like age, economic status, and healthcare are highly significant and associated with disease-wise CHS thresholds. Women in India face divergent financial hardships for healthcare. Given the heterogeneity of morbidities and socio-economic characteristics, the need for women-sensitive public health services and interventions are evident.

Does remittance protect the household from catastrophic health expenditure in India

2020 ◽  
Vol 16 (4) ◽  
pp. 481-493
Author(s):  
Milan Das ◽  
Kaushalendra Kumar ◽  
Junaid Khan
Keyword(s):  
Health Expenditure ◽  
Health Care Expenditure ◽  
Health Spending ◽  
Binary Logistic Regression ◽  
Catastrophic Health Expenditure ◽  
Economic Research ◽  
National Council ◽  
Data Set ◽  
Content Type ◽  
Catastrophic Health Spending

Purpose The purpose of this paper is to examine the dynamic nature of the catastrophic health expenditure (CHE) on remittances receiving households between 2005 and 2012 in India. Design/methodology/approach The study adopted Xu’s (2005) definition of catastrophic health-care expenditure. And also used binary logistic regression to examine the effects of remittances being received on CHE in households across India. The data were drawn from the two rounds of the India Human Development Survey conducted by the University of Maryland, the USA, and the National Council of Applied Economic Research, New Delhi, India. Findings The results show that the percentage of households received remittances, and that the amount of remittances received has substantially increased during 2005 and 2012, though variation is evident by socioeconomic and demographic characteristics of the household. Apparently, the variation (percentage of households received remittances) is more pronounced for factors such as household size, number of 60+ elderly, sectors and by regions. Household’s catastrophic health spending and remittances being received show a statistically significant association. Households which received remittances during both the time showed the lowest likelihood (AOR:0.82; p-value < 0.10; 95% CI:0.64–1.03) to experience catastrophic health spending. Originality/value The paper identified the research gap to examine the occurrence of catastrophic health spending by remittances receiving status of the household using a novel panel data set.

scholarly journals The choices and consequences of seeking care for chronic conditions for disadvantaged populations in Malaysia and the Philippines

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
B Palafox
Keyword(s):  
Low Income ◽  
Chronic Conditions ◽  
Health Expenditure ◽  
Health Spending ◽  
Catastrophic Health Expenditure ◽  
The Philippines ◽  
Antihypertensive Medications ◽  
Disadvantaged Populations ◽  
Catastrophic Health Spending ◽  
Medication Costs

Abstract Disadvantaged populations in LMICs suffering from chronic conditions are often forced to make care choices that increase the risk of receiving substandard care and facing catastrophic bills. These negative impacts widen health disparities across social, economic and urban-rural lines. This study aimed to understand the economic consequences of the choices made by those living with NCD in disadvantaged communities in Malaysia and the Philippines. Using hypertension as a tracer condition, we analysed longitudinal data from surveys of 1200 hypertensive adults from low-income communities in both countries to estimate the prevalence and drivers of catastrophic health expenditure and the coping strategies employed. Interviews and digital diary data from a sub-sample of 80 participants was analysed thematically to elicit how such choices lead to sub-optimal management of their condition. More Filipino households with at least one hypertensive adult experienced catastrophic health spending (40% threshold) than in Malaysia (14.3% vs. 0.4%). Although the average cost of clinic visits in the Philippines was much higher than what was observed in the public sector-dominated system in Malaysia, consultation fees were main drivers of costs in Malaysia, while medication costs predominated in the Philippines (accounting for 38.6% and 70.5% of typical household health expenditure respectively). In both countries, nearly all diagnosed participants were taking antihypertensive medications, however, levels of adherence varied. Participants cited the unavailability, cost and adverse effects of antihypertensives as reasons for poor adherence, delaying treatment and substituting prescriptions. Understanding the barriers faced by disadvantaged populations in LMICs and the ways that they overcome them as they seek care for a chronic disorder may challenge the assumptions of decision makers, and is crucial for designing responsive and equitable health systems that leave none behind.

scholarly journals Small firms and the COVID-19 insolvency gap

2021 ◽  
Author(s):  
Julian Oliver Dörr ◽  
Georg Licht ◽  
Simona Murmann
Keyword(s):  
Financial Distress ◽  
Small Firms ◽  
English Summary ◽  
Policy Support ◽  
Policy Response ◽  
Special Role ◽  
Current Crisis ◽  
Policy Makers ◽  
Large Wave ◽  
Using Data

AbstractCOVID-19 placed a special role on fiscal policy in rescuing companies short of liquidity from insolvency. In the first months of the crisis, SMEs as the backbone of Germany’s economy benefited from large and mainly indiscriminate aid measures. Avoiding business failures in a whatever-it-takes fashion contrasts, however, with the cleansing mechanism of economic crises: a mechanism which forces unviable firms out of the market, thereby reallocating resources efficiently. By focusing on firms’ pre-crisis financial standing, we estimate the extent to which the policy response induced an insolvency gap and analyze whether the gap is characterized by firms which were already struggling before the pandemic. With the policy measures being focused on smaller firms, we also examine whether this insolvency gap differs with respect to firm size. Our results show that the COVID-19 policy response in Germany has triggered a backlog of insolvencies that is particularly pronounced among financially weak, small firms, having potential long-term implications on entrepreneurship and economic recovery.Plain English Summary This study analyzes the extent to which the strong policy support to companies in the early phase of the COVID-19 crisis has prevented a large wave of corporate insolvencies. Using data of about 1.5 million German companies, it is shown that it was mainly smaller firms that experienced strong financial distress and would have gone bankrupt without policy assistance. In times of crises, insolvencies usually allow for a reallocation of employees and capital to more efficient firms. However, the analysis reveals that this ‘cleansing effect’ is hampered in the current crisis as the largely indiscriminate granting of liquidity subsidies and the temporary suspension of the duty to file for insolvency have caused an insolvency gap that is driven by firms which were already in a weak financial position before the crisis. Overall, the insolvency gap is estimated to affect around 25,000 companies, a substantial number compared to the around 16,300 actual insolvencies in 2020. In the ongoing crisis, policy makers should prefer instruments favoring entrepreneurs who respond innovatively to the pandemic instead of prolonging the survival of near-insolvent firms.

The Utility of Family Life Cycle as a Theoretical and Empirical Tool

2003 ◽  
Vol 24 (2) ◽  
pp. 155-184 ◽  
Author(s):  
Carolyn A. Kapinus ◽  
Michael P. Johnson
Keyword(s):  
Life Cycle ◽  
Family Life ◽  
Predictive Power ◽  
National Sample ◽  
Family Life Cycle ◽  
Predictive Tool ◽  
The Family ◽  
Dependent Variables ◽  
Married Men ◽  
Using Data

Using data from a 1980 national sample of married men and women, the analysis examines the utility of the family life cycle concept, employing as dependent variables constructs from Johnson’s conceptualization of commitment. They argue, in disagreement with two classic critiques of the family life cycle concept, that the predictive power of family life cycle is, for many dependent variables, quite independent of age or length of marriage. Their analyses demonstrate that, when using dependent variables one would expect to be related to the presence and ages of children, family life cycle remains a useful predictive tool.

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 Co-benefits associated with public support for climate-friendly COVID-19 recovery policies and political activism

2021 ◽  
Vol 20 (05) ◽  
pp. A08
Author(s):  
Jagadish Thaker ◽  
Brian Floyd
Keyword(s):  
Infectious Disease ◽  
Environmental Protection ◽  
Collective Efficacy ◽  
Public Support ◽  
Disease Outbreaks ◽  
National Sample ◽  
Policy Support ◽  
Sample Survey ◽  
Infectious Disease Outbreaks ◽  
Using Data

Scientists highlight that actions that address environmental protection and climate change can also help with reducing infectious disease threats. Results using data from a national sample survey in New Zealand indicate that perceptions of co-benefits of actions to address environmental protection that also protect against infectious disease outbreaks such as the coronavirus is associated with policy support and political engagement. This association was partly mediated through perceived collective efficacy. Local councils with higher level of community collective efficacy were more likely to declare climate emergency. Communication about potential co-benefits is likely to shape public engagement and enact policy change.

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