scholarly journals Decomposition of changes in socioeconomic inequalities in catastrophic health expenditure in Kenya

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244428
Author(s):  
Purity Njagi ◽  
Jelena Arsenijevic ◽  
Wim Groot
Keyword(s):  
Health Expenditure ◽  
Financial Burden ◽  
Household Wealth ◽  
Catastrophic Health Expenditure ◽  
Socioeconomic Inequalities ◽  
Financial Risk Protection ◽  
Wealth Status ◽  
The Poor ◽  
Household Heads ◽  
Over Time

Background Catastrophic health expenditure (CHE) is frequently used as an indicator of financial protection. CHE exists when health expenditure exceeds a certain threshold of household consumption. Although CHE is reported to have declined in Kenya, it is still unacceptably high and disproportionately affects the poor. This study examines the socioeconomic factors that contribute to inequalities in CHE as well as the change in these inequalities over time in Kenya. Methods We used data from the Kenya household health expenditure and utilisation (KHHEUS) surveys in 2007 and 2013. The concertation index was used to measure the socioeconomic inequalities in CHE. Using the Wagstaff (2003) approach, we decomposed the concentration index of CHE to assess the relative contribution of its determinants. We applied Oaxaca-type decomposition to assess the change in CHE inequalities over time and the factors that explain it. Results The findings show that while there was a decline in the incidence of CHE, inequalities in CHE increased from -0.271 to -0.376 and was disproportionately concentrated amongst the less well-off. Higher wealth quintiles and employed household heads positively contributed to the inequalities in CHE, suggesting that they disadvantaged the poor. The rise in CHE inequalities overtime was explained mainly by the changes in the elasticities of the household wealth status. Conclusion Inequalities in CHE are persistent in Kenya and are largely driven by the socioeconomic status of the households. This implies that the existing financial risk protection mechanisms have not been sufficient in cushioning the most vulnerable from the financial burden of healthcare payments. Understanding the factors that sustain inequalities in CHE is, therefore, paramount in shaping pro-poor interventions that not only protect the poor from financial hardship but also reduce overall socioeconomic inequalities. This underscores the fundamental need for a multi-sectoral approach to broadly address existing socioeconomic inequalities.

scholarly journals Association of socioeconomic status with financial burden of disease among elderly patients with cardiovascular disease: evidence from the China Health and Retirement Longitudinal Survey

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e018703 ◽  
Author(s):  
Chunyan Li ◽  
Belinda-Rose Young ◽  
Weiyan Jian
Keyword(s):  
Socioeconomic Status ◽  
Low Income ◽  
Health Expenditure ◽  
Financial Risk ◽  
Financial Burden ◽  
Catastrophic Health Expenditure ◽  
Longitudinal Survey ◽  
Household Expenditure ◽  
Multilevel Regression ◽  
Financial Risk Protection

ObjectivesThe prevalence of cardiovascular diseases (CVD) within low-income and middle-income countries has reached epidemic proportions. However, the association between out-of-pocket (OOP) payment and socioeconomic status (SES) of patients with CVD is not well studied. We aimed to understand the financial burden among Chinese middle-aged and older patients with CVD, and whether there was an association with SES.SettingsA nationally representative survey—The China Health and Retirement Longitudinal Survey(CHARLS)—was conducted in 28 provinces of mainland China in 2011 and 2013.ParticipantsOf the over 18 000 CHARLS respondents, eligible participants were those aged 45 years and over who had been previously diagnosed with CVD.Outcome measuresFinancial burden was measured byindividualOOP payment andhouseholdcatastrophic health expenditure (CHE) occurrence (ie, the annual household health expenditure was 40% or more of the total non-food household expenditure). Multilevel regression models were used to explore the association between financial burden and SES.ResultsAmong CHARLS respondents, CVD prevalence increased from 14.7% in 2011 to 16.6% in 2013. Average annual CVD OOP payment increased from 5000 RMB (770 USD) to 6120 RMB (970 USD). Furthermore, CHE occurrence increased from 44.2% to 48.1%. Patients spent almost twice on outpatient as on inpatient services. Two of the three SES indicators (total household expenditure, occupation type) were found to be associated with CVD OOP payment amount, and the likelihood of CHE. Unemployed patients had a higher likelihood of CHE compared with agricultural workers. Rural-urban difference was associated with the likelihood of CHE in 2011 alone.ConclusionThe Chinese health system should use this health expenditure pattern among patients with CVD to create more equitable health insurance schemes that financially balance between outpatient and inpatient care, and provide better financial risk protection to patients with low SES.

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.

Treatment as insurance: HIV antiretroviral therapy offers financial risk protection in Malawi

2020 ◽  
Vol 35 (6) ◽  
pp. 676-683
Author(s):  
Sarah Dickerson ◽  
Victoria Baranov ◽  
Jacob Bor ◽  
Jeremy Barofsky
Keyword(s):  
Health Expenditure ◽  
Financial Risk ◽  
Health Expenditures ◽  
Catastrophic Health Expenditure ◽  
Hiv Treatment ◽  
Financial Risk Protection ◽  
Urban Households ◽  
Medical Spending ◽  
Risk Protection ◽  
The Impact

Abstract Many countries have expanded insurance programmes in an effort to achieve universal health coverage (UHC). We assess a complementary path toward financial risk protection: increased access to technologies that improve health and reduce the risk of large health expenditures. Malawi has provided free HIV treatment since 2004 with significant US Government support. We investigate the impact of treatment access on medical spending, capacity to pay and catastrophic health expenditures at the population level, exploiting the phased rollout of HIV treatment in a difference-in-differences design. We find that increased access to HIV treatment generated a 10% decline in medical spending for urban households, a 7% increase in capacity to pay for rural households and a 3-percentage point decrease in the likelihood of catastrophic health expenditure among urban households. These risk protection benefits are comparable to that found from broad-based insurance coverage in other contexts. Our findings show that targeted treatment programmes that provide free care for high burden causes of death can provide substantial financial risk protection against catastrophic health expenditure, while moving developing nations toward UHC.

scholarly journals The Financial Burden of Catastrophic Health Expenditure on Households with Chronic Diseases: Financial Ratio Analysis

2021 ◽  
Author(s):  
Hyunwoo Jung ◽  
Young Dae Kwon ◽  
Jin-Won Noh
Keyword(s):  
Chronic Disease ◽  
Health Expenditure ◽  
Financial Burden ◽  
Catastrophic Health Expenditure ◽  
Financial Strain ◽  
Income Loss ◽  
Absolute Size ◽  
Financial Ratio ◽  
Financial Ratio Analysis ◽  
Indicator Liquid

Abstract Background: The financial status of households is vulnerable to chronic disease related to high medical expenses and income loss; The financial strain could be assessed by the five indicators. household surplus indicator, liquid asset/debt ratio, solvency indicator, and liquidity indicator.Purpose: We investigated the association between catastrophic health expenditure (CHE) and financial ratio indicators in households with chronic disease in South Korea. Methodology: To determine the financial strain, thresholds were applied to the financial ratios. We conducted multiple logistic regression to figure out whether CHE is associated with financial strain. Furthermore, we analyzed the effect of CHE on absolute finance size, which is basic financial indicators, by multiple linear regression.Results: When CHE occurred, all of the financial ratio indicators deteriorated. However, it was not due to decreases in the absolute size of wealth, income, but rather the relative balance between finances. Especially, the loss of the liquid assets was the major factor of deterioration. Also, all types of labor-related income deteriorated. Only the private transfer income increased.Conclusion: This study revealed that CHE in households with chronic disease negatively impacts the household's finances. It turned out that the financial coping strategies are only resource-consuming.

scholarly journals The Prevalence of Household Catastrophic Health Expenditure in Nigeria: A Rural-Urban Comparison

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Paul Oladapo Ajayi ◽  
◽  
Demilade Olusola Ibirongbe ◽  
Tope Michael Ipinnimo ◽  
Oluremi Olayinka Solomon ◽  
...  
Keyword(s):  
Urban Communities ◽  
Rural Areas ◽  
Urban Areas ◽  
Health Expenditure ◽  
Univariate Analysis ◽  
Sampling Technique ◽  
Catastrophic Health Expenditure ◽  
Cross Sectional ◽  
Rural And Urban ◽  
Household Heads

Background: Catastrophic health expenditure occurs when the burden of Out-of-pocket health expenditure has reached a certain level that a household must forego the expenditure on other basic needs of life to meet the health expenses of its member(s) of the household. Worldwide, over 44 million households suffer annually from financial catastrophe. This study intends to determine the prevalence of household catastrophic health expenditure amongst rural and urban communities in Ekiti, Nigeria. Methodology: This is a comparative cross-sectional study of households within selected rural and urban communities in Ekiti State, Nigeria. A pre-tested interviewer-administered semi-structured questionnaire was used to collect data over a period of 4 months from a sample of 1,000 household heads, using a multistage sampling technique. Data obtained were then entered using the SPSS version 20 and analysed with STATA 12. Two different methodologies were used to calculate household catastrophic health expenditure, with sensitivity analysis done. Univariate analysis were used to describe the population in relation to relevant variables. Result: The prevalence of household catastrophic health expenditure is high using the two methodological calculations. It was significantly higher in the rural areas, 18.5% than the urban areas, 12.8% (p=0.015) for first method; it was also higher in the rural areas, 8.3% compared to the urban areas, 2.5% (p<0.001) for the second method. Conclusion: Prevalence of household catastrophic health expenditure is high in Nigeria, but worse in the rural areas. It’s therefore vital to establish financial and social intervention mechanisms that can protect households from incurring catastrophic health expenditure.

Inequalities in Household Catastrophic Health Expenditure and Impoverishment Associated With Noncommunicable Diseases in Chi Linh, Hai Duong, Vietnam

2017 ◽  
Vol 29 (5_suppl) ◽  
pp. 35S-44S ◽  
Author(s):  
Vu Duy Kien ◽  
Hoang Van Minh ◽  
Nguyen Bao Ngoc ◽  
Tran Bich Phuong ◽  
Tran Thu Ngan ◽  
...  
Keyword(s):  
Urban Areas ◽  
Health Expenditure ◽  
Catastrophic Health Expenditure ◽  
Socioeconomic Inequalities ◽  
World Health ◽  
Noncommunicable Diseases ◽  
Economic Losses ◽  
Double Burden ◽  
Catastrophic Health Expenditures ◽  
Health Organization

A costly modern-day double burden, the expenses of noncommunicable diseases (NCDs) are becoming a devastating epidemic. The World Health Organization estimates $7 trillion in economic losses from NCDs in 2011-2025. Although regarded as affluent diseases, the burden of NCDs is shifting into poorer groups. In this study, we assessed the socioeconomic inequalities in catastrophic health expenditure and impoverishment associated with NCDs in Northern Vietnam. We also identified associated factors for catastrophic health expenditure and impoverishment. Households self-reporting NCD diagnoses had the highest association with both catastrophic health expenditure and impoverishment, followed by those in urban areas. Such households were likely poorer according to our calculations estimating socioeconomic inequalities. Households with at least 1 member older than 60 years were also more likely to suffer catastrophic health expenditures. These findings suggest that targeted policy to prevent or subsidize care for NCDs could prevent catastrophic health expenditure and impoverishment among those already most disadvantaged.

scholarly journals The catastrophic out-of-pocket health expenditure of multiple sclerosis patients in Iran

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Farid Gharibi ◽  
Ali Imani ◽  
Koustuv Dalal
Keyword(s):  
Multiple Sclerosis ◽  
Health Expenditure ◽  
Financial Burden ◽  
Occupational Status ◽  
Catastrophic Health Expenditure ◽  
Cross Sectional ◽  
Rehabilitation Care ◽  
Physician Visits ◽  
Out Of Pocket Payments ◽  
Multiple Sclerosis Patients

Abstract Background The present study was designed and conducted to evaluate multiple sclerosis (MS) treatment costs and the resulting economic impact imposed on MS patients in Iran. Methods This was a cross-sectional study, among randomly selected 300 MS patients, registered in the MS Association of East Azerbaijan Province, Iran (1 year after their treatment began). The regression analysis, ANOVA, T-test, and chi-square were used. Results The average amount of out-of-pocket payments (OOPs) by MS patients during the previous year was 1669.20 USD, most of which was spent on medication, rehabilitation care, and physician visits. Their mean annual income was 5182.84 USD. Fifty four percent of families with an MS patient suffer from catastrophic health expenditure (CHE) and 44% experience poverty caused by the OOPs. Occupational status, having supplemental health insurance, and being residents of Tabriz significantly affect OOPs, CHE, and the resulting poverty (P < 0.05). Conclusion The catastrophic financial burden of health care costs on MS patients and their families justifies health policymakers to promote pre-payment systems and provide subsidies to less well-off patients to protect them from the unfairness of OOPs and its resulting CHE and poverty.

scholarly journals Incidence of household catastrophic and impoverishing health expenditures among patients with Breast Cancer in Iran

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Faranak Ahmadi ◽  
Hamidreza Farrokh-Eslamlou ◽  
Hasan Yusefzadeh ◽  
Cyrus Alinia
Keyword(s):  
Breast Cancer ◽  
Financial Burden ◽  
Health Spending ◽  
Bank Loan ◽  
Financial Risk Protection ◽  
Cross Sectional ◽  
Cancer Disease ◽  
Drug Benefits ◽  
The Poor ◽  
Disease Costs

Abstract Background Breast cancer disease is the most common cancer among Iranian women and imposing a significant financial burden on the households. This study calculated out-of-pocket (OOP), catastrophic health expenditure (CHE), and impoverishing health spending attributed to breast cancer in Iran. Methods In this cross-sectional household study, clinical and financial information on breast cancer and also household information (expenditures and income) were obtained through face-to-face interviews and completing a questionnaire by 138 women with this disease in 2019. We applied three non-food expenditure thresholds of 40, 20, and 10% to defining the CHE. Disease costs included periodical visits, diagnostic services, hospitalization care, treatment and rehabilitation services, home, and informal care. Households were disaggregated into socioeconomic status quintiles based on their Adult Equivalent values standardized monthly consumption expenditures. To identify the factors affecting these indicators, we performed the two different multivariate logistic regression models. Results This study finds that each patient had a monthly average OOP payment of $US 97.87 for the requested services, leading to impoverished of 5.07% and exposed 13.77% of their households to CHE. These indicators have been mainly concentrated among the poor, as they have spent a large part of their meager income on buying the needed services, and for this purpose, most of them forced to sell their assets, borrow, or take a bank loan. Conclusions The patients in lower SES quintiles can be protected from impoverishing and catastrophic health spending by expanding insurance coverage, providing financial risk protection programs, and increasing access to quality and effective public sector services. Alongside, expanding inpatient coverage and adding drug benefits for the poor can significantly decrease their OOP payments.

Sign in / Sign up

Export Citation Format

Share Document