scholarly journals Catastrophic spending on health care in Brazil: private health insurance does not seem to be the solution

2011 ◽  
Vol 27 (suppl 2) ◽  
pp. s254-s262 ◽  
Author(s):  
Aluísio J. D. Barros ◽  
João Luiz Bastos ◽  
Andréa H. Dâmaso
Keyword(s):  
Health Insurance ◽  
Socioeconomic Position ◽  
Health Expenditure ◽  
Elderly Person ◽  
Economic Indicator ◽  
Household Consumption ◽  
Catastrophic Health Expenditure ◽  
Vulnerability Indicators ◽  
National Economic ◽  
Country Analysis

The objective of this study was to estimate catastrophic healthcare expenditure in Brazil, using different definitions, and to identify vulnerability indicators. Data from the 2002-2003 Brazilian Household Budget Survey were used to derive total household consumption, health expenditure and household income. Socioeconomic position was defined by quintiles of the National Economic Indicator using reference cut-off points for the country. Analysis was restricted to urban households. Catastrophic health expenditure was defined as expenditure in excess of 10% and 20% of total household consumption, and in excess of 40% of household capacity to pay. Catastrophic health expenditure varied from 2% to 16%, depending on the definition. For most definitions, it was highest among the poorer. The highest proportions of catastrophic health expenditure were found to be in the Central region of Brazil, while the South and the Southeast had the lowest. Presence of an elderly person, health insurance and socioeconomic position were associated with the outcome, and coverage by health insurance did not protect from catastrophic health expenditure.

scholarly journals Socioeconomic inequality in catastrophic health expenditure in Brazil

2014 ◽  
Vol 48 (4) ◽  
pp. 632-641 ◽  
Author(s):  
Alexandra Crispim Boing ◽  
Andréa Dâmaso Bertoldi ◽  
Aluísio Jardim Dornellas de Barros ◽  
Leila Garcia Posenato ◽  
Karen Glazer Peres
Keyword(s):  
Health Expenditure ◽  
Socioeconomic Inequality ◽  
Economic Indicator ◽  
Relative Difference ◽  
Catastrophic Health Expenditure ◽  
Total Consumption ◽  
Socioeconomic Characteristics ◽  
Inequality Measures ◽  
Methods Of Calculation ◽  
National Economic

OBJECTIVE To analyze the evolution of catastrophic health expenditure and the inequalities in such expenses, according to the socioeconomic characteristics of Brazilian families.METHODS Data from the National Household Budget 2002-2003 (48,470 households) and 2008-2009 (55,970 households) were analyzed. Catastrophic health expenditure was defined as excess expenditure, considering different methods of calculation: 10.0% and 20.0% of total consumption and 40.0% of the family’s capacity to pay. The National Economic Indicator and schooling were considered as socioeconomic characteristics. Inequality measures utilized were the relative difference between rates, the rates ratio, and concentration index.RESULTS The catastrophic health expenditure varied between 0.7% and 21.0%, depending on the calculation method. The lowest prevalences were noted in relation to the capacity to pay, while the highest, in relation to total consumption. The prevalence of catastrophic health expenditure increased by 25.0% from 2002-2003 to 2008-2009 when the cutoff point of 20.0% relating to the total consumption was considered and by 100% when 40.0% or more of the capacity to pay was applied as the cut-off point. Socioeconomic inequalities in the catastrophic health expenditure in Brazil between 2002-2003 and 2008-2009 increased significantly, becoming 5.20 times higher among the poorest and 4.17 times higher among the least educated.CONCLUSIONS There was an increase in catastrophic health expenditure among Brazilian families, principally among the poorest and those headed by the least-educated individuals, contributing to an increase in social inequality.

scholarly journals Prevalence and factors associated with catastrophic health expenditure among slum and non-slum dwellers undergoing emergency surgery in a metropolitan area of South Western Nigeria

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255354
Author(s):  
Taiwo A. Obembe ◽  
Jonathan Levin ◽  
Sharon Fonn
Keyword(s):  
Health Insurance ◽  
Marital Status ◽  
Emergency Surgery ◽  
Health Expenditure ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Catastrophic Health Expenditure ◽  
Catastrophic Expenditure ◽  
Slum Dwellers ◽  
Multistage Sampling

Background Out of Pocket (OOP) payment continues to persist as the major mode of payment for healthcare in Nigeria despite the introduction of the National Health Insurance Scheme (NHIS). Although the burden of health expenditure has been examined in some populations, the impact of OOP among slum dwellers in Nigeria when undergoing emergencies, is under-researched. This study sought to examine the prevalence, factors and predictors of catastrophic health expenditure amongst selected slum and non-slum communities undergoing emergency surgery in Southwestern Nigeria. Methods The study utilised a descriptive cross-sectional survey design to recruit 450 households through a multistage sampling technique. Data were collected using pre-tested semi-structured questionnaires in 2017. Factors considered for analysis relating to the payer were age, sex, relationship of payer to patient, educational status, marital status, ethnicity, occupation, income and health insurance coverage. Variables factored into analysis for the patient were indication for surgery, grade of hospital, and type of hospital. Households were classified as incurring catastrophic health expenditure (CHE), if their OOP expenditure exceeded 5% of payers’ household budget. Analysis of the data took into account the multistage sampling design. Results Overall, 65.6% (95% CI: 55.6–74.5) of the total population that were admitted for emergency surgery, experienced catastrophic expenditure. The prevalence of catastrophic expenditure at 5% threshold, among the population scheduled for emergency surgeries, was significantly higher for slum dwellers (74.1%) than for non-slum dwellers (47.7%) (F = 8.59; p = 0.019). Multiple logistic regression models revealed the significant independent factors of catastrophic expenditure at the 5% CHE threshold to include setting of the payer (whether slum or non-slum dweller) (p = 0.019), and health insurance coverage of the payer (p = 0.012). Other variables were nonetheless significant in the bivariate analysis were age of the payer (p = 0.017), income (p<0.001) and marital status of the payer (p = 0.022). Conclusion Although catastrophic health expenditure was higher among the slum dwellers, substantial proportions of respondents incurred catastrophic health expenditure irrespective of whether they were slum or non-slum dwellers. Concerted efforts are required to implement protective measures against catastrophic health expenditure in Nigeria that also cater to slum dwellers.

scholarly journals Unmet Healthcare Needs, Catastrophic Health Expenditure, and Health in South Korea’s Universal Healthcare System: Progression Towards Improving Equity by NHI Type and Income Level

Healthcare ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 408 ◽  
Author(s):  
Minsung Sohn ◽  
Xianhua Che ◽  
Hee-Jung Park
Keyword(s):  
Health Insurance ◽  
Health Status ◽  
Low Income ◽  
Health Expenditure ◽  
Income Level ◽  
Catastrophic Health Expenditure ◽  
Poor Health ◽  
Medical Aid ◽  
Healthcare Needs ◽  
Unmet Healthcare Needs

This study examined the effects of healthcare inequality on personal health. It aimed to determine how health insurance type and income level influence catastrophic health expenditure and unmet healthcare needs among South Koreans. Unbalanced Korean Health Panel data from 2011 to 2015, including 33,374 adults, were used. A time-trend and panel regression analysis were performed. The first to identify changes in the main variables and, the second, mediating effects of unmet healthcare needs and catastrophic health expenditure on the relationship between health insurance type, income level, and health status. The independent variables were: high-, middle-, low-income employee insured, high-, middle-, low-income self-employed insured, and medical aid. The dependent variable was health status, and the mediators were unmet needs and catastrophic health expenditure. The medical aid beneficiaries and low-income self-employed insured groups demonstrated a higher probability of reporting poor health status than the high-income, insured group (15.6%, 2.2%, and 2.3%, respectively). Participants who experienced unmet healthcare needs or catastrophic health expenditure were 10.7% and 5.6% higher probability of reporting poor health, respectively (Sobel test: p < 0.001). National policy reforms could improve healthcare equality by integrating insurance premiums based on income among private-sector employees and self-employed individuals within the health insurance network.

scholarly journals Catastrophic health expenditure incidence and its equity in China: a study on the initial implementation of the medical insurance integration system

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Huan Liu ◽  
Hong Zhu ◽  
Jiahui Wang ◽  
Xinye Qi ◽  
Miaomiao Zhao ◽  
...  
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Low Income ◽  
Health Expenditure ◽  
Concentration Index ◽  
Medical Insurance ◽  
Catastrophic Health Expenditure ◽  
Integration System ◽  
Integration Policies ◽  
The Impact

Abstract Background By 2013, several regions in China had introduced health insurance integration policies. However, few studies addressed the impact of medical insurance integration in China. This study investigates the catastrophic health expenditure and equity in the incidence of catastrophic health expenditure by addressing its potential determinants in both integrated and non-integrated areas in China in 2013. Methods The primary data are drawn from the fifth China National Health Services Survey in 2013. The final sample comprises 19,788 households (38.4%) from integrated areas and 31,797 households (61.6%) from non-integrated areas. A probit model is employed to decompose inequality in the incidence of catastrophic health expenditure in line with the methodology used for decomposing the concentration index. Results The incidence of catastrophic health expenditure in integrated areas is higher than in non-integrated areas (13.87% vs. 13.68%, respectively). The concentration index in integrated areas and non-integrated areas is − 0.071 and − 0.073, respectively. Average household out-of-pocket health expenditure and average capacity to pay in integrated areas are higher than those in non-integrated areas. However, households in integrated areas have lower share of out-of-pocket expenditures in the capacity to pay than households in non-integrated areas. The majority of the observed inequalities in catastrophic health expenditure can be explained by differences in the health insurance and householders’ educational attainment both in integrated areas and non-integrated areas. Conclusions The medical insurance integration system in China is still at the exploratory stage; hence, its effects are of limited significance, even though the positive impact of this system on low-income residents is confirmed. Moreover, catastrophic health expenditure is associated with pro-poor inequality. Medical insurance, urban-rural disparities, the elderly population, and use of health services significantly affect the equity of catastrophic health expenditure incidence and are key issues in the implementation of future insurance integration policies.

scholarly journals Minimizing the Risk of Catastrophic Health Expenditure in China: A Multi-Dimensional Analysis of Vulnerable Groups

2021 ◽  
Vol 9 ◽  
Author(s):  
Jiahui Wang ◽  
Xiao Tan ◽  
Xinye Qi ◽  
Xin Zhang ◽  
Huan Liu ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Health Insurance ◽  
Low Socioeconomic Status ◽  
Health Expenditure ◽  
Household Head ◽  
Catastrophic Health Expenditure ◽  
Two Dimensions ◽  
Medical Expenditure ◽  
Vulnerable Groups ◽  
Low Socioeconomic

Background: In moving toward universal health coverage in China, it is crucial to identify which populations should be prioritized for which interventions rather than blindly increasing welfare packages or capital investments. We identify the characteristics of vulnerable groups from multiple perspectives through estimating catastrophic health expenditure (CHE) and recommend intervention priorities.Methods: Data were from National Health Service Survey conducted in 2003, 2008, and 2013. According to the recommendation of WHO, this study adopted 40% as the CHE threshold. A binary regression was used to identify the determinants of CHE occurrence; a probit model was used to obtain CHE standardized incidence under the characteristics of single and two dimensions in 2013.Results: The total incidence of CHE in 2013 was 13.9%, which shows a general trend of growth from 2003 to 2013. Families in western and central regions and rural areas were more at risk. Factors related to social demography show that households with a female or an unmarried head of household or with a low socioeconomic status were more likely to experience CHE. Households with older adults aged 60 and above had 1,524 times higher likelihood of experiencing CHE. Among the health insurance schemes, the participants covered by the New Rural Cooperative Medical Scheme had the highest risk compared with the participants of all basic health insurance schemes. Households with several members seeking outpatient, inpatient care or with non-communicable diseases were more likely to experience CHE. Households with members not seeing a doctor or hospitalized despite the need for it were more likely to experience CHE. Characteristics such as a household head with characteristics related to low socioeconomic status, having more than two hospitalized family members, ranked high. Meanwhile, the combination of having illiterate household heads and with being covered by other health insurance plans or by none ranked the first place. Cancer notably caused a relatively high medical expenditure among households with CHE.Conclusion: In China, considering the vulnerability of the population across different dimensions is conducive to the alleviation of high CHE. Furthermore, people with multiple vulnerabilities should be prioritized for intervention. Identifying and targeting them to offer help and support will be an effective approach.

scholarly journals Trends in out of pocket payments and catastrophic health expenditure in the Kyrgyz Republic post “Manas Taalimi” and  “Den Sooluk” health reforms, 2012 - 2018

2020 ◽  
Author(s):  
Mariia Iamschikova ◽  
Roman Mogilevskii ◽  
Michael N Onah
Keyword(s):  
Health Expenditure ◽  
Health Financing ◽  
Household Consumption ◽  
Catastrophic Health Expenditure ◽  
Kyrgyz Republic ◽  
Consumption Expenditure ◽  
Cross Sectional ◽  
Financial Barriers ◽  
Health Reforms ◽  
Out Of Pocket Payments

Abstract Background: Over the years, the Kyrgyz Republic has implemented health reforms that target health financing with the aim of removing financial barriers to healthcare including out-of-pocket health payments (OOPPs). This study examines the trends in OOPPs and the incidence of catastrophic health expenditure (CHE) post the “Manas Taalimi” and “Den Sooluk” health reforms. Methods: We used data from the Kyrgyzstan Integrated Household Surveys (2012 – 2018). Population-weighted descriptive statistics were used to examine the trends in OOPPs and CHE at three thresholds; 10 percent of total household consumption expenditure (Cata10), 25 percent of total household consumption expenditure (Cata25) and 40 percent of total household non-food consumption expenditure (Cata40). Panel and cross-sectional logistic regression with marginal effects were used to examine the predictors of Cata10 and Cata40. Findings: Between 2012 and 2018, OOPPs increased by about US $6 and inpatient costs placed the highest cost burden on users (US $13.6), followed by self-treatment (US $10.7), and outpatient costs (US $9). Medication continues to predominantly drive inpatient, outpatient, and self-treatment OOPPs. About 0.378 to 2.084 million people (6 – 33 percent) of the population incurred catastrophic health expenditure at the three thresholds between 2012 and 2018. Residing in households headed by a widowed or single head, or residing in rural regions, increases the likelihood of incurring catastrophic health expenditure. Conclusions: The initial gains in the reduction of OOPPs and catastrophic health expenditure appear to gradually erode since costs continue to increase after an initial decline and catastrophic health expenditure continues to rise unabated. This implies that households are increasingly incurring economic hardship from seeking healthcare. Considering that this could result to forgone expenditure on essential items including food and education, efforts should target the sustainability of these health reforms to sustain the reduction of catastrophic health payments and its dire consequences.

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

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e026638 ◽  
Author(s):  
Weixia Duan ◽  
Wen Zhang ◽  
Chengguo Wu ◽  
Qingya Wang ◽  
Ya Yu ◽  
...  
Keyword(s):  
Health Insurance ◽  
Health Expenditure ◽  
Protective Factor ◽  
Diagnostic Delay ◽  
Cross Sectional Study ◽  
Catastrophic Health Expenditure ◽  
Patient Delay ◽  
Sectional Study ◽  
Cross Sectional ◽  
Chongqing Municipality

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.

scholarly journals Catastrophic health expenditure of Vietnamese patients with gallstone diseases – a case for health insurance policy revaluation

2019 ◽  
Vol Volume 11 ◽  
pp. 151-158 ◽  
Author(s):  
Bach Xuan Tran ◽  
Tho Dinh Tran ◽  
Nila Nathan ◽  
Chau Quy Ngo ◽  
Loi Thi Nguyen ◽  
...  
Keyword(s):  
Health Insurance ◽  
Health Expenditure ◽  
Catastrophic Health Expenditure ◽  
Insurance Policy

scholarly journals Trends in out of pocket payments and catastrophic health expenditure in the Kyrgyz Republic post “Manas Taalimi” and  “Den Sooluk” health reforms, 2012 - 2018

2020 ◽  
Author(s):  
Mariia Iamschikova ◽  
Roman Mogilevskii ◽  
Michael N Onah
Keyword(s):  
Health Expenditure ◽  
Health Financing ◽  
Household Consumption ◽  
Catastrophic Health Expenditure ◽  
Kyrgyz Republic ◽  
Consumption Expenditure ◽  
Cross Sectional ◽  
Financial Barriers ◽  
Health Reforms ◽  
Out Of Pocket Payments

Abstract Background: Over the years, the Kyrgyz Republic has implemented health reforms that target health financing with the aim of removing financial barriers to healthcare including out-of-pocket health payments (OOPPs). This study examines the trends in OOPPs and the incidence of catastrophic health expenditure (CHE) post the “Manas Taalimi” and “Den Sooluk” health reforms. Methods: We used data from the Kyrgyzstan Integrated Household Surveys (2012 – 2018). Population-weighted descriptive statistics were used to examine the trends in OOPPs and CHE at three thresholds; 10 percent of total household consumption expenditure (Cata10), 25 percent of total household consumption expenditure (Cata25) and 40 percent of total household non-food consumption expenditure (Cata40). Panel and cross-sectional logistic regression with marginal effects were used to examine the predictors of Cata10 and Cata40. Findings: Between 2012 and 2018, OOPPs increased by about US $6 and inpatient costs placed the highest cost burden on users (US $13.6), followed by self-treatment (US $10.7), and outpatient costs (US $9). Medication continues to predominantly drive inpatient, outpatient, and self-treatment OOPPs. About 0.378 to 2.084 million people (6 – 33 percent) of the population incurred catastrophic health expenditure at the three thresholds between 2012 and 2018. Residing in households headed by a widowed or single head, or residing in rural regions, increases the likelihood of incurring catastrophic health expenditure.Conclusions: The initial gains in the reduction of OOPPs and catastrophic health expenditure appear to gradually erode since costs continue to increase after an initial decline and catastrophic health expenditure continues to rise unabated. This implies that households are increasingly incurring economic hardship from seeking healthcare. Considering that this could result to forgone expenditure on essential items including food and education, efforts should target the sustainability of these health reforms to sustain the reduction of catastrophic health payments and its dire consequences.

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