Health expenditure in Paraguay relies heavily on out-of-pocket payments

2021 ◽  
Author(s):  
Maryam Hedayati ◽  
Iravan Masoudi Asl ◽  
Mohammad Reza Maleki ◽  
Salime Goharinezhad ◽  
Ali Akbar Fazaeli

BACKGROUND Health expenditure is a vital issue for policymakers not as it were due to the health outcome significance, but moreover since of the gradual total health expenditure rises that has ended up a major concern. To survey the financial related burden due to out-of-pocket payments, two commonly elite approaches have been utilized: catastrophic and impoverishing health expenditures. Catastrophic healthcare expenditures and impoverishment both can prevent individuals from accessing effective healthcare services. In Iran, the high out-of-pocket and increase in the share of the population experiencing catastrophic healthcare expenditures and poor financial protection of households against catastrophic healthcare expenditures are among the major public health concerns. To identify the drivers, key factors, and the trends of catastrophic and impoverishing healthcare expenditures among Iranian households, this study will be conducted by futures studies approach. OBJECTIVE - To identify the key drivers affecting the future of catastrophic and impoverishing healthcare expenditure in Iran. - To assess the trend in the incidence and intensity of CHE in Iran. - To categorize the key drivers - To prioritize main promoter factors in terms of importance, effectiveness and lack of uncertainty. METHODS This study will conduct in four steps. The drivers of the future of Exposure Households with Catastrophic and Impoverishing Health Expenditure will be listed by analyzing the results of a scoping review and then semi-structured interviews with health financial experts. Afterward, key drivers will be categorized using Porter's five forces (social, technical, economic, environmental, and political) for the macro environment and prioritized using the Fuzzy Analytical Hierarchy Process (FAHP) formulated in excel software. Further, cross-impact analysis of promoter factors and analytic hierarchy process will be used to determine main promoter factors in terms of importance, effectiveness, and lack of uncertainty. RESULTS We anticipate that the results of this protocol study will provide a comprehensive overview of the evidence on the determinants of unfairness and payments that expose the Iranian households to catastrophic and impoverishing health care expenditures and identify research gaps. CONCLUSIONS In our study, we will examine the rates of catastrophic health expenditure and impoverishment from medical expenses and its drivers in Iran. This will provide insight into the level of financial protection that a healthcare financing system provides for its citizens. It reflects the financial burden shouldered by families and the financial barriers that reduce their access to health care.


BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e038158
Author(s):  
Catriona Crookes ◽  
Raffaele Palladino ◽  
Paraskevi Seferidi ◽  
Raeena Hirve ◽  
Olga Siskou ◽  
...  

Objectives and settingThe 2008 financial crisis had a particularly severe impact on Greece. To contain spending, the government capped public health expenditure and introduced increased cost-sharing. The Greek case is important for studying the impact of recessions on health systems. This study analysed changes in household health expenditure in Greece over the economic crisis and explored whether the impact differed across socioeconomic groups.ParticipantsWe used data from the Greek Household Budget Survey for the years 2004 and 2008–2017. The dataset comprised 51 654 households, with a total of 128 111 members.DesignWe compared pre-crisis and post-crisis trends in Greek household out-of-pocket payments for healthcare from 2004 to 2017 using an interrupted time series analysis. This study explored spending in euros and as a share of total household purchases.ResultsOur results indicated that the population level trend in household health spending was reversed after the crisis began (pre-crisis trend: €0.040 decrease per quarter (95% CI: −0.785 to −0.022), post-crisis trend: €0.315 increase per quarter (95% CI: −0.004 to 0.635)). We also found that spending on inpatient services and pharmaceuticals has been increasing since the start of the crisis, whereas outpatient services expenditure has been decreasing. Across all households, out-of-pocket payments incurred a greater financial burden after the crisis relative to pre-existing trends, but the poorest households incurred a disproportionately higher burden.ConclusionsThis was the first study to use an interrupted time series analysis to assess the impact of the economic crisis on household health expenditure in Greece. Our findings suggest that there was an erosion of financial protection for Greek households as a consequence of the economic crisis. This effect was particularly pronounced among poorer households, which is indicative of a regressive financing system.


Author(s):  
Mihajlo Jakovljevic ◽  
Paula Odete Fernandes ◽  
João Paulo Teixeira ◽  
Nemanja Rancic ◽  
Yuriy Timofeyev ◽  
...  

This study examined the differences in health spending within the World Health Organization (WHO) Europe region by comparing the EU15, the EU post-2004, CIS, EU Candidate and CARINFONET countries. The WHO European Region (53 countries) has been divided into the following sub-groups: EU15, EU post-2004, CIS, EU Candidate countries and CARINFONET countries. The study period, based on the availability of WHO Global Health expenditure data, was 1995 to 2014. EU15 countries have exhibited the strongest growth in total health spending both in nominal and purchasing power parity terms. The dynamics of CIS members’ private sector expenditure growth as a percentage of GDP change has exceeded that of other groups. Private sector expenditure on health as a percentage of total government expenditure, has steadily the highest percentage point share among CARINFONET countries. Furthermore, private households’ out-of-pocket payments on health as a percentage of total health expenditure, has been dominated by Central Asian republics for most of the period, although, for the period 2010 to 2014, the latter have tended to converge with those of CIS countries. Western EU15 nations have shown a serious growth of health expenditure far exceeding their pace of real economic growth in the long run. There is concerning growth of private health spending among the CIS and CARINFONET nations. It reflects growing citizen vulnerability in terms of questionable affordability of healthcare. Health care investment capability has grown most substantially in the Russian Federation, Turkey and Poland being the classical examples of emerging markets.


2020 ◽  
Author(s):  
Mariia Iamschikova ◽  
Roman Mogilevskii ◽  
Michael N Onah

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.


Author(s):  
Xiaochen Ma ◽  
Ziyue Wang ◽  
Xiaoyun Liu

Background: To provide an updated estimate of the level and change in catastrophic health expenditure in China and examine the association between catastrophic health expenditure and family net income, we obtained data from four waves of the China Family Panel Studies conducted between 2010 and 2016. Method: We defined catastrophic health expenditure as out-of-pocket payments equaling or exceeding 40% of the household’s capacity to pay. The Poisson regression with robust variance and generalized estimated equation (Poisson-GEE) model was used to quantify the level and change of catastrophic health expenditure, as well as the association between catastrophic heath expenditure and family net income. Result: Overall, the incidence of catastrophic expenditure in China experienced a 0.70-fold change between 2010 (12.57%) and 2016 (8.94%). The incidence of catastrophic health expenditure (CHE) decreased more in the poorest income quintile than the richest income quintile (annual decrease of 1.17% vs. 0.24% in urban areas, p < 0.001; 1.64% vs. −0.02% in rural areas, p < 0.001). Every 100% increase in income was associated with a 14% relative-risk reduction in CHE (RR = 0.86, 95% CI: 0.85–0.88) after adjusting for demographics, health needs, and health utilization characteristics; this association was weaker in recent years. Conclusion: Our analysis found that China made progress to reduce catastrophic health expenditure, especially for poorer groups. Income growth is strongly associated with this change.


Author(s):  
Morteza JOSHANI KHEIBARI ◽  
Reza ESMAEILI ◽  
Mahmood KAZEMIAN

Background: Health reform in Iran began in 2014, aimed at improving financing pattern of health services. We assessed the reform by changes in variables representing distribution of health payments and catastrophic expenditures. Methods: Using data from households’ income-expenditure survey, this study computed the financial variables, representing poverty line and households at poor state, household’s catastrophic health expenditure, fairness in financial contribution (FFC) index, and household’s impoverishment state, in the years 2010-2016, in urban and rural areas. The variables were computed by special software designed for this study, based on C-Sharp(C#) programming language, with yearly data on more than 38000 households, each with 1072 information sources. Results: The food share-based poverty line after sharp rise in 2010-2013, in 2014-2016 raised slowly, and the average percent of households facing catastrophic health expenditure, after sharp rise in 2011-2013, left at 3.25 in 2014-2015 and raised to 3.45 in 2016. The average FFC index remained at 0.839 to 0.837 in 2013-2016. However, interestingly, the average percent of households impoverished after out-of-pocket payments improved from 1.36 to 0.912 in 2013-2016. Conclusion: In three years of health reform, the major impact of reform was considerable improvements in the rate of the impoverished after out-of-pocket payments. The reform had limited impacts on the rates of households facing catastrophic health expenditure, and on FFC indexes, for the rural and urban residents.


2019 ◽  
Vol 34 (9) ◽  
pp. 694-705 ◽  
Author(s):  
Lucia Fiestas Navarrete ◽  
Simone Ghislandi ◽  
David Stuckler ◽  
Fabrizio Tediosi

Abstract A central pillar of universal health coverage (UHC) is to achieve financial protection from catastrophic health expenditure. There are concerns, however, that national health insurance programmes with premiums may not benefit impoverished groups. In 2003, Ghana became the first sub-Saharan African country to introduce a National Health Insurance Scheme (NHIS) with progressively structured premium charges. In this study, we test the impact of being insured on utilization and financial risk protection compared with no enrolment, using the 2012–13 Ghana Living Standards Survey (n = 72 372). Consistent with previous studies, we observed that participating in health insurance significantly decreased the probability of unmet medical needs by 15 percentage points (p.p.) and that of incurring catastrophic out-of-pocket (OOP) health payments by 7 p.p. relative to no enrolment in the NHIS. Households living outside a 1-h radius to the nearest hospital had lower reductions in financial risk from excess OOP medical spending relative to households living closer (−5 p.p. vs −9 p.p.). We also find evidence that in Ghana, the scheme was highly pro-poor. Once insured, the poorest 40% of households experienced significantly larger improvements in medical utilization (18 p.p. vs. 8 p.p.) and substantively larger reductions in catastrophic OOP health expenditure (−10 p.p. vs. −6 p.p.) compared with that of the richest households. However, health insurance did not benefit vulnerable persons equally from financial risk. Once insured, poor, low-educated and self-employed households living far from hospitals had significantly lower reductions in catastrophic OOP medical spending compared with their counterparts living closer. Taken together, we show that enrolment in the NHIS is associated with improved financial protection but less so among geographically remote vulnerable groups. Efforts to boost not just insurance uptake but also health service delivery may be needed as a supplement for insurance schemes to accelerate progress towards UHC.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Farid Gharibi ◽  
Ali Imani ◽  
Koustuv Dalal

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.


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