Catastrophic health expenditure: A comparative study between hypertensive patients with and without complication in rural Shandong, China

Abstract Background: Some previous studies have assessed catastrophic health expenditure (CHE) in households with hypertensive patients, but few have examined the difference of CHE in hypertensive patients with and without complications. The purpose of this study is to compare the incidence and determinants of CHE between hypertensive patients with and without complications. Methods: Data of this study were from a cross-sectional study in Shandong Province in China in 2016. Of the recruited 3,457 hypertensive patients registered in the NCDs management system in the sampling villages, 3,113 completed the survey, with a response rate of 90.05%.CHE was defined as out-of-pocket payments for hypertensive care that equaled or exceeded 40% of the household capacity to pay (non-food expenditure). Hypertension complications (e.g., stroke, coronary heart disease, hypertensive kidney disease, etc.) were collected in this study, which was categorized into 0 (no), 1(single), and 2 and more according to the types of hypertensive complications. We employed Chi-square test to explore associated factors and logistic regression model to identify the determinants of CHE. Results: The incidence of CHE and impoverishment is 13.6% and 10.8% among hypertensive patients. The incidence of CHE with one complication is 25.3% ( R =0.000, OR=2.29 ) and 47.3% ( P =0.000, OR=3.60 ) in patients with two or more complications, which are both statistically higher than that in patients without complication (6.1%). Across all types of patients, income levels are inversely related to the incidence of CHE. Patients who use outpatient or inpatient service are more likely to experience CHE ( R =0.000 ). Factors including living arrangements, family size, educational attainment are found to be significantly associated with CHE in some subgroups ( P ＜ 0.05 ). Conclusions: CHE and impoverishment incidence among hypertensive patients are both high in rural China. Patients with hypertensive complication are at higher catastrophic risk than those without complication.More attention needs to be paid to households with hypertension patients, especially for those with hypertension complications.

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Catastrophic health expenditure: A comparative study between hypertensive patients with and without complication in rural Shandong, China

10.21203/rs.2.14646/v1 ◽

2019 ◽

Author(s):

Xinyi Zhang ◽

Qiongqiong Xu ◽

Xiaolei Guo ◽

Zhengyue Jing ◽

Long Sun ◽

...

Keyword(s):

Living Arrangements ◽

Health Expenditure ◽

Rural China ◽

Cross Sectional Study ◽

Catastrophic Health Expenditure ◽

Inpatient Service ◽

Chi Square ◽

Cross Sectional ◽

Hypertensive Patients ◽

Out Of Pocket Payments

Abstract Background Some previous studies have assessed catastrophic health expenditure (CHE) in households with hypertensive patients, but few have examined the difference of CHE in hypertensive patients with and without complications. The purpose of this study is to compare the prevalence and determinants of CHE between hypertensive patients with and without complications.Methods The data were draw from a cross-sectional study conducted in four rural counties of Shandong Province in China in 2016, including 3,113 hypertensive patients. CHE was defined as out-of-pocket payments for hypertensive care that equaled or exceeded 40% of the household capacity to pay. We employed Chi-square test to explore associated factors and logistic regression model to identify the determinants of CHE.Results The prevalence of CHE is 13.6% among hypertensive patients. The prevalence of CHE with one complication is 25.3% ( Ρ =0.000, OR=2.29 ) and 47.3% ( P=0.000, OR=3.60 ) in patients with two or more complications, which are both statistically higher than that in patients without complication (6.1%). Across all types of patients, income levels are inversely related to the prevalence of CHE. Patients who use outpatient or inpatient service are more likely to experience CHE ( Ρ =0.000 ). Factors including living arrangements, family size, educational attainment are found to be significantly associated with CHE in some subgroups ( Ρ <0.05 ).Conclusions CHE prevalence among hypertensive patients is high in rural China. Patients with hypertensive complication are at higher catastrophic risk than those without complication.

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Association between livelihood capital and catastrophic health expenditure among patients with critical illness: a cross-sectional study in rural Shandong, China

BMJ Open ◽

10.1136/bmjopen-2021-051234 ◽

2021 ◽

Vol 11 (10) ◽

pp. e051234

Author(s):

Xin Che ◽

Jiajia Li ◽

Wenhao Fu ◽

Feng Fang

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Health Expenditure ◽

Natural Capital ◽

Cross Sectional Study ◽

Catastrophic Health Expenditure ◽

Secondary Outcome ◽

Sectional Study ◽

Cross Sectional ◽

Out Of Pocket Payments

ObjectiveThe objective of this study is to examine the association between livelihood capital and catastrophic health expenditure (CHE).DesignBetween July and August 2019, a cross-sectional study was conducted in critically ill patients.SettingShandong, China.Participants1041 households with critically ill patients from 77 villages.Primary and secondary outcome measuresWe defined expenditure as being catastrophic if a household’s out-of-pocket payments were greater than or equal to 40% of their capacity to pay. Using the sustainable livelihoods framework, this study explored the associations between CHE and the various forms of livelihood capital—inclusive of human capital, natural capital, physical capital, financial capital and social capital. χ2 tests, t-tests, Wilcoxon tests and binary logistic regression analysis were performed to examine these associations.ResultsThe incidence of CHE among households with critically ill patients was 76.37% in this study. Better livelihood capital was significantly associated with lower incidence of CHE. After controlling for confounding factors, households with healthier patients (OR 0.47, 95% CI 0.23 to 0.96), more real estate ownership (OR 0.35, 95% CI 0.19 to 0.67) and better economic status (OR 0.33, 95% CI 0.18 to 0.62) were associated with a reduction in the occurrence of CHE.ConclusionsLivelihood capital was significantly associated with CHE in rural families with critically ill patients. This association suggests that, in addition to providing health insurance to the critically ill, more attention should be paid to their ability to create and preserve livelihood capital.

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Analisis Faktor Determinan yang berhubungan dengan Kepatuhan Rekomendasi Modifikasi Gaya Hidup Pasien Hipertensi

Jurnal Ners dan Kebidanan (Journal of Ners and Midwifery) ◽

10.26699/jnk.v7i2.art.p256-263 ◽

2020 ◽

Vol 7 (2) ◽

pp. 256-263

Author(s):

Abdul Qodir

Keyword(s):

Blood Pressure ◽

Lifestyle Modification ◽

Multivariate Logistic Regression Analysis ◽

Cross Sectional Study ◽

Lifestyle Modifications ◽

Chi Square ◽

Cross Sectional ◽

Hypertensive Patients ◽

Consecutive Sampling ◽

Knowledge Practice

Penatalaksanaan farmakologis dan non farmakologis dipercaya dapat mengontrol tekanan darah dan mencegah komplikasi, tetapi banyak pasien hipertensi tekanan darahnya tidak terkontrol. Hal tersebut dikarenakan kepatuhan yang buruk dalam melaksanakan rekomendasi gaya hidup. Penelitian ini bertujuan untuk menganalisis determinan faktor yang berhungan dengan kepatuhan melaksanakan rekomendasi modifikasi gaya hidup. Penelitian ini menggunakan metode cross-sectional di pukesmas dinoyo Kota Malang tahun 2019. Teknik pengambilan sampel menggunakan Consecutive Sampling. Kuesioner yang digunakan meliputi : karakteristik demografi, pengetahuan dan rekomendasi mofifikasi gaya hidup pasien hipertensi. Hubungan antara rekomendasi modifikasi gaya hidup dengan variabel independen dianalisis menggunakan uji chi square dan analisis regresi logistik. 140 pasien hipertensi berpartisipasi dalam penelitian ini (60 laki-laki, 80 wanita). Prevalensi kepatuhan adalah 28,6 %. Tingkat pengetahuan berhubungan signifikan dengan kepatuhan melaksanakan rekomendasi gaya hidup (p=0,00). Jenis kelamin, usia, dan tingkat pendidikan tidak mempunyai hubungan signifikan dengan kepatuhan rekomendasi modifikasi gaya hidup (p= 0,06; p=0,21; p=0,87). Pengetahuan mempunyai hubungan yang signifikan dengan kepatuhan rekomendasi modifikasi gaya hidup. Management of pharmacological and non-pharmacological is believed to control blood pressure and prevent complications, but many hypertensive patients have uncontrolled blood pressure. This is due to poor adherence to recommended lifestyle modifications. This study was aimed to determine the factors associated with adherence to recommended lifestyle modifications of hypertensive patients. A cross-sectional study was conducted in Pukesmas Dinoyo Malang in 2019. Consecutive Sampling was used to select study subjects. The questionnaire included information about demographic characteristics, knowledge, practice of lifestyle-modification measures. Associations between adherence to lifestyle modification and independent variables were analyzed using chi square and multivariate logistic regression analysis. 140 hypertensive patients participated in the study (60 men, 80 women). The prevalence of adherence was 28.6%. The level of knowledge was significant associated with adherence to recommended lifestyle modifications (p = 0.00). Genders , age, and educational level were no significant associated with to recommended lifestyle modifications (p= 0.06; p=0.21; p=0.87). Knowledge was significant associated with adherence to recommended lifestyle modifications of hypertensive patients.

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Decomposing inequality in catastrophic health expenditure for self-reported hypertension household in Urban Shaanxi, China from 2008 to 2013: two waves’ cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2018-023033 ◽

2019 ◽

Vol 9 (5) ◽

pp. e023033 ◽

Cited By ~ 4

Author(s):

Yafei Si ◽

Zhongliang Zhou ◽

Min Su ◽

Xiao Wang ◽

Xin Lan ◽

...

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Health Expenditure ◽

Economic Status ◽

Cross Sectional Study ◽

Catastrophic Health Expenditure ◽

Urban China ◽

Shaanxi Province ◽

Vulnerable Groups ◽

Cross Sectional

ObjectiveDespite the latest wave of China’s healthcare reform initiated in 2009 has achieved unprecedented progress in rural areas, little is known for specific vulnerable groups’ catastrophic health expenditure (CHE) in urban China. This study aims to estimate the trend of incidence, intensity and inequality of CHE in hypertension households (households with one or more than one hypertension patient) in urban Shaanxi, China from 2008 to 2013.MethodsBased on the fourth and the fifth National Health Service Surveys of Shaanxi, we identified 460 and 1289 households with hypertension in 2008 and 2013, respectively for our analysis. We classified hypertension households into two groups: simplex households (with hypertension only) and mixed households (with hypertension plus other non-communicable diseases). CHE would be identified if out-of-pocket healthcare expenditure was equal to or higher than 40% of a household’s capacity to pay. Concentration index and its decomposition based on Probit regressions were employed to measure the income-related inequality of CHE.ResultsWe find that CHE occurred in 11.2% of the simplex households and 22.1% of the mixed households in 2008, and the 21.5% of the simplex households and the 46.9% of mixed households incurred CHE in 2013. Furthermore, there were strong pro-poor inequalities in CHE in the simplex households (−0.279 and −0.283) and mixed households (−0.362 and −0.262) both in 2008 and 2013. The majority of observed inequalities in CHE could be associated with household economic status, household head’s health status and having elderly members.ConclusionWe find a sharp increase of CHE occurrence and the sustained strong pro-poor inequalities for simplex and mixed households in urban Shaanxi Province of China from 2008 to 2013. Our study suggests that more concerns are needed for the vulnerable groups such as hypertension households in urban areas of China.

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

10.21203/rs.3.rs-39366/v3 ◽

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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Catastrophic Health Expenditure, Distress Financing and Impoverishment due to Out-of-Pocket Expenses for Healthcare among Patients with Chronic Liver Disease: A Cross-sectional Study among Hospitalized Patients in Bangladesh

10.31219/osf.io/svdkr ◽

2021 ◽

Author(s):

Mohammad Farhadul Haque ◽

ANM Shamsul Islam ◽

Samina Pervin ◽

Emily Akter ◽

Mahmudul Hasan

Keyword(s):

Liver Disease ◽

Chronic Liver Disease ◽

Health Expenditure ◽

Cross Sectional Study ◽

Catastrophic Health Expenditure ◽

Hospitalized Patients ◽

Chronic Liver ◽

Sectional Study ◽

Cross Sectional ◽

Distress Financing

Out-of-pocket (OOP) expenses for hospitalized patients with chronic liver disease (CLD) poses an economic challenge on affected household in the form of catastrophic health expenditure (CHE), distress financing and impoverishment. OOP Expenses data for hospitalized CLD patients from Bangladesh is scarce. This study aimed to estimate the OOP expenses and resulting CHE, distress financing and impoverishment among hospitalized patients with CLD. This cross-sectional study was conducted among conveniently selected 107 diagnosed CLD patients admitted at Bangabandhu Sheikh Mujib Medical University (BSMMU) and Dhaka Medical College Hospital (DMCH) aged 18 years and above. Data were collected from the respondents using a semi-structured questionnaire through face to face interview during discharge from hospital. Out of pocket expenditure for chronic liver disease in selected hospitals was Bangladeshi Taka (BDT) 19,262. Direct medical, direct non-medical and indirect cost was BDT 16,240; 2,165 and 1,510, respectively. Investigation cost and medicine cost contributed to 48.48% and 31.81% of the total OOP expenses, respectively. At 10% threshold level, 29% of the respondents were affected by CHE. 64.5% of the respondents were facing distress financing due to OOP expenses. Among the respondents, 1.9% slipped below the international poverty line of $1.90 (BDT 161.10, in 2019).There was statistically significant (p < 0.05) difference among the mean OOP expenses for different etiological types of chronic liver disease. The study concluded that it requires establishing a more accessible and affordable decentralized health care system for CLD treatment along with the implementation of financial risk protection.

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

BMJ Open ◽

10.1136/bmjopen-2018-026638 ◽

2019 ◽

Vol 9 (4) ◽

pp. e026638 ◽

Cited By ~ 6

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.

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

BMC Health Services Research ◽

10.1186/s12913-021-06251-4 ◽

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.

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

10.21203/rs.3.rs-39366/v2 ◽

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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Prevalence and Risk Factors of Microalbuminuria in Nondiabetic Hypertensive Patients

Community Based Medical Journal ◽

10.3329/cbmj.v3i2.53399 ◽

2014 ◽

Vol 3 (2) ◽

pp. 15-22

Author(s):

Amdadul Haque ◽

Mahmud Javed Hasan ◽

Md Asaduzzaman Raja ◽

Md Aminul Islam

Keyword(s):

Laboratory Data ◽

Binary Logistic Regression ◽

Cross Sectional Study ◽

Binary Logistic Regression Model ◽

Chi Square ◽

Cross Sectional ◽

Hypertensive Patients ◽

Medical College ◽

Low Hdl ◽

History Of

The aim of this study to determine the prevalence of microalbuminuria as well as associated factors in non-diabetic hypertensive patients. Hospital-based cross sectional study. Main outcome of measure is microalbuminuria. A total of 100 nondiabetic hypertensive patients age 18 years without a history of pre-existing kidney disease attending the outpatient department of Community Based Medical College Bangladesh, Mymensingh over a period 6 months from June to December 2014 and who consented and met the criteria were enrolled in this study. A questionnaire including clinical and laboratory data was completed for all cases. The survey data were checked, coded and entered into a SPSS statistical package (Version 11.5). All variables were tested for normal distribution of the data. The data were then cleaned and analyzed using Chi-square (x2) Test, One-Way ANOVA statistics and Binary logistic regression model. Results were considered statistically significant for two-sided P values of <0.05. The overall prevalence of microalbuminuria was 17% of patients (11(64.7%) were male and 6(35.3%) female). The mean age and BMI were 49.2±9.1 years and 23.5±3.8 kg/m2 respectively. There were only 2(2%) patients whose systolic BP and diastolic BP were both well controlled (<140/˂90 mmHg), while normalization rates of either systolic BP (<140 mmHg) or diastolic BP (<90 mmHg) were 10% and 26% respectively. Age 50 years, low HDL, duration of HTN and triglyceride >150 mg/dl were found independent predictors of elevated UAE with ORs being 0.18, 3.9, 0.13 and 0.49 respectively. Microalbuminuria was not uncommon in non-diabetic hypertensive patients and older age, low HDL, high LDL, raised triglyceride and duration of HTN were significant predictors of microalbuminuria. There is an urgent need to screening of microalbuminuria should be mainstreamed into routine investigation and follow-up of patients with HBP. CBMJ 2014 July: Vol. 03 No. 02 P: 15-22

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