Mapping the Multidimensionality of Medical Care related Catastrophe on Households: A Study of Four Blocks in Birbhum District, West Bengal

2020 ◽  
Author(s):  
Priyanka Dasgupta ◽  
Subrata Mukherjee
Keyword(s):  
Medical Care ◽  
Healthcare Utilization ◽  
Health Expenditure ◽  
Negative Binomial ◽  
West Bengal ◽  
Catastrophic Health Expenditure ◽  
Multidimensional Analysis ◽  
Medical Expenditure ◽  
Cross Sectional ◽  
Multiple Indicators

Abstract Background Medical care related catastrophe is generally identified by healthcare expenses crossing a certain percentage of household’s resources (Wagstaff and van Doorslaer, 2003). This paper attempts to examine medical care related ‘catastrophe’ by going beyond the threshold-oriented approach of catastrophic medical expenditure and include multiple indicators which seeks to explore the catastrophe from a multidimensional perspective. Methods Drawing from multidimensional vulnerability to poverty approach (Alkire and Forster, 2008), we provide a measure which incorporates multiple indicators that might put households in medical care related catastrophic situation. Our study uses data from a cross-sectional household survey conducted by the Society for Health and Demographic Surveillance (SHDS) of the Government of West Bengal in 2012. Using negative binomial and logistic regression, the study also attempts to find the correlates of healthcare utilization, incurring catastrophic health expenditure for both 10 per cent of household consumption expenditure and 40 per cent of non-food expenditure as well as resorting to distress financing and availing low quality/ no care despite chronic illness. Results Estimates show that illness, presence of elderly members, hospitalization and outpatient visits increases the risk of incurring catastrophic health expenditure and healthcare utilization counts. In addition, households belonging to backward socio-religious categories and having members engaged as casual labourers face higher odds of distressed financing and availing informal/ no healthcare. In contrast to Wagstaff and van Doorslaer’s measure of catastrophic medical expenses, the multidimensional measure shows a lower medical care catastrophe for the upper economic classes and forward caste groups and vice versa which is more realistic and convincing. Conclusions The evidence generated from the multidimensional analysis presents a more convincing and reliable picture of vulnerability imparted due to health shocks as compared to identifying households with catastrophic medical expenditure by Wagstaff and van Doorslaer’s method. However, this study has its limitations as it has given equal weightage to all the dimensions and restricted itself to headcount measures. However, extension and refinement of this approach can provide more insightful findings.

scholarly journals Economic burden and catastrophic health expenditure associated with COVID-19 hospitalisations in Kerala, South India

2021 ◽  
Author(s):  
Ronnie Thomas ◽  
Quincy Mariam Jacob ◽  
Sharon Raj Eliza ◽  
Malathi Mini ◽  
Jobinse Jose ◽  
...  
Keyword(s):  
Health Expenditure ◽  
South India ◽  
Study Participant ◽  
Poverty Line ◽  
Catastrophic Health Expenditure ◽  
Medical Expenditure ◽  
Health Coverage ◽  
Cross Sectional ◽  
Hospitalised Patients ◽  
Distress Financing

Introduction - Catastrophic health expenditure during COVID-19 hospitalization has altered the economic picture of households especially in low resource settings with high rates of COVID-19 infection. This study aimed to estimate the Out of Pocket (OOP) expenditure and the proportion of households that incurred catastrophic health expenditures due to COVID-19 hospitalisation in Kerala, South India. Materials and Methods - A cross-sectional study was conducted among a representative sample of 155 COVID-19 hospitalised patients in Kottayam district over four months, using a pretested interview schedule. The direct medical and non-medical costs incurred by the study participant during hospitalisation and the total monthly household expenditure were obtained from the respective COVID-19 affected households. Catastrophic health expenditure was defined as direct medical expenditure exceeding 40% of effective household income. Results - From the study, median and mean Out of Pocket (OOP) expenditures were obtained as USD 93.57 and USD 502.60 respectively. The study revealed that 49.7% of households had Catastrophic health expenditure, with 32.9% having incurred Distress financing. Multivariate analysis revealed being Below poverty line, hospitalisation in private healthcare facility and presence of co-morbid conditions as significant determinants of Catastrophic health expenditure. Conclusion - High levels of Catastrophic health expenditure and distress financing revealed by the study unveils major unaddressed challenges in the road to Universal health coverage.

scholarly journals 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 ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e023033 ◽  
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.

scholarly journals Inequity of healthcare access and use and catastrophic health spending in slum communities: a retrospective, cross-sectional survey in four countries

2021 ◽  
Vol 6 (11) ◽  
pp. e007265
Author(s):  
Keyword(s):  
Health Expenditure ◽  
Healthcare Access ◽  
Health Spending ◽  
Catastrophic Health Expenditure ◽  
Small Scale ◽  
Health Coverage ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Gini Coefficients ◽  
Country Level

IntroductionTracking the progress of universal health coverage (UHC) is typically at a country level. However, country-averages may mask significant small-scale variation in indicators of access and use, which would have important implications for policy choice to achieve UHC.MethodsWe conducted a retrospective cross-sectional household and individual-level survey in seven slum sites across Nigeria, Kenya, Bangladesh and Pakistan. We estimated the adjusted association between household capacity to pay and report healthcare need, use and spending. Catastrophic health expenditure was estimated by five different methods.ResultsWe surveyed 7002 households and 6856 adults. Gini coefficients were wide, ranging from 0.32 to 0.48 across the seven sites. The total spend of the top 10% of households was 4–47 times more per month than the bottom 10%. Households with the highest budgets were: more likely to report needing care (highest vs lowest third of distribution of budgets: +1 to +31 percentage points (pp) across sites), to spend more on healthcare (2.0 to 6.4 times higher), have more inpatient and outpatient visits per year in five sites (1.0 to 3.0 times more frequently), spend more on drugs per visit (1.1 to 2.2 times higher) and were more likely to consult with a doctor (1.0 to 2.4 times higher odds). Better-off households were generally more likely to experience catastrophic health expenditure when calculated according to four methods (−1 to +12 pp), but much less likely using a normative method (−60 to −80 pp).ConclusionsSlums have a very high degree of inequality of household budget that translates into inequities in the access to and use of healthcare. Evaluation of UHC and healthcare access interventions targeting these areas should consider distributional effects, although the standard measures may be unreliable.

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 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.

scholarly journals 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

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 &lt; 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.

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.

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