scholarly journals Trends in Out of Pocket Payments and Catastrophic Health Expenditure in the Kyrgyz Republic Post the “Den Sooluk” Health Reform, 2012 - 2018

2020 ◽  
Author(s):  
Mariia Iamschikova ◽  
Roman Mogilevskii ◽  
Michael N Onah
Keyword(s):  
Health Reform ◽  
Health Expenditure ◽  
Household Survey ◽  
Household Consumption ◽  
Catastrophic Health Expenditure ◽  
Kyrgyz Republic ◽  
Consumption Expenditure ◽  
Rural Regions ◽  
Cross Sectional ◽  
Out Of Pocket Payments

Abstract Background: To examine the trends in out- of- pocket health payments (OOPPs) and the incidence of catastrophic health expenditure post the “Den Sooluk” health reform, we used data from the Kyrgyzstan Integrated Household Survey (2012 – 2018). Methods: Population-weighted descriptive statistics were used to examine the trends in OOPPs and catastrophic health expenditure 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 progress in the reduction of OOPPs and catastrophic health expenditure gained appear to gradually erode since costs continue to increase after an initial decline and catastrophic health expenditure continues to rise unabated. Efforts needs to be made to check the rising out-of-pocket costs to enable a reduction in catastrophic health payments.

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 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 Catastrophic health expenditure among single empty-nest elderly with multimorbidity in rural Shandong, China: the effect of co-occurrence of frailty

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Zhengyue Jing ◽  
Jie Li ◽  
Pei Pei Fu ◽  
Yi Wang ◽  
Yemin Yuan ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Expenditure ◽  
Interaction Analysis ◽  
Economic Status ◽  
Household Survey ◽  
Catastrophic Health Expenditure ◽  
Empty Nest ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Out Of Pocket Payments

Abstract Background Previous studies have indicated that older adults with multimorbidity had higher risk of incurring catastrophic health expenditure (CHE). However, the effect of co-occurrence of frailty on CHE among single empty-nest elderly with multimorbidity remains unclear. This study aims to explore the effect of co-occurrence of frailty on CHE among single empty-nest elderly with multimorbidity, and whether this effect is moderated by economic status. Methods A cross-sectional household survey of the older adults in 2019 in Shandong province, China. A total of 606 single empty-nest elderly aged 60 years or older were included in this study. CHE was defined as the out-of-pocket payments for health care that equals or exceeds 40% of the household’ s capacity to pay. Logistic regression models are employed to examine the effect of co-occurrence of frailty on CHE among single empty-nest elderly with multimorbidity. The interaction term is introduced to explore the economic status difference in this effect. Results The CHE incidence for single empty-nest elderly with multimorbidity alone is 64.2%, and the co-occurrence of frailty results in an increase by almost 1.3 times (84.0%) in CHE incidence among single empty-nest elderly with multimorbidity. The co-occurrence of frailty increases the risk of incurring CHE among the single empty-nest elderly with multimorbidity, with the odds of incurring CHE increased by 3.19 times (OR = 3.19; P = 0.005). Furthermore, the interaction analysis shows that the effect of co-occurrence of frailty on CHE among single empty-nest elderly with multimorbidity still exist in lower economic status groups (OR = 4.64; P = 0.027), but not in higher economic status (OR = 2.76; P = 0.062). Conclusions This study demonstrates that there is a positive effect of co-occurrence of frailty on the CHE among the single empty-nest elderly with multimorbidity, and this effect varies by economic status. The health policy-makers should reorganize the healthcare system to make it pro-poor, so as to meet the multiple medical demand and reduce the potential economic burden and inequalities of older adults.

Impacts of Health Reform Plan in Iran on Health Payments Distributions and Catastrophic Expenditure

2020 ◽  
Author(s):  
Morteza JOSHANI KHEIBARI ◽  
Reza ESMAEILI ◽  
Mahmood KAZEMIAN
Keyword(s):  
Rural Areas ◽  
Health Reform ◽  
Health Expenditure ◽  
Poverty Line ◽  
Catastrophic Health Expenditure ◽  
Sharp Rise ◽  
Financial Variables ◽  
Reform Plan ◽  
Out Of Pocket Payments ◽  
Food Share

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.

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

BMJ Open ◽  
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.

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

2020 ◽  
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 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.

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

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.

scholarly journals Catastrophic Effects of Out-of-Pocket Payments for Health Care Using Synthetic Panel Data

2018 ◽  
pp. 22-41
Author(s):  
Shiva Raj Adhikari ◽  
Vishnu Prasad Sapkota
Keyword(s):  
Panel Data ◽  
Health Expenditure ◽  
Catastrophic Health Expenditure ◽  
Accurate Information ◽  
Cross Sectional ◽  
Out Of Pocket Payments ◽  
Food Expenditure ◽  
Second Period ◽  
Catastrophic Impact ◽  
Synthetic Panel

Panel data can provide more accurate information about the movement of catastrophic payments. The study measures dynamics of catastrophic payment by utilizing recently developed method of creating synthetic panel from two cross-sectional data. It is interested to estimate percentage of households that faced catastrophic health expenditure in first period but didn't face it in second period. Catastrophic payment is defined as OOP payments as a share of total non-food consumption. The threshold for catastrophic health expenditure for non-food expenditure has been set 15% to 50%. The findings related to the movement of households from catastrophic health expenditure to non-catastrophic health expenditure and vice versa between the period of 2004 and 2011. Probability of percentage population faced catastrophic impact due to medicine costs in the first period and in the second period is decreasing from 20.1 per cent to 0.01 percent as increased in threshold 15% to 50%. Similarly, probability of catastrophic impact in the first period but not in the second period is decreasing from 3.1 per cent to 0.00 percent as increased in threshold 15% to 50%. Probability of not having catastrophic impact in the first period but catastrophic impact in the second period is decreasing from 17.2 per cent to 1.9 percent as increased in threshold 15% to 50%. Probability of not having catastrophic impact in both periods is increasing from 60.0 per cent to 98.3 percent as increased in threshold 15% to 50%.  Catastrophic to catastrophic incidences in Terai ecological belt are higher than in hills and Mountain. Similarly, Disadvantaged non Dalit Terai caste have higher incidence than other caste groups. Synthetic panel gives the indicative trends; incidences may not be directly comparable with incidences estimated from cross-sectional data.Economic Journal of Development Issues Vol. 21 & 22 No. 1-2 (2016) Combined Issue, Page: 22-41 

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.

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