scholarly journals Measurement and determinants of catastrophic health expenditures among the elderly in China using longitudinal data from the CHARLS

2020 ◽  
Author(s):  
Shiai Liu ◽  
Peter Christopher Coyte ◽  
Mingqi Fu ◽  
Qilin Zhang
Keyword(s):  
Logistic Regression ◽  
Health Expenditures ◽  
The Elderly ◽  
Chronic Health Condition ◽  
Health Condition ◽  
Andersen Model ◽  
Food Expenditures ◽  
Catastrophic Health Expenditures ◽  
Food Expenditure ◽  
Key Policy

Abstract Introduction: Catastrophic health expenditures (CHE) among Chinese elderly is an issue worthy of attention. However, the incidence, intensity and determinants of CHE have not been fully investigated by previous studies. This study explores the incidence, intensity and determinants of CHE among elderly Chinese citizens, i.e. those aged 60 years or older.Methods: Data were obtained from three waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011, 2013 and 2015. Cutoff points used in this study for catastrophic health expenditures were 10% of the total expenditures and 40% of non-food expenditures. Under the guidance of the Andersen model of health services utilization, this study used the logistic regression analysis to explore the determinants of catastrophic health expenditures.Results: The incidence of catastrophic health expenditures rose over the study period, 2011-2015, from 20.86% (95% CI: 19.35% to 22.37%) to 31.00% (95% CI: 29.28% to 32.72%) with 40% non-food expenditure. The intensity of CHE had also increased. The Overshoot(O) rose from from 3.12% (95% CI: 2.71% to 3.53%) to 8.75% (95% CI: 8.14% to 9.36%) with 40% non-food expenditure, while the mean positive overshoot (MPO) rose from 14.96% (95% CI: 12.99% to 16.92%) to 28.23% (95% CI: 26.26% to 30.19%), which means that the problem of catastrophic health expenditures was even more serious in 2015 than in 2011. Logistic regression revealed that households were more likely to face CHE if they: had a spouse as a household member, reported an inpatient event in the last year, reported an outpatient visit in the last month, are disabled; are members of a poor expenditure quartile, are located in the middle and western zones and reside in an Urban area. In contrast, catastrophic health expenditures were not significantly affected by age above 75 years, household size, having a chronic health condition or insurance type.Conclusion: Key policy recommendations include efforts to gradually improve medical assistance and to expand the use of health insurance to reduce household liability exposure for health expenditures.

scholarly journals Measurement and determinants of catastrophic health expenditure among the elderly households in China using longitudinal data from the CHARLS

2020 ◽  
Author(s):  
Shiai Liu ◽  
Peter Christopher Coyte ◽  
Mingqi Fu ◽  
Qilin Zhang
Keyword(s):  
Logistic Regression ◽  
Health Expenditure ◽  
The Elderly ◽  
Chronic Health Condition ◽  
Catastrophic Health Expenditure ◽  
Health Condition ◽  
Gradual Improvement ◽  
Food Expenditure ◽  
Key Policy ◽  
Elderly Households

Abstract Background: Catastrophic health expenditure (CHE) among the Chinese elderly warrants attention. However, the incidence, intensity and determinants of CHE have not been fully investigated. This study explores the incidence, intensity and determinants of CHE among elderly Chinese citizens, i.e., those aged 60 years or older.Methods: Data were obtained from three waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011, 2013 and 2015. The cut-off points used in this study for CHE were 10% of the total expenditures and 40% of non-food expenditure. Under the guidance of Andersen’s model of health services utilization, this study used logistic regression analysis to explore the determinants of CHE.Results: The incidence of CHE defined as more than 40% of non-food expenditure rose over the study period, 2011-2015, from 20.86% (95% CI: 19.35% to 22.37%) to 31.00% (95% CI: 29.28% to 32.72%). The intensity of CHE also increased. The overshoot (O) based on non-food expenditure rose from 3.12% (95% CI: 2.71% to 3.53%) to 8.75% (95% CI: 8.14% to 9.36%), while the mean positive overshoot (MPO) rose from 14.96% (95% CI: 12.99% to 16.92%) to 28.23% (95% CI: 26.26% to 30.19%). Thus, the problem of CEH was even more serious in 2015 than in 2011. Logistic regression revealed that households were more likely to face CHE if they had a spouse as a household member, reported an inpatient event in the last year, reported an outpatient visit in the last month, were disabled, were members of a poor expenditure quartile, lived in the middle and western zones or resided in an urban area. In contrast, CEH was not significantly affected by respondents being older than 75 years or having a chronic health condition, by household size or by insurance type.Conclusions: Key policy recommendations include the gradual improvement of medical assistance and the expansion of the use of health insurance to reduce household liability for health expenditures.Trial Registration: None.

scholarly journals Measurement and determinants of catastrophic health expenditure among elderly households in China using longitudinal data from the CHARLS

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Shiai Liu ◽  
Peter C. Coyte ◽  
Mingqi Fu ◽  
Qilin Zhang
Keyword(s):  
Logistic Regression ◽  
Health Expenditure ◽  
Chronic Health Condition ◽  
Catastrophic Health Expenditure ◽  
Health Condition ◽  
Gradual Improvement ◽  
Services Utilization ◽  
Food Expenditure ◽  
Key Policy ◽  
Elderly Households

Abstract Background Catastrophic health expenditure (CHE) among the Chinese elderly warrants attention. However, the incidence, intensity and determinants of CHE have not been fully investigated. This study explores the incidence, intensity and determinants of CHE among elderly Chinese citizens, i.e., those aged 60 years or older. Methods Data were obtained from three waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011, 2013 and 2015. The cut-off points used in this study for CHE were 10% of the total expenditures and 40% of non-food expenditure. Under the guidance of Andersen’s model of health services utilization, this study used logistic regression analysis to explore the determinants of CHE. Results The incidence of CHE defined as more than 40% of non-food expenditure rose over the study period, 2011–2015, from 20.86% (95% CI: 19.35 to 22.37%) to 31.00% (95% CI: 29.28 to 32.72%). The intensity of CHE also increased. The overshoot (O) based on non-food expenditure rose from 3.12% (95% CI: 2.71 to 3.53%) to 8.75% (95% CI: 8.14 to 9.36%), while the mean positive overshoot (MPO) rose from 14.96% (95% CI: 12.99 to 16.92%) to 28.23% (95% CI: 26.26 to 30.19%). Thus, the problem of CEH was even more serious in 2015 than in 2011. Logistic regression revealed that households were more likely to face CHE if they had a spouse as a household member, reported an inpatient event in the last year, reported an outpatient visit in the last month, were disabled, were members of a poor expenditure quartile, lived in the middle and western zones or resided in an urban area. In contrast, CEH was not significantly affected by respondents being older than 75 years or having a chronic health condition, by household size or by insurance type. Conclusions Key policy recommendations include the gradual improvement of medical assistance and the expansion of the use of health insurance to reduce household liability for health expenditures.

scholarly journals Examining the incidence of catastrophic health expenditures and its determinants using multilevel logistic regression in Malawi

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248752
Author(s):  
Atupele N. Mulaga ◽  
Mphatso S. Kamndaya ◽  
Salule J. Masangwi
Keyword(s):  
Public Health ◽  
Logistic Regression ◽  
Health Services ◽  
Health Expenditures ◽  
Free Access ◽  
Public Health Services ◽  
Factors Associated ◽  
Out Of Pocket Payments ◽  
Catastrophic Health Expenditures ◽  
Catastrophic Expenditures

Background Despite a free access to public health services policy in most sub-Saharan African countries, households still contribute to total health expenditures through out-of-pocket expenditures. This reliance on out-of-pocket expenditures places households at a risk of catastrophic health expenditures and impoverishment. This study examined the incidence of catastrophic health expenditures, impoverishing effects of out-of-pocket expenditures on households and factors associated with catastrophic expenditures in Malawi. Methods We conducted a secondary analysis of the most recent nationally representative integrated household survey conducted by the National Statistical Office between April 2016 to 2017 in Malawi with a sample size of 12447 households. Catastrophic health expenditures were estimated based on household annual nonfood expenditures and total household annual expenditures. We estimated incidence of catastrophic health expenditures as the proportion of households whose out-of-pocket expenditures exceed 40% threshold level of non-food expenditures and 10% of total annual expenditures. Impoverishing effect of out-of-pocket health expenditures on households was estimated as the difference between poverty head count before and after accounting for household health payments. We used a multilevel binary logistic regression model to assess factors associated with catastrophic health expenditures. Results A total of 167 households (1.37%) incurred catastrophic health expenditures. These households on average spend over 52% of household nonfood expenditures on health care. 1.6% of Malawians are impoverished due to out-of-pocket health expenditures. Visiting a religious health facility (AOR = 2.27,95% CI:1.24–4.15), hospitalization (AOR = 6.03,95% CI:4.08–8.90), larger household size (AOR = 1.20,95% CI:1.24–1.34), higher socioeconomic status (AOR = 2.94,95% CI:1.39–6.19), living in central region (AOR = 3.54,95% CI:1.79–6.97) and rural areas (AOR = 5.13,95% CI:2.14–12.29) increased the odds of incurring catastrophic expenditures. Conclusion The risk of catastrophic health expenditures and impoverishment persists in Malawi. This calls for government to improve the challenges faced by the free public health services and design better prepayment mechanisms to protect more vulnerable groups of the population from the burden of out-of-pocket payments.

scholarly journals Prevalence and Correlates of Pain in People Aged 60 Years and above in Singapore: Results from the WiSE Study

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Pratika Satghare ◽  
Siow Ann Chong ◽  
Janhavi Vaingankar ◽  
Louisa Picco ◽  
Edimansyah Abdin ◽  
...  
Keyword(s):  
Older Adults ◽  
The Elderly ◽  
Epidemiological Survey ◽  
Chronic Health Condition ◽  
Health Condition ◽  
World Health ◽  
Cross Sectional ◽  
Singapore Chinese ◽  
Nationally Representative ◽  
Health Organization

Background. Although pain is experienced among people of all ages, there is a need to study its risk factors and impact among older adults.Aims. The study sought to determine the prevalence, sociodemographics, and clinical correlates of pain along with association of pain with disability among older adults in Singapore.Methods. The WiSE study was a comprehensive cross-sectional, single phase, epidemiological survey conducted among the elderly aged 60 years and above and used a nationally representative sample of three main ethnic groups in Singapore: Chinese, Malays, and Indians. The survey administered 10/66 protocol pain questionnaire, sociodemographic questionnaire, health status questionnaire, World Health Organization Disability Assessment Scale (WHODAS 2.0), and Geriatric Mental State (GMS) examination.Results. A total of 2565 respondents completed the study giving a response rate of 65.5%. The prevalence of pain among the elderly aged 60 years and above is 19.5 %. Females, incomplete primary education Indians, and those diagnosed with any chronic health condition were associated with risk of pain and disability.Conclusion. Study findings showed that disability related to pain among the elderly is considerable making it a priority to reduce the morbidity and disability among the elderly with pain.

Budaya Kerja Petugas Panti Menurut Persepsi Lansia Dengan Kejadian Pengabaian di PSTW X

2019 ◽  
Vol 4 (3) ◽  
pp. 651
Author(s):  
Lola Felnanda Amri
Keyword(s):  
Logistic Regression ◽  
Nursing Home ◽  
Work Environment ◽  
The Elderly ◽  
Statistical Test ◽  
Nursing Personnel ◽  
Work Culture ◽  
Chi Square ◽  
Cross Sectional ◽  
Correlation Design

<p><em>Perawatan pada lansia di panti tresna werdha X dilakukan berdasarkan rutinitas kerja dan petugas belum mendapat pelatihan mengenai kebutuhan dasar lansia yang harus dipenuhi. Berdasarkan hal tersebut, peneliti ingin mengetahui hubungan budaya kerja petugas panti menurut persepsi lansia dengan kejadian pengabaian di PSTW X Sumatera Barat. Desain penelitian deskriptif korelasi, menggunakan pendekatan cross sectional. Pengambilan sampel dengan total sampling, berjumlah 75. Uji statistik digunakan chi square dan regresi logistik. Hasil yang diperoleh seluruh lansia mengalami pengabaian; ada hubungan antara sikap terhadap apa yang dikerjakan, lingkungan pekerjaan; waktu dengan pengabaian lansia; Tidak ada hubungan antara perilaku ketika mengambil keputusan dengan pengabaian lansia. Sikap terhadap apa yang dikerjakan memiliki pengaruh paling besar terhadap kejadian pengabaian lansia. Disimpulkan bahwa petugas harus lebih memahami tentang peran dan fungsinya sebagai pemberi pelayanan pada lansia. Direkomendasikan agar pejabat yang berwenang dapat menempatkan petugas panti sesuai dengan peran dan fungsi serta kewenangannya, dan merekrut perawat sesuai dengan kebutuhan panti.</em></p><p> </p><p><em>The nursing of elderly in </em><em>Tresna Werda X nursing home is mainly based on the workrout in and that the caregiver have not yet received training on the basic needs of the elderly that they should meet. Therefore, the researcher wanted to know the relations of the work culture of caregiver according to the elderly’s perception with the incidence of neglect in PSTW X West Sumatera. This study used Descriptive correlation design with cross sectional approach. The method of sampling used total sampling, which amounts to 75. The statistical test used chi square and logistic regression. The results of the study show that all of the elderly experienced neglect; there is a relation between attitude towards what is conducted, work environment, time with elderly neglect; no relation between behavior in making decisions with elderly neglect. The attitude towards what is conducted has the most impacton the incidence of elderly neglect. It is concluded that the caregiver should have a better understanding on their roles and functions as the caregivers to the elderly. Moreover, it is recommended that the authorities should put nursing personnel in accordance with the roles, functions and competence, and recruit nurses in accordance with the needs of the nursing home.</em></p>

scholarly journals Cross-Sectional Association between Hypercholesterolemia and Knee Pain in the Elderly with Radiographic Knee Osteoarthritis: Data from the Korean National Health and Nutritional Examination Survey

2021 ◽  
Vol 10 (5) ◽  
pp. 933
Author(s):  
Byung Woo Cho ◽  
Du Seong Kim ◽  
Hyuck Min Kwon ◽  
Ick Hwan Yang ◽  
Woo-Suk Lee ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Knee Pain ◽  
Logistic Regression Analysis ◽  
National Health ◽  
Large Scale ◽  
Metabolic Diseases ◽  
The Elderly ◽  
Cross Sectional ◽  
Ordinal Logistic Regression Analysis

Few studies have reported the relationship between knee pain and hypercholesterolemia in the elderly population with osteoarthritis (OA), independent of other variables. The aim of this study was to reveal the association between knee pain and metabolic diseases including hypercholesterolemia using a large-scale cohort. A cross-sectional study was conducted using data from the Korea National Health and the Nutrition Examination Survey (KNHANES-V, VI-1; 2010–2013). Among the subjects aged ≥60 years, 7438 subjects (weighted number estimate = 35,524,307) who replied knee pain item and performed the simple radiographs of knee were enrolled. Using multivariable ordinal logistic regression analysis, variables affecting knee pain were identified, and the odds ratio (OR) was calculated. Of the 35,524,307 subjects, 10,630,836 (29.9%) subjects experienced knee pain. Overall, 20,290,421 subjects (56.3%) had radiographic OA, and 8,119,372 (40.0%) of them complained of knee pain. Multivariable ordinal logistic regression analysis showed that among the metabolic diseases, only hypercholesterolemia was positively correlated with knee pain in the OA group (OR 1.24; 95% Confidence Interval 1.02–1.52, p = 0.033). There were no metabolic diseases correlated with knee pain in the non-OA group. This large-scale study revealed that in the elderly, hypercholesterolemia was positively associated with knee pain independent of body mass index and other metabolic diseases in the OA group, but not in the non-OA group. These results will help in understanding the nature of arthritic pain, and may support the need for exploring the longitudinal associations.

scholarly journals Human Nonmercaptalbumin Is a New Biomarker of Motor Function

2021 ◽  
Vol 10 (11) ◽  
pp. 2464
Author(s):  
Sadayuki Ito ◽  
Hiroaki Nakashima ◽  
Kei Ando ◽  
Kazuyoshi Kobayashi ◽  
Masaaki Machino ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Grip Strength ◽  
Motor Function ◽  
Walking Speed ◽  
The Elderly ◽  
Elderly Subjects ◽  
Locomotive Syndrome ◽  
Reduced Mobility

The ratio of human nonmercaptalbumin (HNA) and reduced albumin (HMA) may be a new marker for oxidative stress. Locomotive syndrome (LS) is reduced mobility due to impairment of locomotive organs. We investigated whether the HNA/HMA ratio could be a new biomarker of LS. This study included 306 subjects (mean age 64.24 ± 10.4 years) who underwent LS tests, grip strength, walking speed, and tests for HNA and HMA. Oxidative stress was measured by the ratio of HMA (f(HMA) = (HMA/(HMA + HNA) × 100)), and the subjects were divided into normal (N group; f[HMA] ≥ 70%) and low (L group; f[HMA] < 70%) groups. There were 124 non-elderly (<65 years) and 182 elderly subjects (≥65 years). There were no significant differences in LS, grip strength, and walking speed between the L and N groups in the non-elderly subjects. However, significant differences were found in the elderly subjects. In logistic regression analysis, there was an association between f(HMA) and the LS severity at older ages. LS in the elderly is associated with a decline in HMA and, thus, an increase in oxidative stress. Thus, f(HMA) is a new biomarker of LS.

The Risk of Catastrophic Health Expenditures Due to Direct Non-Medical Costs in Patients: A Study of the Outpatients in Qazvin, Iran

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Saeed Asefzadeh ◽  
Bahman Ahadi Nezhad ◽  
Saeed Norouzi
Keyword(s):  
Health Expenditures ◽  
Medical Costs ◽  
Healthcare Services ◽  
Disease Diagnosis ◽  
Cross Sectional Survey ◽  
Diagnostic Laboratory ◽  
Cross Sectional ◽  
Out Of Pocket Payments ◽  
Catastrophic Health Expenditures ◽  
Catastrophic Expenditures

Background: Out-of-pocket payment encompasses the costs that patients pay for healthcare services, which is an inefficient approach to healthcare financing as it may lead to poverty. Objectives: The present study aimed to determine the risk of catastrophic health expenditures due to non-medical costs in the outpatients in Qazvin, Iran. Methods: This cross-sectional survey was conducted on 341 outpatients referring to the internists of Velayat Hospital and Bu-Ali Sina Hospital in Qazvin. The required data were collected using a researcher-made questionnaire and the prescriptions of the patients. Out-of-pocket payments were defined as the direct medical and non-medical costs within one month. Results: The mean out-of-pocket payments of the patients in one month was 49.97 dollars, 75.8% of which covered direct medical cost (disease diagnosis and treatment), and 24.2% covered direct non-medical costs to receive health services. The highest out-of-pocket payments were for diagnostic/laboratory tests (50.3%), medications (21.5%), and transportation (18.2%). In addition, the exposure rate to catastrophic expenditures was estimated at 31%, and the patients with lower income had less exposure compared to those without incomes. Conclusions: According to the results, direct non-medical costs were associated with the increased out-of-pocket payments of the patients, which in turn led to the higher rates of catastrophic expenditures.

Abstract 17309: Scope and Determinants of Nonfinancial Barriers to Healthcare Access in Individuals With Atherosclerotic Cardiovascular Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Isaac Acquah ◽  
Javier Valero-Elizondo ◽  
Miguel Cainzos Achirica ◽  
Rahul Singh ◽  
Karan Shah ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Logistic Regression ◽  
Low Income ◽  
Barriers To Care ◽  
Multinomial Logistic Regression ◽  
The Elderly ◽  
Atherosclerotic Cardiovascular Disease ◽  
The Us ◽  
Barriers To Healthcare ◽  
Relative Prevalence

Introduction: Barriers to healthcare - financial and nonfinancial - may result in unmet health needs and adverse outcomes. Despite this, the nonfinancial barriers to care among adults with atherosclerotic cardiovascular disease (ASCVD) is poorly defined in the US. We aimed to explore the scope and determinants of nonfinancial barriers to care among individuals with ASCVD. Methods: We analyzed data from the 2013-17 National Health Interview Survey (NHIS). We included adults with self-reported ASCVD (heart attack, angina, and/or stroke). Nine key variables in the NHIS that represent nonfinancial barriers to healthcare were assessed as absent/present, and participants were classified as having 0-1, 2, or ≥3 barriers. Multinomial logistic regression (using 0-1 nonfinancial barriers as reference) was used to evaluate the relationship between various sociodemographic factors, and an increasing number of nonfinancial barriers. Results: Of all the 15,758 adults with ASCVD (8.1% annually in the US; representing 19.6 million), 23.4% reported having at least one nonfinancial barrier to care while 4.9% reported 3 nonfinancial barriers. In a multivariable multinomial logistic regression, after stratifying by age, individuals from low-income families had an almost 2-fold relative prevalence of 3 nonfinancial barriers ( Figure) . In the elderly, however, lack of insurance was the strongest predictor (relative prevalence ratio of 6.51 [95% confidence interval; 2.25, 18.87]) of having ≥3 barriers. Conclusion: Among adults with ASCVD, the relative prevalence of ≥3 nonfinancial barriers was low (4.9%) with low-income being the only modifiable predictor of reporting ≥3 nonfinancial barriers and lack of insurance being the strongest predictor in the elderly. Addressing financial barriers to healthcare may help alleviate these nonfinancial barriers.

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