Has Iran achieved the goal of reducing the prevalence of households faced with catastrophic health expenditure to 1%? The results of a national study

Abstract Background Access to universal health coverage and reducing the prevalence of catastrophic health expenditure (CHE) to 1% are the commitments of the Islamic Republic of Iran. The aim of this study was to investigate the prevalence of households exposed to CHE. Methods This cross-sectional study was performed on 2000 households in five provinces of Iran in 2021. Data were collected through interviews using the World Health Survey questionnaire. Results Data from households whose health care costs were more than 40% of their capacity to pay were included in the group of households with CHE. Determinants of CHE were identified using multivariate regression analysis. 8.3% of households were exposed to CHE. The variables of being a female head of household, use of inpatient, outpatient, dental, and rehabilitation services, families with disabled members and low economic status of the households were significantly associated with increased odds of facing CHE. Conclusion In the final year of the sixth five-year development plan, Iran has not yet achieved its goal of "reducing the percentage of households exposed to CHE to 1%," and a high percentage of Iranian households still face CHE. Policymakers should pay attention to factors increasing the chance of facing CHE in designing interventions and this can help the goal of financial protection against health costs.

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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 inequalities in childhood stunting in Ethiopia from 2000 to 2016: a cross sectional study

Journal of Public Health ◽

10.1093/pubmed/fdaa051 ◽

2020 ◽

Author(s):

Betregiorgis Zegeye ◽

Gebretsadik Shibre ◽

Dina Idriss-Wheeler ◽

Sanni Yaya

Keyword(s):

Rural Areas ◽

Economic Status ◽

Statistical Significance ◽

Population Attributable Risk ◽

Cross Sectional Study ◽

World Health ◽

Demographic And Health Surveys ◽

Uncertainty Interval ◽

Cross Sectional ◽

Agenda 2030

Abstract Background The decrease in the magnitude of stunting over the past 20 years has been slow in Ethiopia. To date, in Ethiopia, the trends in and extent of inequality in stunting have not been investigated using methods suitably developed for disparity studies. This paper investigated both the extent and overtime dynamics of stunting inequality in Ethiopia over the last 17 years. Methods Using the World Health Organization’s Health Equity Assessment Toolkit software, data from the Ethiopia Demographic and Health surveys (EDHS) were analyzed between 2000 and 2016. The inequality analysis consisted of disaggregated rates of stunting using five equity stratifiers (economic status, education, residence, region and sex) and four summary measures (Difference, Population Attributable risk, Ratio and Absolute Concentration Index). A 95% uncertainty interval was constructed around point estimates to measure statistical significance. Results The study showed that both absolute and relative inequalities in stunting exist in all the studied years in Ethiopia. The inequality disfavors children of mothers who are poor, uneducated and living in rural areas and specific regions such as Amhara. The pro-rich (R = 1.2; 1.1, 1.3 in 2000 to R = 1.7; 1.4, 2 in 2016) and pro-educated (R = 1.6; 95%UI = 1.3, 1.9 in 2000 and R = 2.3; 95%UI = 1.5, 3 in 2011) inequalities slightly increased with time. Male children bear a disproportionately higher burden of stunting, and the disparity increased between the first and the last time points (PAR = −1.5 95%UI = −2.5, −0.6 in 2000 and PAR = −2.9 95%UI = −3.9, −1.9) based on complex measures but remained constant with simple measures (R = 1; 95%UI = 0.9, 1.1 in 2000 and R = 1.1 95%UI = 1, 1.2 in 2016). Similarly, both the sub-national regional and residence-related stunting disparities generally widened over time according to some of the inequality measures. Conclusions Stunting appeared to be highly prevalent among certain sub-groups (i.e. poor, uneducated and living in rural regions). The subpopulations experiencing excessively high stunting prevalence should be the focus of policy makers’ attention as they work to achieve the WHO 40% reduction in stunting target by 2025 and the UN Agenda 2030 for Sustainable Development Goals.

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

BMJ Global Health ◽

10.1136/bmjgh-2021-007265 ◽

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.

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Patterns of antenatal care services utilization in rural Amroha, Uttar Pradesh: a community based cross sectional study

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20194015 ◽

2019 ◽

Vol 6 (9) ◽

pp. 4048

Author(s):

Bhaskar K. Watode ◽

Anurag Srivastava ◽

Rajeev Kumar

Keyword(s):

Antenatal Care ◽

Care Delivery ◽

Economic Status ◽

Uttar Pradesh ◽

Health Care Delivery System ◽

Cross Sectional Study ◽

Family Type ◽

World Health ◽

Cross Sectional ◽

Maternal Deaths

Background: Antenatal care (ANC) services are considered to be the crucial element in the primary health care delivery system of a country. World Health Organization (WHO) estimates suggested that almost all of the maternal deaths (99%) and child deaths (98%) occurred in developing countries. These maternal deaths could have been prevented if the pregnant women or adolescent girls had been able to access quality antenatal care. The objectives of the present study were conducted in rural parts of district Amroha, Uttar Pradesh for assessing the patterns of utilization of the ANC services and to ascertain the factors influencing utilization of ANC services.Methods: The present study was a cross sectional in nature. Recently delivered women were selected as study subject. A multi-stage stratified sampling design with random approaches had been used. Total 360 subjects included in the study.Results: Respondents age, education, occupation, socio economic status, family type and family size were the factors that influenced the utilization of the ANC services. With 100% ANC registration, sub centre was the most preferred place for registration. 76.9% of woman received more than 3 ANC visits. 315 (87.5%) and (71.9%) respondents received 2 doses to TT vaccine and more than 100 IFA tablets respectively.Conclusions: Utilization of ANC services are on rise in rural parts of Amroha, Uttar Pradesh. Still significant proportions of women are doesn’t return to health facility after the ANC registration. Intensification of efforts is needed to cater this left out group through improving community awareness and motivation.

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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 BURDEN OF ENGAGING IN VOLUNTEER ATTENUATE THE RELATIONSHIP BETWEEN VOLUNTEER ENGAGEMENT AND HEALTH OUTCOMES

Innovation in Aging ◽

10.1093/geroni/igz038.524 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S145-S146

Author(s):

Yuta Nemoto ◽

Ryota Sakurai ◽

Masami Hasebe ◽

Kumiko Nonaka ◽

Hiroko Mtsunaga ◽

...

Keyword(s):

Older Adults ◽

Health Outcomes ◽

Economic Status ◽

Living Arrangement ◽

Well Being ◽

Cross Sectional Study ◽

World Health ◽

Cross Sectional ◽

Volunteer Activity ◽

Volunteer Engagement

Abstract This study examined the interaction of participating in volunteer activity and its burden on health outcomes. A community-based cross-sectional study was conducted in 2018. Of 8426 older adults aged 65 and over, 5232 individuals were included in the analyses (response rate: 62.1%). Health outcomes included self-rated health (SRH), mental health (The World Health Organization Five Well-Being Index: WHO-5), and Instrumental Activities of Daily Living (Tokyo Metropolitan Institute of Gerontology Index of Competence: TMIG-IC) as dependent variables. Independent variables included engagement in volunteer activity and its burden. These variables were combined and classified into three groups: non-participants; participants with burden; and participants without burden. Covariates included age, gender, educational attainments, economic status, and living arrangement. Logistic regression analysis and analysis of covariates were conducted to examine the interaction of volunteer activity and its burden on health outcomes. Of 5232 older adults, 76.3% of subjects were non-participants, 3.4% were participants with burden, and 20.3% were participants without burden. Multivariate analysis showed that non-participants were more likely to have poor health outcomes compared with participants with burden. Moreover, participants without burden were more likely to have better health outcomes (SRH: Odds Ratio [OR] = 1.92, 95% Confidence Interval [CI] = 1.70 to 2.17, WHO-5: OR = 1.69, 95% CI = 1.51 to 1.88, TMIG-IC: Coefficient = 0.36, 95% CI = 0.10 to 0.62). Our findings suggest that volunteer activity is related to better health regardless of their burden. However, burden of volunteer engagement might attenuate the relationships between volunteer activity and health outcomes.

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Mental Disorders Among Elderly People in Baghdad, Iraq, 2017

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.1177/0046958019845960 ◽

2019 ◽

Vol 56 ◽

pp. 004695801984596

Author(s):

Ahmed Abdulameer Ibrahim ◽

Faris AI-Lami ◽

Riyadh Al-Rudainy ◽

Yousef S. Khader

Keyword(s):

Mental Disorders ◽

Elderly People ◽

Low Income ◽

Health Care Services ◽

Economic Status ◽

Cross Sectional Study ◽

World Health ◽

Cross Sectional ◽

Psychological Distress Scale ◽

Distress Scale

This study aimed to estimate the prevalence and determinants of mental disorders (MDs) among elderly people residing in nursing homes (NHs) and those living with their families (WF) in Baghdad, Iraq, 2017. A cross-sectional study was conducted on all elderly individuals residing in all NHs in Baghdad and an equal number of elderly people residing WF. MDs were defined based on Kessler Psychological Distress Scale (K10). We used relevant World Health Organization–accredited tools to identify the types of MDs. The prevalence of MDs among elderly people was 38.7%, being statistically significantly ( P < .01) higher among those in NH (55.8%) compared with those living WF (21.5%). The proportion of types of MDs among NH versus WF residents was as follows: depression (35.4% vs 16.6%), anxiety (32.6% vs 9.9%), dementia (19.3% vs 5%), and suicide thoughts (25.4% vs 4.4%). The multivariate analysis showed many factors that were associated with MD. Low income, dependency on others, and being neglected were stronger determinant of MD among elderly people living WF. However, chronic joint pain, visual impairment, auditory impairment, and economic status deterioration were stronger determinant among those in NHs. The prevalence of MDs in the NH is more than double the prevalence in the community. We recommended enhancing elderly mental health care services including curative, preventive, and promotive activities.

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Health Care Expenditure of Rural Households in Pondicherry, India

International Journal of Medical Students ◽

10.5195/ijms.2013.208 ◽

2013 ◽

Vol 1 (2) ◽

pp. 74-79

Author(s):

Poornima Varadarajan ◽

Lopamudra Moharana ◽

Murugan Venkatesan

Keyword(s):

Health Care ◽

Health Expenditure ◽

Health Care Expenditure ◽

Rural Households ◽

Healthcare Delivery ◽

Calculated Data ◽

Catastrophic Health Expenditure ◽

World Health ◽

Income Quintile ◽

Cross Sectional

Background: Shortcomings in healthcare delivery has led people to spend a substantial proportion of their incomes on medical treatment. World Health Organization (2005) estimates reveal that every year 25 million households are forced into poverty by illness and the struggle to pay for healthcare. Thus we planned to calculate the health care expenditure of rural households and to assess the households incurring catastrophic health expenditure. Methods: A cross-sectional study was conducted in the service area of Sri Manakula Vinayagar Medical College and Hospital from May to August 2011. A total of 100 households from the 4 adjoining villages of our Institute were selected for operational and logistic feasibility. The household’s capacity to pay, out of pocket expenditure and catastrophic health expenditure were calculated. Data collection was done using a pretested questionnaire by the principal investigator and the analysis was done using SPSS (version 16). Results: The average income in the highest income quintile was Rs 51,885 but the quintile ratio was 14.98. The median subsistence expenditure was Rs 4,520. About 18% of households got impoverished paying for health care. About 81% of households were incurring out of pocket expenditure and 66% were facing catastrophic health expenses of 40%. Conclusion: There was very high out of pocket spending and a high prevalence of catastrophic expenditure noted. Providing quality care at affordable cost and appropriate risk pooling mechanism are warranted to protect households from such economic threats.

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

10.1101/2021.12.20.21268081 ◽

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.

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