National and Provincial Estimates of Catastrophic Health Expenditure and its Determinants in Nepal

Background: Despite various supply-side efforts, out of pocket expenditure occupies a considerable portion of healthcare financing in Nepal. With the recent process of federalization in country, there is additional scope for contextualized planning at provincial level to prevent catastrophic health expenditure among Nepalese households. In this context, this study intends to estimate the proportion of population facing catastrophic health expenditure at national and provincial level and identify the determinants of catastrophic health expenditure.Methods: This study involved analysis of Nepal Living Standard Survey III, which was a cross sectional study. Out of 5,988 households comprising 28,460 individuals, data from total of 7,911 individuals who reported having acute or chronic illness was extracted and analyzed in the study.Results: In the study, 11.11% of households had faced catastrophic health expenditure. Catastrophic health expenditure was found to be 11.3% in Province 1, 9.4% in Province 2, 10.7% in Bagmati Province, 10% in Gandaki Province, 11.7% in Lumbini Province, 13.3% in Karnali Province and 13.4% in Sudurpaschim Province. Household size, literacy status of household head, consumption quintile, urban or rural residence, type of illness and type of health facility visited were identified as determinants of catastrophic health expenditure.Conclusions: A tenth of households, most of whom lying below poverty line, residing in rural areas, suffering from chronic illness are facing catastrophic healthcare burden. The government needs to pursue its equity-oriented strategies preventing catastrophic health expenditure and impoverishment associated with it.Keywords: Catastrophic health expenditure; out of pocket payment; Nepal

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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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The Prevalence of Household Catastrophic Health Expenditure in Nigeria: A Rural-Urban Comparison

Journal of Health and Medical Sciences ◽

10.31014/aior.1994.04.02.160 ◽

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.

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An Assessment of Household’s Out of Pocket Healthcare Payment and Impoverishment in Nepal: Evidence from Nepal Living Standard Survey III

Journal of Development and Social Engineering ◽

10.3126/jdse.v3i1.27956 ◽

2017 ◽

Vol 3 (1) ◽

pp. 17-24

Author(s):

Arjun K. Thapa

Keyword(s):

Health Services ◽

Rural Areas ◽

Health Care Services ◽

Secondary Data ◽

Poverty Line ◽

Living Standard ◽

Cross Sectional ◽

Utilization Of Health Services ◽

Development Region ◽

Free Health Care

Despite Government of Nepal’s effort of universalizing basic free health care services and other demand side financing health schemes, there is an ongoing debate regarding equity in health service coverage, availability and high out of pocket payment. So this study intends to assess out of pocket payment and its associated factors and its implication on impoverishment. A cross sectional descriptive study was designed which is based on Nepal Living Standard Survey III 2010/11, a rich and well representative secondary data of Central Bureau of Statistics, National Planning Commission Nepal. The information about individuals who reported out of pocket healthcare payment was extracted from 28,747 individuals (or 7,020 households) of the survey. An individual from a household is considered as the unit of study. The major findings of the study show that age, caste ethnicity, place of residence, ecological belt and development region have statistically significant association with OOP payment. Due to OOP expenditure near about 3 percent of people are falling below the poverty line. The impoverishment rate is high among people residing in rural areas (3.4%), Terai belt (3.4%) and Eastern development region (3.7%). Higher impoverishment level in Terai and Eastern development region where health facilities are fairly available in comparison to remote Mountain belt, low developed Far west and Mid-west only signifies low availability and utilization of health services. So there is a need to address lacunae in fair coverage and utilization of health services across the country along with impoverishment.

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Effect of Critical Illness Insurance on Household Catastrophic Health Expenditure: The Latest Evidence from the National Health Service Survey in China

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16245086 ◽

2019 ◽

Vol 16 (24) ◽

pp. 5086 ◽

Cited By ~ 2

Author(s):

Anqi Li ◽

Yeliang Shi ◽

Xue Yang ◽

Zhonghua Wang

Keyword(s):

National Health Service ◽

Critical Illness ◽

Health Service ◽

National Health ◽

Rural Areas ◽

Health Expenditure ◽

Household Head ◽

Catastrophic Health Expenditure ◽

Jiangsu Province ◽

Related Factors

Background: China fully implemented the critical illness insurance (CII) program in 2016 to alleviate the economic burden of diseases and reduce catastrophic health expenditure (CHE). With an aging society, it is necessary to analyze the extent of CHE among Chinese households and explore the effect of CII and other associated factors on CHE. Methods: Data were derived from the Sixth National Health Service Survey (NHSS, 2018) in Jiangsu Province. The incidence and intensity of CHE were calculated with a sample of 3660 households in urban and rural areas in Jiangsu Province, China. Logistic regression and multiple linear regression models were used for estimating the effect of CII and related factors on CHE. Results: The proportion of households with no one insured by CII was 50.08% (1833). At each given threshold, from 20% to 60%, the incidence and intensity were higher in rural households than in urban ones. CII implementation reduced the incidence of CHE but increased the intensity of CHE. Meanwhile, the number of household members insured by CII did not affect CHE incidence but significantly decreased CHE intensity. Socioeconomic factors, such as marital status, education, employment, registered type of household head, household income and size, chronic disease status, and health service utilization, significantly affected household CHE. Conclusions: Policy effort should further focus on appropriate adjustments, such as dynamization of CII lists, medical cost control, increasing the CII coverage rate, and improving the reimbursement level to achieve the ultimate aim of using CII to protect Chinese households against financial risk caused by illness.

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Measuring Catastrophic Health Expenditures and its Inequality: Evidence from Iran’s Health Transformation Program

Health Policy and Planning ◽

10.1093/heapol/czz031 ◽

2019 ◽

Vol 34 (4) ◽

pp. 316-325 ◽

Cited By ~ 2

Author(s):

Vahid Yazdi-Feyzabadi ◽

Mohammad Hossein Mehrolhassani ◽

Ali Darvishi

Keyword(s):

Rural Areas ◽

Health Expenditure ◽

Catastrophic Health Expenditure ◽

Rural Populations ◽

Financial Protection ◽

Dominance Test ◽

Cross Sectional ◽

Poor Households ◽

Before And After ◽

Urban And Rural Areas

Abstract One of the important goals of Iran’s health transformation programme (HTP) is to improve financial protection for households against health expenditure. This study aimed to investigate the occurrence, intensity and inequality in distribution of catastrophic health expenditure (CHE) using the WHO and the World Bank (WB) methodologies with different thresholds in the years before and after HTP. We used data from seven annual national repeated cross-sectional surveys on households’ income and expenditures from 2011 to 2017. The intensity to CHE was calculated using overshoot and mean positive overshoot (MPO) indices. Finally, the inequality in distribution of exposure to CHE was calculated using the concentration index (CI), and the dominance test of concentration curves was used to inference about the significant changes in inequality of the years before and after HTP. The exposure rate to CHE in the total population and at 40% threshold of the WHO methodology changed from 1.99% in 2011 to 3.46% in 2017. Additionally, at 20% threshold of the WB methodology, it was changed from 5.14% to 8.68%. Overshoot and MPO indices increased on average based on two methodologies in urban and rural areas during seven years. The CIs for all the years show a negative value in both methodologies, indicating that CHE occurrence is higher among the poor households. In 2017, at 40% threshold of the WHO, the numerical values of the CIs were −0.15 and −0.14 in urban and rural populations, respectively. These values were −0.07 and −0.05 for the 20% threshold of WB, respectively. Results of dominance test showed no significant change in inequality for the years after than before HTP with two exceptions for total and rural populations based on the WB methodology. Generally, HTP had no considerable success in financial protection, requiring a review in actions to support pro-poor adaptation strategies.

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

Iranian Journal of Public Health ◽

10.18502/ijph.v48i10.3494 ◽

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.

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Assessing the household economic burden of non-communicable diseases in India: evidence from repeated cross-sectional surveys

BMC Public Health ◽

10.1186/s12889-021-10828-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Veenapani Rajeev Verma ◽

Piyush Kumar ◽

Umakant Dash

Keyword(s):

Rural Areas ◽

Financial Risk ◽

Multinomial Logistic Regression ◽

Poverty Line ◽

Catastrophic Health Expenditure ◽

Financial Risk Protection ◽

Cross Sectional ◽

Economic Determinants ◽

Insurance Cover ◽

Risk Protection

Abstract Background Financing for NCDs is encumbered by out-of-pocket expenditure (OOPE) assuming catastrophic proportions. Therefore, it is imperative to investigate the extent of catastrophic health expenditure (CHE) on NCDs, which are burgeoning in India. Thus, our paper aims to examine the extent of CHE and impoverishment in India, in conjunction with socio-economic determinants impacting the CHE. Methods We used cross-sectional data from nationwide healthcare surveys conducted in 2014 and 2017–18. OOPE on both outpatient and inpatient treatment was coalesced to estimate CHE on NCDs. Incidence of CHE was defined as proportion of households with OOPE exceeding 10% of household expenditure. Intensity of catastrophe was ascertained by the measure of Overshoot and Mean Positive Overshoot Indices. Further, impoverishing effects of OOPE were assessed by computing Poverty Headcount Ratio and Poverty Gap Index using India’s official poverty line. Concomitantly, we estimated the inequality in incidence and intensity of catastrophic payments using Concentration Indices. Additionally, we delineated the factors associated with catastrophic expenditure using Multinomial Logistic Regression. Results Results indicated enormous incidence of CHE with around two-third households with NCDs facing CHE. Incidence of CHE was concentrated amongst poor that further extended from 2014(CI = − 0.027) to 2017–18(CI = − 0.065). Intensity of CHE was colossal as households spent 42.8 and 34.9% beyond threshold in 2014 and 2017-18 respectively with poor enduring greater overshoot vis-à-vis rich (CI = − 0.18 in 2014 and CI = − 0.23 in 2017–18). Significant immiserating impact of NCDs was unraveled as one-twelfth in 2014 and one-eighth households in 2017–18 with NCD burden were pushed to poverty with poverty deepening effect to the magnitude of 27.7 and 30.1% among those already below poverty on account of NCDs in 2014 and 2017–18 respectively. Further, large inter-state heterogeneities in extent of CHE and impoverishment were found and multivariate analysis indicated absence of insurance cover, visiting private providers, residing in rural areas and belonging to poorest expenditure quintile were associated with increased likelihood of incurring CHE. Conclusion Substantial proportion of households face CHE and subsequent impoverishment due to NCD related expenses. Concerted efforts are required to augment the financial risk protection to the households, especially in regions with higher burden of NCDs.

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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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The Prevalence of Household Catastrophic Health Expenditure in Nigeria: A Rural-Urban Comparison

10.31219/osf.io/k6x4f ◽

2021 ◽

Author(s):

Paul Oladapo Ajayi ◽

Demilade Olusola Ibirongbe ◽

Tope Michael Ipinnimo ◽

Oluremi Olayinka Solomon ◽

Austin Idowu Ibikunle ◽

...

Keyword(s):

Urban Communities ◽

Rural Areas ◽

Urban Areas ◽

Health Expenditure ◽

Univariate Analysis ◽

Sampling Technique ◽

Catastrophic Health Expenditure ◽

Cross Sectional ◽

Rural And Urban ◽

Household Heads

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Urban-rural differences in catastrophic health expenditure among households with chronic non-communicable disease patients : evidence from China Family Panel Studies

10.21203/rs.3.rs-37742/v1 ◽

2020 ◽

Author(s):

Xianzhi Fu ◽

Qi-wei Sun ◽

Chang-qing Sun ◽

Fei Xu ◽

Jun-jian He

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Health Expenditure ◽

Communicable Disease ◽

Rural Households ◽

Catastrophic Health Expenditure ◽

System Reform ◽

Cross Sectional ◽

Urban Rural ◽

Panel Studies

Abstract Background: The prevalence of chronic non-communicable diseases (NCDs) challenges the Chinese health system reform. Little is known for the differences in catastrophic health expenditure (CHE) between urban and rural households with NCD patients. This study aims to measure the differences above and quantify the contribution of each variable in explaining the urban-rural differences.Methods: The second and the fourth waves of the China Family Panel Studies (CFPS) data, conducted in 2012 and 2016, were employed in this cross-sectional study. The techniques of Fairlie nonlinear decomposition and Blinder-Oaxaca decomposition were employed to measure the contribution of each independent variable to the urban-rural differences.Results: The CHE incidence and intensity of households with NCD patients were significantly higher in rural areas than in urban areas. The explained disparity of CHE incidence increased from 3.15% in 2012 to 27.04% in 2016, and the corresponding values of CHE intensity rose from 21.30% in 2012 to 53.37% in 2016. The major contribution to the urban-rural differences in CHE was associated with household economic status, education level, health status and supplementary medical insurance (SMI).Conclusions: Compared with urban households with NCD patients, rural households with NCD patients have higher risk of incurring CHE and heavier economic burden of diseases. Policy interventions should give priority to decreasing the urban-rural disparity in observable characteristics.

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