Unmet Healthcare Needs, Catastrophic Health Expenditure, and Health in South Korea’s Universal Healthcare System: Progression Towards Improving Equity by NHI Type and Income Level

This study examined the effects of healthcare inequality on personal health. It aimed to determine how health insurance type and income level influence catastrophic health expenditure and unmet healthcare needs among South Koreans. Unbalanced Korean Health Panel data from 2011 to 2015, including 33,374 adults, were used. A time-trend and panel regression analysis were performed. The first to identify changes in the main variables and, the second, mediating effects of unmet healthcare needs and catastrophic health expenditure on the relationship between health insurance type, income level, and health status. The independent variables were: high-, middle-, low-income employee insured, high-, middle-, low-income self-employed insured, and medical aid. The dependent variable was health status, and the mediators were unmet needs and catastrophic health expenditure. The medical aid beneficiaries and low-income self-employed insured groups demonstrated a higher probability of reporting poor health status than the high-income, insured group (15.6%, 2.2%, and 2.3%, respectively). Participants who experienced unmet healthcare needs or catastrophic health expenditure were 10.7% and 5.6% higher probability of reporting poor health, respectively (Sobel test: p < 0.001). National policy reforms could improve healthcare equality by integrating insurance premiums based on income among private-sector employees and self-employed individuals within the health insurance network.

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Catastrophic health expenditure incidence and its equity in China: a study on the initial implementation of the medical insurance integration system

BMC Public Health ◽

10.1186/s12889-019-8121-2 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Huan Liu ◽

Hong Zhu ◽

Jiahui Wang ◽

Xinye Qi ◽

Miaomiao Zhao ◽

...

Keyword(s):

Health Insurance ◽

Health Services ◽

Low Income ◽

Health Expenditure ◽

Concentration Index ◽

Medical Insurance ◽

Catastrophic Health Expenditure ◽

Integration System ◽

Integration Policies ◽

The Impact

Abstract Background By 2013, several regions in China had introduced health insurance integration policies. However, few studies addressed the impact of medical insurance integration in China. This study investigates the catastrophic health expenditure and equity in the incidence of catastrophic health expenditure by addressing its potential determinants in both integrated and non-integrated areas in China in 2013. Methods The primary data are drawn from the fifth China National Health Services Survey in 2013. The final sample comprises 19,788 households (38.4%) from integrated areas and 31,797 households (61.6%) from non-integrated areas. A probit model is employed to decompose inequality in the incidence of catastrophic health expenditure in line with the methodology used for decomposing the concentration index. Results The incidence of catastrophic health expenditure in integrated areas is higher than in non-integrated areas (13.87% vs. 13.68%, respectively). The concentration index in integrated areas and non-integrated areas is − 0.071 and − 0.073, respectively. Average household out-of-pocket health expenditure and average capacity to pay in integrated areas are higher than those in non-integrated areas. However, households in integrated areas have lower share of out-of-pocket expenditures in the capacity to pay than households in non-integrated areas. The majority of the observed inequalities in catastrophic health expenditure can be explained by differences in the health insurance and householders’ educational attainment both in integrated areas and non-integrated areas. Conclusions The medical insurance integration system in China is still at the exploratory stage; hence, its effects are of limited significance, even though the positive impact of this system on low-income residents is confirmed. Moreover, catastrophic health expenditure is associated with pro-poor inequality. Medical insurance, urban-rural disparities, the elderly population, and use of health services significantly affect the equity of catastrophic health expenditure incidence and are key issues in the implementation of future insurance integration policies.

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Catastrophic Health Expenditures and Its Inequality in Households with Cancer Patients: A Panel Study

Processes ◽

10.3390/pr7010039 ◽

2019 ◽

Vol 7 (1) ◽

pp. 39 ◽

Cited By ~ 6

Author(s):

Munjae Lee ◽

Kichan Yoon

Keyword(s):

Health Insurance ◽

Cancer Patients ◽

Health Expenditure ◽

Private Health Insurance ◽

Transition Probability ◽

Panel Study ◽

Catastrophic Health Expenditure ◽

Occurrence Rate ◽

Logit Analysis ◽

Healthcare Needs

This study aims to examine the determinants of catastrophic health expenditure in households with cancer patients by conducting a panel analysis of three-year data. Data are adopted from surveys administered by Korea Health Panel for 2012–2014. We conducted correspondence and conditional transition probability analyses to examine households that incurred catastrophic health expenditure, followed by a panel logit analysis. The analyses reveal three notable results. First, the occurrence of catastrophic health expenditure differs by age group, that is, the probability of incurring catastrophic health expenditure increases with age. Second, this probability is higher in households with National Health Insurance than those receiving medical care benefits. Finally, households without private health insurance report a higher occurrence rate. The findings suggest that elderly people with cancer have greater medical coverage and healthcare needs. Private health insurance contributes toward protecting households from catastrophic health expenditure. Therefore, future research is needed on catastrophic health expenditure with focus on varying age groups, healthcare coverage type, and private health insurance.

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Catastrophic Health Expenditure Incidence and Its Equity in China: A Study on the Initial Implementation of the Medical Insurance Integration System

10.21203/rs.2.11043/v2 ◽

2019 ◽

Author(s):

huan liu ◽

hong zhu ◽

jiahui wang ◽

xinye qi ◽

miaomiao zhao ◽

...

Keyword(s):

Health Insurance ◽

Health Services ◽

Low Income ◽

Health Expenditure ◽

Concentration Index ◽

Medical Insurance ◽

Catastrophic Health Expenditure ◽

Integration System ◽

Integration Policies ◽

The Impact

Abstract Introduction: By 2013, several regions in China had introduced health insurance integration policies. However, few studies addressed the impact of medical insurance integration in China. This study investigates the catastrophic health expenditure and equity in the incidence of catastrophic health expenditure by addressing its potential determinants in both integrated and non-integrated areas in China in 2013. Methods: The primary data are drawn from the fifth China National Health Services Survey in 2013. The final sample comprises 19,788 households (38.4%) from integrated areas and 31,797 households (61.6%) from non-integrated areas. A probit model is employed to decompose inequality in the incidence of catastrophic health expenditure in line with the methodology used for decomposing the concentration index. Results: The incidence of catastrophic health expenditure in integrated areas is higher than in non-integrated areas (13.87% vs. 13.68%, respectively). The concentration index in integrated areas and non-integrated areas is -0.071 and -0.073, respectively. Average household out-of-pocket health expenditure and average capacity to pay in integrated areas are higher than those in non-integrated areas. However, households in integrated areas have lower share of out-of-pocket expenditures in the capacity to pay than households in non-integrated areas. The majority of the observed inequalities in catastrophic health expenditure can be explained by differences in the health insurance and householders’ educational attainment both in integrated areas and non-integrated areas. Conclusions: The medical insurance integration system in China is still at the exploratory stage; hence, its effects are of limited significance, even though the positive impact of this system on low-income residents is confirmed. Moreover, catastrophic health expenditure is associated with pro-poor inequality. Medical insurance, urban-rural disparities, the elderly population, and use of health services significantly affect the equity of catastrophic health expenditure incidence and are key issues in the implementation of future insurance integration policies. Keywords: Catastrophic health expenditure, Medical insurance integration system, Equity, Influencing factors

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Impact of non-communicable disease multimorbidity on health service use, catastrophic health expenditure and productivity loss in Indonesia: a population-based panel data analysis study

BMJ Open ◽

10.1136/bmjopen-2020-041870 ◽

2021 ◽

Vol 11 (2) ◽

pp. e041870

Author(s):

Tiara Marthias ◽

Kanya Anindya ◽

Nawi Ng ◽

Barbara McPake ◽

Rifat Atun ◽

...

Keyword(s):

Panel Data ◽

Health Service ◽

Low Income ◽

Health Expenditure ◽

Service Use ◽

Financial Burden ◽

Panel Data Analysis ◽

Productivity Loss ◽

Catastrophic Health Expenditure ◽

Health Service Use

ObjectivesTo examine non-communicable diseases (NCDs) multimorbidity level and its relation to households’ socioeconomic characteristics, health service use, catastrophic health expenditures and productivity loss.DesignThis study used panel data of the Indonesian Family Life Survey conducted in 2007 (Wave 4) and 2014 (Wave 5).SettingThe original sampling frame was based on 13 out of 27 provinces in 1993, representing 83% of the Indonesian population.ParticipantsWe included respondents aged 50 years and above in 2007, excluding those who did not participate in both Waves 4 and 5. The total number of participants in this study are 3678 respondents.Primary outcome measuresWe examined three main outcomes; health service use (outpatient and inpatient care), financial burden (catastrophic health expenditure) and productivity loss (labour participation, days primary activity missed, days confined in bed). We applied multilevel mixed-effects regression models to assess the associations between NCD multimorbidity and outcome variables,ResultsWomen were more likely to have NCD multimorbidity than men and the prevalence of NCD multimorbidity increased with higher socioeconomic status. NCD multimorbidity was associated with a higher number of outpatient visits (compared with those without NCD, incidence rate ratio (IRR) 4.25, 95% CI 3.33 to 5.42 for individuals with >3 NCDs) and inpatient visits (IRR 3.68, 95% CI 2.21 to 6.12 for individuals with >3 NCDs). NCD multimorbidity was also associated with a greater likelihood of experiencing catastrophic health expenditure (for >3 NCDs, adjusted OR (aOR) 1.69, 95% CI 1.02 to 2.81) and lower participation in the labour force (aOR 0.23, 95% CI 0.16 to 0.33) compared with no NCD.ConclusionsNCD multimorbidity is associated with substantial direct and indirect costs to individuals, households and the wider society. Our study highlights the importance of preparing health systems for addressing the burden of multimorbidity in low-income and middle-income countries.

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Prevalence and factors associated with catastrophic health expenditure among slum and non-slum dwellers undergoing emergency surgery in a metropolitan area of South Western Nigeria

PLoS ONE ◽

10.1371/journal.pone.0255354 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0255354

Author(s):

Taiwo A. Obembe ◽

Jonathan Levin ◽

Sharon Fonn

Keyword(s):

Health Insurance ◽

Marital Status ◽

Emergency Surgery ◽

Health Expenditure ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

Catastrophic Health Expenditure ◽

Catastrophic Expenditure ◽

Slum Dwellers ◽

Multistage Sampling

Background Out of Pocket (OOP) payment continues to persist as the major mode of payment for healthcare in Nigeria despite the introduction of the National Health Insurance Scheme (NHIS). Although the burden of health expenditure has been examined in some populations, the impact of OOP among slum dwellers in Nigeria when undergoing emergencies, is under-researched. This study sought to examine the prevalence, factors and predictors of catastrophic health expenditure amongst selected slum and non-slum communities undergoing emergency surgery in Southwestern Nigeria. Methods The study utilised a descriptive cross-sectional survey design to recruit 450 households through a multistage sampling technique. Data were collected using pre-tested semi-structured questionnaires in 2017. Factors considered for analysis relating to the payer were age, sex, relationship of payer to patient, educational status, marital status, ethnicity, occupation, income and health insurance coverage. Variables factored into analysis for the patient were indication for surgery, grade of hospital, and type of hospital. Households were classified as incurring catastrophic health expenditure (CHE), if their OOP expenditure exceeded 5% of payers’ household budget. Analysis of the data took into account the multistage sampling design. Results Overall, 65.6% (95% CI: 55.6–74.5) of the total population that were admitted for emergency surgery, experienced catastrophic expenditure. The prevalence of catastrophic expenditure at 5% threshold, among the population scheduled for emergency surgeries, was significantly higher for slum dwellers (74.1%) than for non-slum dwellers (47.7%) (F = 8.59; p = 0.019). Multiple logistic regression models revealed the significant independent factors of catastrophic expenditure at the 5% CHE threshold to include setting of the payer (whether slum or non-slum dweller) (p = 0.019), and health insurance coverage of the payer (p = 0.012). Other variables were nonetheless significant in the bivariate analysis were age of the payer (p = 0.017), income (p<0.001) and marital status of the payer (p = 0.022). Conclusion Although catastrophic health expenditure was higher among the slum dwellers, substantial proportions of respondents incurred catastrophic health expenditure irrespective of whether they were slum or non-slum dwellers. Concerted efforts are required to implement protective measures against catastrophic health expenditure in Nigeria that also cater to slum dwellers.

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Population’s unmet needs in relation to primary care in Romania- a pilot survey in County Brasov.

10.21203/rs.2.14590/v1 ◽

2019 ◽

Author(s):

Andrea Elena Neculau ◽

Liliana Rogozea ◽

Daniela Popa ◽

Ioana Atudorei ◽

Florin Leasu ◽

...

Keyword(s):

Primary Care ◽

Low Income ◽

Unmet Needs ◽

Family Doctor ◽

Health Needs ◽

Medical Services ◽

Out Of Hours ◽

Health Technologies ◽

Healthcare Needs ◽

Unmet Healthcare Needs

Abstract Background Patients’ expectations and needs for healthcare services are changing. These changes are correlated with changes in disease profiles, a higher prevalence of chronic diseases, the introduction of new and innovative treatments and health technologies, and the emergence of new social and economic contexts. National health reports on Romania show that decisions in healthcare planning are not correlated with the health needs of the population. At the same time, this report shows a high degree of unmet healthcare needs of the Romanian population (related to cost, distance and waiting times), especially for low-income populations. The objective of the study was to identify the unmet needs of the population in relation to primary care medical services in the context of actual health regulations through a pilot study in a representative county in Romania. Methods The study is survey-based, and part of a health needs assessment programme commissioned by the District Health Authority to the university. A questionnaire with 21 items was designed to gather information about the structures, processes and outcomes of primary care from the perspective of the population. A total of 877 questionnaires were returned and validated. The data were analysed with SPSS version 25. Results Access to primary care was considered to be good by most of the population. Most of the settlements have a family doctor, and 80.5% can schedule an appointment on the same or the following day. Most basic medical services are provided, except for out-of-hours primary care services and cervical cancer screening. The family doctors are considered to be a reliable health resource. Conclusions Despite limitations in the practice of family medicine in Romania and therefore a narrow spectrum of services offered by primary care in general, the level of contentment of the population with this healthcare resource is still high. Barriers to access are related to the lack of some essential services, especially preventive and out-of-hours services. Unmet needs are presumably not recognised by patients due to a lack of medical culture. Further research is needed to clarify this conclusion. Key words: unmet health needs, primary care, Romania

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Population’s perceptions and availability of primary care services in Romania- a pilot survey in County Brasov.

10.21203/rs.2.14590/v3 ◽

2019 ◽

Author(s):

Andrea Elena Neculau ◽

Liliana Rogozea ◽

Daniela Popa ◽

Ioana Atudorei ◽

Florin Leasu ◽

...

Keyword(s):

Primary Care ◽

Family Medicine ◽

Low Income ◽

National Level ◽

Health Needs ◽

Out Of Hours ◽

Healthcare Planning ◽

Healthcare Needs ◽

Unmet Healthcare Needs ◽

Health Services Needs

Abstract Background National health reports on Romania show that decisions in healthcare planning are not correlated with the health needs of the population and that there is a high degree of unmet healthcare needs of the population (related to cost, distance and waiting times), especially for low-income populations. Family medicine is facing underfinancing, slow pace of development. Methods The research is part of a wider project of health services needs assessment in county Brasov, Romania. A subset of questions where dedicated to identifying the perception of population on primary healthcare services. Comparison with previous national and international studies was done. Results The characteristics of the population questioned: predominantly women (67.2%), 61.1% graduates of high school or other professional schools. 97.4% are registered with a FD. The average number of visits at the FD is 11.25, higher than the national average of 7.7 reported in a previous study in 2009. Access to the FD is appreciated as satisfactory in terms of availability of doctors in the community (97.4%), opening times by (91.1%), phone access (90.5%). Only 26.6% of participants reported a same day opportunity to reach the FD. Continuity of care is reported as present in 58.7% of cases in out of hours centres. The population is appreciating the fact that FDs knows their history (90%), knows how to treat them (88.2%). Most of the preventative services are offered by FDs. 94.4% flu vaccination, 85.6% pregnancy monitoring, 90.7% well child visits. Procedures like blood draws, pap smear have less availability (46.2% respectively 63.1%). Conclusions Despite limitations in the practice of family medicine in Romania and therefore a narrow spectrum of services offered by primary care in general, the level of contentment of the population with this healthcare resource is still high. Barriers to access are related to the lack of some essential services, especially preventive and out-of-hours services. Research at national level should be done in order to better categorize population’ perceptions on primary care and be able to use their opinion to influence policies and healthcare planning. Key words: unmet health needs, population’s perception, primary care, Romania

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Assessment of State of Health and Healthcare Expenditure by Single-Person Households

European Journal of Public Health ◽

10.1093/eurpub/ckz186.389 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

A Tur-Sinai ◽

R Magnezi ◽

H Grinvald-Fogel

Keyword(s):

Health Insurance ◽

Health Status ◽

Indirect Effects ◽

Health Expenditure ◽

Healthcare Expenditure ◽

Equation Modeling ◽

State Of Health ◽

Expenditure Patterns ◽

Single Person ◽

The Eu

Abstract Background The latest statistics on household size in the EU show that in 2017 around one third of households in the EU comprised single adults without children. The study documents a direct relationship between individuals’ health and patterns of healthcare expenditure by isolating single-person households and creating a new reference group in which household healthcare expenditure is based on one person’s expenditure patterns in accordance with his or her own state of health. Methods The study matched two surveys using Propensity Score Matching based on single-person household, age, and gender. Structural Equation Modeling (SEM) explores paths of relation between the population’s income and socioeconomic level and its health self-assessment and expenditure. Results Single-person households’ health expenditure increases with age and the differences in most expenditure categories are significant. The current study looks into the direct and indirect effects of income, gender, and SES on health insurance and other out-of-pocket health expenses among single-person households. A direct link exists between income, gender, and socioeconomic status (SES) and several aspects of health expenditure, depending on the specific age group. The indirect effects are attested via health status assessment, in which a negative correlation is found between self-assessed health status and various health-expenditure categories. Conclusions The last-mentioned result may support the general perception that single-person households who feel that they are doing better than their near-equals enjoy better health. This line of inquiry yields a better examination of how a single-person household’s state of health affects expenditure patterns without assuming ab initio that expenditure patterns attest to state of health. Key messages Healthcare system and policymakers have to be mindful of the profile of single-person households and should ensure to examine these households’ patterns of healthcare expenditure as a function of age. Policymakers should seek alternative sources of funding for the single-person households’ health-insurance outlays and should examine alternative ways of restraining their expenditure on dental care.

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Are People Enrolled in NCMS and CURBMI Susceptible in Catastrophic Health Expenditure? Evidence From China

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.1177/0046958020919282 ◽

2020 ◽

Vol 57 ◽

pp. 004695802091928

Author(s):

Xinpeng Xu ◽

Hai Gu ◽

Hua You ◽

Lan Bai ◽

Decheng Li ◽

...

Keyword(s):

Low Income ◽

Health Expenditure ◽

Medical Insurance ◽

Catastrophic Health Expenditure ◽

New Cooperative Medical Scheme ◽

Basic Medical Insurance ◽

Medical Institutions ◽

Significant Difference ◽

Cooperative Medical Scheme ◽

Basic Medical

This study investigated associations between different types of medical insurance and the incidence of catastrophic health expenditure among middle-aged and the aged in China. The data came from the China Health and Retirement Longitudinal Survey implemented in 2013, with 9782 individuals analyzed. Probit regression models and multiple linear regressions were employed to explore the relationship mentioned above and potential mechanisms behind it. It was found that compared with participants in Urban Resident Basic Medical Insurance, individuals participating in New Cooperative Medical Scheme and Coordinating Urban and Rural Basic Medical Insurance was less likely to undergo catastrophic health expenditure ( P < .001, P = .008), especially for low-income and middle-income group. Participants in New Cooperative Medical Scheme and Coordinating Urban and Rural Basic Medical Insurance were more likely to utilize inpatient medical service ( P < .001, P = .020) and choose low-level medical institutions for treatment ( P = .003, P = .006). And individuals participating in New Cooperative Medical Scheme had lower out-of-pocket expenditure ( P = .034). The study showed the significant difference in the incidence of catastrophic health expenditure among participants in different medical insurances. Efforts should be made to improve the service quality of grassroots medical institutions except for the increase of reimbursement ratio, so that rural residents can enjoy high-quality medical services.

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