scholarly journals Self-Declared Roma Ethnicity and Health Insurance Expenditures: A Nationwide Cross-Sectional Investigation at the General Medical Practice Level in Hungary

2020 ◽  
Vol 17 (23) ◽  
pp. 8998
Author(s):  
Feras Kasabji ◽  
Alaa Alrajo ◽  
Ferenc Vincze ◽  
László Kőrösi ◽  
Róza Ádány ◽  
...  
Keyword(s):  
Health Insurance ◽  
Medical Practice ◽  
Health Expenditure ◽  
Health Expenditures ◽  
Insurance Fund ◽  
List Size ◽  
Cross Sectional ◽  
General Medical Practice ◽  
Per Capita ◽  
Structural Indicators

The inevitable rising costs of health care and the accompanying risk of increasing inequalities raise concerns. In order to make tailored policies and interventions that can reduce this risk, it is necessary to investigate whether vulnerable groups (such as Roma, the largest ethnic minority in Europe) are being left out of access to medical advances. Objectives: The study aimed to describe the association between general medical practice (GMP) level of average per capita expenditure of the National Health Insurance Fund (NHIF), and the proportion of Roma people receiving GMP in Hungary, controlled for other socioeconomic and structural factors. Methods: A cross-sectional study that included all GMPs providing care for adults in Hungary (N = 4818) was conducted for the period 2012–2016. GMP specific data on health expenditures and structural indicators (GMP list size, providing care for adults only or children also, type and geographical location of settlement, age of GP, vacancy) for secondary analysis were obtained from the NHIF. Data for the socioeconomic variables were from the last census. Age and sex standardized specific socioeconomic status indicators (standardized relative education, srEDU; standardized relative employment, srEMP; relative housing density, rHD; relative Roma proportion based on self-reported data, rRP) and average per capita health expenditure (standardized relative health expenditure, srEXP) were computed. Multivariate linear regression model was applied to evaluate the relationship of socioeconomic and structural indicators with srEXP. Results: The srEDU had significant positive (b = 0.199, 95% CI: 0.128; 0.271) and the srEMP had significant negative (b = −0.282, 95% CI: −0.359; −0.204) effect on srEXP. GP age > 65 (b = −0.026, 95% CI: −0.036; −0.016), list size <800 (b = −0.043, 95% CI: −0.066; −0.020) and 800–1200 (b = −0.018, 95% CI: −0.031; −0.004]), had significant negative association with srEXP, and GMP providing adults only (b = 0.016, 95% CI: 0.001;0.032) had a positive effect. There was also significant expenditure variability across counties. However, rRP proved not to be a significant influencing factor (b = 0.002, 95% CI: −0.001; 0.005). Conclusion: As was expected, lower education, employment, and small practice size were associated with lower NHIF expenditures in Hungary, while the share of self-reported Roma did not significantly affect health expenditures according to our GMP level study. These findings do not suggest the necessity for Roma specific indicators elaborating health policy to control for the risk of widening inequalities imposed by rising health expenses.

scholarly journals Who Spends More on Health Expenditures among Elderly? Men or Women?

2020 ◽  
Author(s):  
Tika Dwi Tama ◽  
Nurnaningsih Herya Ulfa ◽  
Anindya Hapsari
Keyword(s):  
Health Expenditure ◽  
Health Expenditures ◽  
Health Costs ◽  
Health Coverage ◽  
Self Medication ◽  
Cross Sectional ◽  
Medication Costs ◽  
Elderly Males ◽  
Significant Difference ◽  
Males And Females

Women face various health problems during their lives. This has an impact on health costs that must be paid. Gender bias tends to place women in subordinate positions, so they have limited power in making a decision. This study aimed to examine whether gender is a factor impacting health expenditures among the elderly. A cross-sectional study based on the Indonesian Family Life Survey (IFLS) wave 5 included all elderly who accessed self-medication and health services in health facilities during the past 12 months (n=6773). Data regarding outpatient, inpatient, and self-medication costs was obtained from section RJ, RN, and PS from book 3B IFLS wave 5. The health costs that come out of the personal pocket resulted from the total cost of treatment that paid for self-medication, outpatient, and inpatient. Independent T-Test was performed to analyze the difference in health expenditure between elderly males and females. This study found that the average health expenditure was higher among elderly males (IDR 471,011; SD 7,103,932.7) than females (IDR 296,969.9; SD 2,552,816.4), but it was not statistically significant (p=0.195). Based on the type of health expenditure, there was no significant difference in self-medication spending between elderly males and females, as well as in outpatient and inpatient expenditures (p>0.05). Nevertheless, elderly males tended to spend more money on self-medication, outpatient, and inpatient services than females. It concluded that health expenditures between elderly males and females were almost the same. Gender equality in health care was addressed to establish universal health coverage. Keywords: gender, health expenditure, IFLS, elderly, out-of-pocket

scholarly journals Financial Burden and Health-seeking Behaviors Related to Chronic Diseases Under the National Health Insurance Scheme in Bolikhamxay Province, Lao PDR: A Cross-sectional Study

2021 ◽  
Author(s):  
TOMOO ITO ◽  
Sengchanh Kounnavong ◽  
Chiaki Miyoshi
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Health Expenditure ◽  
Financial Burden ◽  
Lao Pdr ◽  
Health Seeking ◽  
Chronic Patients ◽  
National Health Insurance System ◽  
Cross Sectional

Abstract BackgroundFinancial protection is a key dimension of universal health coverage. In 2016, Lao PDR implemented a National Health Insurance system covering the entire population of certain provinces. This cross-sectional study investigated the health-seeking behavior and financial burden of households, including those with chronic patients, post coverage. MethodThe study was conducted in Bolikhamxay province from January 15 to February 13, 2019. In total, 487 households, selected via stratified random sampling, were surveyed, and questionnaire-based interviews were conducted. Health care service utilization and financial burden were examined.ResultsA total of 370 households had at least one member with some type of self-reported health problem within the last 3 months prior to the interview, while 170 had at least one member with a chronic condition. More than 75% of the households accessed a health facility when a member experienced health problems. The prevalence of catastrophic health expenditure (health expenditure/income between 20% and 40%) was 25.1% (threshold of 20%) and 16.2% (threshold of 40%). Through logistic regression, we found that the major factors determining financial catastrophes owing to health problems were household members with chronic illness, hospitalization, household poverty status, family size (both 20% and 40% thresholds), visiting a private facility (20% threshold), and distance from the province to the referral hospital (40% threshold).ConclusionsThe National Health Insurance system has positively impacted households’ access to health facilities. However, catastrophic health expenditure remains high, especially among chronic patients. Facilities under the National Health Insurance should be strengthened to provide more services, including care for chronic conditions.

scholarly journals Catastrophic Health Expenditures for Children with Disabilities in Iran: A National Survey

2020 ◽  
Author(s):  
Ghobad Moradi ◽  
Amjad Mohamadi Bolbanabad ◽  
Farman Zahir Abdullah ◽  
Hossein Safari ◽  
Satar Rezaei ◽  
...  
Keyword(s):  
Health Insurance ◽  
Financial Burden ◽  
Health Expenditures ◽  
World Health ◽  
Health Costs ◽  
Financial Protection ◽  
Disabled Children ◽  
World Health Survey ◽  
Cross Sectional ◽  
Catastrophic Health Expenditures

Abstract Background: Higher health costs and financial burden are imposed on people with disabilities due to their health status associated with their disability. Measuring the incidence of catastrophic health expenditures (CHE) can provide good evidence for health policymakers to assess the current state of financial protection of the health system. The aim of this study was to investigate the percentage of households with disabled children aged 0 to 8 years who had faced CHE due to the health costs of these children in Iran.Methods: This cross-sectional study was carried out on 2000 households with disabled children aged 0 to 8 years in five provinces of Iran in 2020. Data were collected using the World Health Survey questionnaire and face-to-face interview. Households whose health expenditures for disabled members in the family were more than 40% of the household payment capacity were included in the group of households with CHE. Determinants of CHE were identified using logistic regression.Findings: 32.7% of households with disabled children had faced CHE. Head of household being female (Adjusted OR=18.89, 95%CI: 10.88- 29.42), poor economic status of the household (Q1: Adjusted OR = 20.26, 95% CI, 11.42-35.94; Q2: Adjusted OR= 8.27, 95%CI, 4.45-15.36; Q3: Adjusted OR= 13.88, 95%CI, 7.89-24.41), lack of supplementary insurance by a child with disabilities (Adjusted OR= 6.13, 95%CI, 3.39-11.26), having a child with mental disability (Adjusted OR= 2.71, 95%CI, 1.60-4.69), and type of basic health insurance [having Iranian Health Insurance: Adjusted OR= 2.20, 95%CI, 1.38-3.49; having Social security insurance: Adjusted OR= 1.66, 95%CI, 1.06-2.61] significantly increased the chances of facing CHE.Conclusion: A significant percentage of households with disabled children had faced CHE because of their disabled child's health costs. The key determinants of CHE should be considered by health policy-makers in order to more financial protection of these households.

scholarly journals Financial Burden and Health-seeking Behaviors Related to Chronic Diseases Under the National Health Insurance Scheme in Bolikhamxay Province, Lao PDR: a Cross-sectional Study

2021 ◽  
Author(s):  
Tomoo Ito ◽  
Chiaki Miyoshi ◽  
Sengchanh Kounnavong
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Health Expenditure ◽  
Financial Burden ◽  
Lao Pdr ◽  
Health Seeking ◽  
Chronic Patients ◽  
National Health Insurance System ◽  
Cross Sectional

Abstract Background: Financial protection is a key dimension of universal health coverage. In 2016, Lao PDR implemented the National Health Insurance system covering the entire population of certain provinces. This cross-sectional study investigated households’ health-seeking behavior and their financial burden with chronic patients, post coverage. Method: The study was conducted in Bolikhamxay province from January 15 to February 13, 2019. In total, 487 households, selected via stratified random sampling, were surveyed, and questionnaire-based interviews conducted. Health care service utilization and financial burden were examined.Results: Totally, 370 households had at least one member with some type of self-reported health problem within the last 3 months prior to the interview, while 170 had at least one member with a chronic condition. More than 75% of the households accessed a health facility when a member experienced health problems. We observed that the prevalence of catastrophic health expenditure (health expenditure/income between 20% and 40%) was 25.1% (threshold of 20%) and 16.2% (threshold of 40%). Through logistic regression, we found that the major factors determining financial catastrophes owing to health problems were household members with chronic illness, hospitalization, household poverty status, family size (both 20% and 40% thresholds), visiting a private facility (20% threshold), and distance from provincial top referral hospital (40% threshold).Conclusions: The National Health Insurance system has positively impacted households’ access to health facilities. However, catastrophic health expenditure remains high, especially among chronic patients. Facilities under National Health Insurance should be strengthened to provide more services, including care for chronic conditions.

scholarly journals Fear of catastrophic health expenditures and unrealistic expectations from supplementary health insurance: ethnic differences

2018 ◽  
Vol 11 (4) ◽  
pp. 283-289
Author(s):  
Neta HaGani ◽  
Samah Hayek ◽  
Jalal Tarabeia ◽  
Mohammad Yehia ◽  
Manfred S Green
Keyword(s):  
Health Insurance ◽  
Health Expenditures ◽  
Health Coverage ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Accessible Information ◽  
Catastrophic Health Expenditures ◽  
Supplementary Health Insurance ◽  
Universal Health ◽  
Unrealistic Expectations

Abstract Background In Israel, the whole population is covered by comprehensive universal health insurance. Despite that, most of the population purchases supplementary health insurance (SHI). It has been shown that individuals purchase more health insurance and preventive medicine when they are uncertain of their state of health, while a majority may not fully understand basic concepts in their health insurance coverage. The purpose of this study was to examine the role of fear of catastrophic health expenditures and unrealistic expectations in purchasing SHI, which does not cover expenses for life-threatening illnesses. Methods A cross-sectional survey was conducted among random samples of 814 Jews and 800 Arabs in Israel. A structured questionnaire was administered by telephone using random digit dialling. Log-linear regression was used to identify factors associated with reasons for purchasing SHI and expectations from SHI. Results The most common reason for purchasing SHI was fear of catastrophic health-related expenditures (41%). The most important service expected from SHI was ‘cancer medications’ (mean 4.68 [standard deviation 0.87]). Differences in the reasons for purchasing SHI and in expectations from SHI were found according to population group, age, gender and education. Conclusions Consumers’ misconceptions and fear of catastrophic health expenditures are major factors leading to the purchase of SHI, despite universal health coverage. Improved and accessible information should help consumers make informed decisions as to whether or not to purchase SHI.

scholarly journals Extent and determinants of catastrophic health expenditure for tuberculosis care in Chongqing municipality, China: a cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e026638 ◽  
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.

scholarly journals Household catastrophic health expenditure and its effective factors: a case of Iran

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Ramin Ravangard ◽  
Faride Sadat Jalali ◽  
Mohsen Bayati ◽  
Andrew J. Palmer ◽  
Abdosaleh Jafari ◽  
...  
Keyword(s):  
Health Insurance ◽  
Insurance Coverage ◽  
Health Expenditures ◽  
Health Care Expenditures ◽  
Health Insurance Coverage ◽  
World Health ◽  
P Value ◽  
Cross Sectional ◽  
Supplementary Health Insurance ◽  
Multiple Logistic Regression Modeling

Abstract Background The World Health Organization (WHO) has placed special emphasis on protecting households from health care expenditures. Many households face catastrophic health expenditures (CHEs) from a combination of economic poverty and financing the treatment of medical conditions. The present study aimed to measure the percentage of households facing catastrophic CHEs and the factors associated with the occurrence of CHEs in Shiraz, Iran in 2018. Methods The present cross-sectional study was performed on 740 randomly selected households from different districts of Shiraz, Iran in 2018 using a multi-stage sampling method. Data were collected using the Persian version of the “WHO Global Health Survey” questionnaire. CHEs were defined as health expenditures exceeding 40% of households’ capacity to pay. Households living below the poverty line before paying for health services were excluded from the study. The associations between the households’ characteristics and facing CHEs were determined using the Chi-Square test as well as multiple logistic regression modeling in SPSS 23.0 at the significance level of 5%. Results The results showed that 16.48% of studied households had faced CHEs. The higher odds of facing CHEs were observed in the households living in rented houses (OR = 3.14, P-value < 0.001), households with disabled members (OR = 27.98, P-value < 0.001), households with children under 5 years old (OR = 2.718, P-value = 0.02), and those without supplementary health insurance coverage (OR = 1.87, P-value = 0.01). Conclusion CHEs may be reduced by increasing the use of supplementary health insurance coverage by individuals and households, increasing the support of the Social Security and the State Welfare Organizations for households with disabled members, developing programs such as the Integrated Child Care Programs, and setting home rental policies and housing policies for tenants.

scholarly journals Who Have a Higher Risk of Falling Into Catastrophic Health Expenditures?

2021 ◽  
Vol 12 (3) ◽  
pp. 217-228
Author(s):  
Amalia Noviani
Keyword(s):  
Health Insurance ◽  
Health Expenditure ◽  
Service Use ◽  
Social Economic ◽  
Outpatient Service ◽  
Health Expenditures ◽  
Catastrophic Health Expenditure ◽  
Economic Factors ◽  
Inpatient Service ◽  
Catastrophic Health Expenditures

Catastrophic health expenditure is one of the challenges Indonesia faces in achieving Universal Health Coverage. Aside from being a financial disaster, the incident caused by out-of-pocket health expenditure exceeding a fixed limit can drive people into poverty. Unfortunately, the availability of the data causes the limitation of the study in Indonesia. This study aims to analyze the association between catastrophic health expenditure and several social-economic factors by using the latest data of out-of-pocket expenditure collected at the individual level from the 2019 Susenas Module of Health and Housing. Using the Chi-square test, this study confirms a significant association between catastrophic health expenditures and the following social-economic factors: outpatient and inpatient service use, health insurance ownership, age, sex, marital status, educational level, work status, welfare status, type of area, and geographic location. From the logistic regression, the probability of the population to experience catastrophic health expenditure is higher for people in the following categories: use inpatient or outpatient services, do not have health insurance, are elderly, ever-married, not working, not poor, and live in the rural areas or Java island. Disaggregation by outpatient and inpatient service use shows the large gap in the probability of falling into catastrophic health expenditures. The probability for people who used inpatient service is more than four times people who never used the service. Meanwhile, for outpatient service, the probability is almost three times. Therefore, people can strengthen preventive care, especially those with low or no cost, to avoid falling into catastrophic health expenditure.

scholarly journals List size and patient contact in general medical practice.

BMJ ◽  
1984 ◽  
Vol 289 (6457) ◽  
pp. 1501-1505 ◽  
Author(s):  
D Wilkin ◽  
D H Metcalfe
Keyword(s):  
Medical Practice ◽  
Patient Contact ◽  
List Size ◽  
General Medical Practice

scholarly journals Future financial impact of the current health financing system

1998 ◽  
Vol 21 (4) ◽  
pp. 96 ◽  
Author(s):  
Jenny Badham
Keyword(s):  
Health Insurance ◽  
Political Parties ◽  
Health Expenditure ◽  
Health Financing ◽  
Financial Impact ◽  
Demographic Changes ◽  
Major Contributor ◽  
Financing System ◽  
Current Health ◽  
Per Capita

Major political parties remain publicly committed to Medicare and community-ratedvoluntary health insurance. It is important to understand the future financialconsequences of this policy in order to assist community debate about whether sucha commitment is appropriate or some other policy should be developed.This paper describes development of, and results from, the APHA health financingmodel. It suggests that health expenditure would represent 12.9percent; of gross domesticproduct by 2021, compared to 8.5percent; in 1995. Increasing per capita expenditureis the major contributor to the growth, with demographic changes responsible foronly 14.3percent;.

Sign in / Sign up

Export Citation Format

Share Document