scholarly journals Out-Of-Pocket Health Expenditure Among the Elderly in Kenya

2020 ◽  
Vol 12 (11) ◽  
pp. 53
Author(s):  
Emmanuel Mulaa Opondo ◽  
Martine Odhiambo Oleche
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Expenditure ◽  
The Elderly ◽  
Chronic Illnesses ◽  
Elderly Persons ◽  
Health Coverage ◽  
Financial Risk Protection ◽  
Insurance Cover ◽  
Concentration Curves

Financial risk protection against the burden of out-of-pocket health expenditure (OOPHE) by achieving universal health coverage (UHC) is a key health priority for developing countries. The elderly is a vulnerable demographic group that need this protection. This study sought to analyze how selected social and demographic factors affect OOPHE among the elderly in Kenya. Further, it aimed to determine the distribution of OOPHE among the various wealth quintiles in the elderly using a cross-sectional study. Data was sourced from the Kenya Household Health Expenditure and Utilization Survey (KHHEUS) 2013. The sample size (2,853) consisted of individuals ≥ 60 years who had utilized health services. A multiple regression model and concentration curves were applied. Increasing age, having chronic illnesses, male gender, higher education level, more wealth, possessing health insurance, increased distance, and a higher number of visits to the health facility positively affected OOPHE. These results were statistically significant (P < .050) for presence of chronic illnesses, increasing age, possessing a health insurance cover and being in the richest wealth quintile and insignificant for the rest. Moreover, concentration curves revealed that out-of-pocket (OOP) health payments were concentrated in the richest quintile individuals. Consequently, OOPHE is a regressive way of funding health care among the elderly. In conclusion, elderly persons need financial protection when seeking health care: achievable mainly through health reforms, especially the ones targeting health insurance.

scholarly journals The Wedge Between Need and Access to Healthcare: Does Health Insurance Improve Utilization for People With Non- Communicable Diseases?

2021 ◽  
Author(s):  
Agness Ngwira ◽  
Maio Bulawayo ◽  
Peter Hangoma
Keyword(s):  
Health Insurance ◽  
Health Facility ◽  
Health Expenditure ◽  
Quantitative Research ◽  
Healthcare Access ◽  
Communicable Diseases ◽  
Health Coverage ◽  
Middle Income ◽  
Non Communicable Diseases ◽  
Insurance Cover

Abstract BackgroundWith progress towards universal health coverage (UHC) the disease burden of non-communicable diseases (NCDs) in LMICs is increasing while inequalities in healthcare access exist. We aimed to investigate whether health insurance enables people with NCDs to utilize health services more than their counterparts without insurance.MethodsUsing a quantitative research method and data from the Zambia Household Health Expenditure Utilization Survey (ZHHEUS, 2013) conducted in 2013, we focussed on the people who recalled visiting a health facility a month prior to the survey, 8,146 of whom said yes. Approximately 2247 had an NCD while 229 were covered by health insurance. Only women age 15-49 and men age 15-59 who were interviewed for information regarding themselves and other members of the household. The survey included questions on demographics, health status (self-rated health); illness experiences, healthcare utilization (visits, admission, type of providers sought, health expenditure); and insurance cover. Specifically, individuals were asked if they had visited a health facility in the 4 weeks preceding the survey. ResultsWe find that NCDs are associated with an increase in healthcare use (5.4 percentage points (pp); 95% CI -0.28 to 0.09; p=<0.001). Utilization increases further for those with NCDs by having health insurance (6.4pp; 95% CI -0.18 to 0.05; p=0.285) though the association was not statistically significant. Having health insurance itself, regardless of NCD status, is associated with a higher utilization (6.4pp; 95% CI -0.13 to 0.0005; p=0.048). ConclusionsOur results suggest that health insurance may play an important role in improving access among people with chronic conditions, and since they mainly affect poorer households, health insurance may have a strong equity result in a low- and middle-income country context.

scholarly journals Availability Does Not Mean Utilisation: Analysis of a Large Micro Health Insurance Programme in Pakistan

2020 ◽  
Vol 12 (10) ◽  
pp. 14
Author(s):  
Abdur Rehman Cheema ◽  
Shehla Zaidi ◽  
Rabia Najmi ◽  
Fazal Ali Khan ◽  
Sultana Ali Kori ◽  
...  
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Providers ◽  
Health Expenditure ◽  
Access To Health Care ◽  
Catastrophic Health Expenditure ◽  
Health Coverage ◽  
Care Providers ◽  
Micro Health Insurance ◽  
Factors Affecting

In recent years, several Micro Health Insurance (MHI) schemes have been initiated in low- and middle-income countries (LMIC) to meet the universal health coverage targets. Evidence on the utilization of these MHI schemes is scarce. Field experiences and lesson learning is crucial to effectively increase access to health care and offer protection against catastrophic health expenditure to the poorest population through the MHI schemes. This paper analyzes community utilization and factors affecting utilization of an MHI provided to the poorest rural households in eight districts of Sindh province of Pakistan. This initiative is part of a larger pro-poor European Union (EU) funded Sindh Union Council and Community Economic Strengthening Support (SUCCESS) Programme implemented by the Rural Support Programs (RSPs). The analysis draws on insurance utilization records and an internal assessment report by the RSPs Network (RSPN). The analysis provides qualitative experiences of the community, empanelled health care providers, the insurance agency and frontline management staff. Our analysis revealed that the overall utilization was very low (0.42%) and the highest number of cases treated at the hospital were of women utilizing obstetric and gynaecology related care. The scheme was noted to prevent catastrophic health expenditure in households that were able to successfully utilize the scheme. Key factors affecting utilization were identified to be around i) awareness creation, ii) distance to empanelled hospitals, and iii) access issues at the health facility level. We aim to add to the knowledge base around MHI for policy makers to design and implement more informed initiatives in the future.

scholarly journals The impact of chronic disease and disability on the elderly

1999 ◽  
Vol 55 (3) ◽  
pp. 9-14
Author(s):  
C. J. Eales
Keyword(s):  
Health Care ◽  
Chronic Disease ◽  
Chronic Diseases ◽  
Health Care Systems ◽  
The Elderly ◽  
Therapeutic Interventions ◽  
Elderly Persons ◽  
Care Systems ◽  
And Function ◽  
The Impact

Health care systems for elderly people should aim to delay the onset of illness, reducing the final period of infirmity and illness to the shortest possible time. The most effective way to achieve this is by health education and preventative medicine to maintain mobility and function. Changes in life style even in late life may result in improved health, effectively decreasing the incidence of chronic diseases associated with advancing age. This paper presents the problems experienced by elderly persons with chronic diseases and disabilities with indications for meaningful therapeutic interventions.

Prevalence and Correlates of Depression in Elderly Persons

1980 ◽  
Vol 47 (3_suppl) ◽  
pp. 1055-1061 ◽  
Author(s):  
Edward F. Raymond ◽  
Timothy J. Michals ◽  
Robert A. Steer
Keyword(s):  
Health Care ◽  
Regression Analysis ◽  
Health Care Providers ◽  
Older Persons ◽  
Stepwise Regression ◽  
The Elderly ◽  
Elderly Persons ◽  
Care Providers ◽  
Self Assessment ◽  
Psychiatric Intervention

A sample of 504 elderly persons living within a metropolitan area were questioned about their socio-medical characteristics and administered the Wakefield Self-assessment Depression Inventory. The distribution of depression scores indicated that 34.5% were depressed. Stepwise regression analysis was next used to examine the relationships between the characteristics and depression scores. Total number of self-reported symptoms and being partially housebound were positively associated with depression. Recommendations were made that health care providers for the elderly be alerted that older persons with physical complaints and those who are partially restricted to their homes may tend to develop levels of depression which might require psychiatric intervention.

Health Care, Health Insurance, and the Distribution of American Incomes

2010 ◽  
Vol 13 (1) ◽  
Author(s):  
Gary Burtless ◽  
Pavel Svaton
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Panel Study ◽  
The United States ◽  
Medical Expenditure ◽  
Cash Income ◽  
Health Coverage ◽  
Money Income ◽  
Health Care Consumption ◽  
The Impact

Cash income offers an incomplete picture of the resources available to finance household consumption. Most American families are covered by an insurance plan that pays for some or all of the health care they consume. Only a comparatively small percentage of families pays for the full cost of this insurance out of their cash incomes. As health care has claimed a growing share of consumption, the percentage of care that is financed out of household incomes has declined. Because health care consumption is more important for some groups in the population than others, the growth in spending and changes in the payment system for medical care have reduced the value of standard income measures for assessing relative incomes of the rich and poor and the young and old. More than a seventh of total personal consumption now consists of health care that is purchased with government insurance and employer contributions to employee health plans. This paper combines health care spending and insurance reimbursement data in the Medical Expenditure Panel Study and money income and health coverage data in the Current Population Survey to assess the impact of health insurance on the distribution of income. Our estimates imply that gross money income significantly understates the resources available to finance household purchases. The estimates imply that a more complete measure of resources would show less inequality than the income measures that are currently used. The addition of estimates of the value of health insurance to countable incomes reduces measured inequality in the population and the income gap between young and old. If the analysis were extended over a longer period, it would show a sizeable impact of insurance on inequality trends in the United States.

scholarly journals Home-based oral healthcare strategies of elderly people with Alzheimer's disease

2016 ◽  
Vol 19 (5) ◽  
pp. 851-860 ◽  
Author(s):  
Alessandra Martins Ferreira Warmling ◽  
Silvia Maria Azevedo dos Santos ◽  
Ana Lúcia Schaefer Ferreira de Mello
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Health Care ◽  
Oral Health ◽  
Elderly Person ◽  
The Elderly ◽  
Oral Health Care ◽  
University Graduates ◽  
Elderly Persons ◽  
Home Based

Abstract Objective: To identify strategies used in the oral health care of elderly persons with Alzheimer's disease in the home. Method: an exploratory, descriptive study with a qualitative approach to collecting and analyzing data was performed. Data was collected through interviews with 30 caregivers and analyzed by the content analysis technique. Results: The majority of subjects were female, daughters of the elderly person, university graduates and aged 32-77 years. The strategies identified were grouped into categories according to the participation of the caregiver: does not participate in care actions or oral health assessments; reminds the elderly person about oral hygiene, demonstrates movements and assists with some procedures; directly carries out actions of care. Conclusion: The strategies employed are related to the degree of dependence of the elderly person, as the caregiver acts based on the need for oral health care and the difficulties in carrying out such care.

scholarly journals Analysis of the Effect of Health Insurance on Health Care Utilization in Rwanda

2021 ◽  
Author(s):  
Roger Muremyi ◽  
Dominique Haughton ◽  
François Niragire ◽  
Ignace Kabano
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Services ◽  
Health Care Utilization ◽  
Health Care Services ◽  
Insurance Coverage ◽  
Secondary Data ◽  
Living Condition ◽  
Care Utilization ◽  
Health Coverage

In Rwanda, more than 90% of the population is insured for health care. Despite the comprehensiveness of health insurance coverage in Rwanda, some health services at partner institutions are not available, causing insured patients to pay unintended cost. We aimed to analyze the effect of health insurance on health care utilization and factors associated with the use of health care services in Rwanda. This is an analysis of secondary data from the Rwanda integrated living condition survey 2016-2017. The survey gathered data from 14580 households, and decision tree and multilevel logistic regression models were applied. Among 14580 households only (20%) used health services. Heads of households aged between [56-65] years (AOR=1.28, 95% CI:1.02-1.61), aged between [66-75] years (AOR=1.52, 95% CI: 1.193-1.947), aged over 76 years (AOR=1.48, 95% CI:1.137-1.947), households with health insurance (AOR=4.57, 95% CI: 3.97-5.27) displayed a significant increase in the use of health services. This study shows evidence of the effect of health insurance on health care utilization in Rwanda: a significant increase of 4.57 times greater adjusted odds of using health services compared to those not insured. The findings from our research will guide policymakers and provide useful insights within the Rwanda context as well as for other countries that are considering moving towards universal health coverage through similar models.

Health

Getting By ◽  
2019 ◽  
pp. 329-428
Author(s):  
Helen Hershkoff ◽  
Stephen Loffredo
Keyword(s):  
United States ◽  
Health Care ◽  
Health Insurance ◽  
Low Income ◽  
The United States ◽  
Health Coverage ◽  
Eligibility Criteria ◽  
Insurance Program ◽  
Health Insurance Program ◽  
Child Health Insurance

This chapter addresses the issue of health care for low-income people. The United States, virtually alone among developed nations, does not offer universal access to health care, leaving many millions of individuals without health insurance or other means of obtaining necessary medical services. In 2010, Congress enacted the landmark Patient Protection and Affordable Care Act (ACA)—popularly known as “Obamacare”—marking an important but incomplete response to the nation’s health care crisis. This chapter examines the ACA in detail, including its impact on Medicaid and Medicare, the major government health programs in the United States, its creation of Health Insurance Exchanges and tax credits to help low-income households obtain private health coverage, and the reform of private health insurance markets through a patient’s bill of rights, which, among other measures, prohibits insurance companies from refusing coverage for preexisting medical conditions. Perhaps the most critical aspect of the ACA was its expansion of Medicaid to cover virtually all low-income citizens (and certain immigrants) who do not qualify for other health coverage. Although several states opted out of the ACA’s Medicaid expansion, the Medicaid program nevertheless remains the largest single provider of health coverage in the United States. This chapter also provides a detailed description of Medicaid, its eligibility criteria and scope of coverage; the Child Health Insurance Program (CHIP), a government-funded health insurance program for children in households with too much income to qualify for Medicaid; and Medicare, the federal health insurance program for aged, blind, and disabled individuals.

scholarly journals Measuring the Direct Cost Burden of Illness in Burkina Faso

2018 ◽  
Vol 10 (4) ◽  
pp. 60
Author(s):  
Ousmane Traoré
Keyword(s):  
Health Care ◽  
Burkina Faso ◽  
Direct Cost ◽  
Health Expenditure ◽  
Burden Of Illness ◽  
Methodological Approach ◽  
Catastrophic Health Expenditure ◽  
Cost Burden ◽  
Health Coverage ◽  
Universal Health

In this article, we evaluate the direct cost burden of illness in Burkina Faso. The methodological approach predicts the normative health expenditure based on the population’s health risk factors and adjusts the income based on people’s asset portfolios, which are supposed to influence their ability to manage shocks, or their vulnerability to shocks like illness. Thus, using the National Institute for Statistics and Demography’s priority surveys database of 1996, our methodology leads to a better information on the distributions of income and health care spending across a subsample of 1022 treated individuals. Subsequently, the average of the direct cost burden of illness is 11.17%, and 50% of the population spend more than 10.52% of their adjusted income on normative health care. Otherwise, there is a difference of 66.84 of percentage points between the highest and lowest cost burdens. Overall, women face higher direct costs burden compared to men. Given the “catastrophic health expenditure” threshold conventionally set at 10% of income, to decrease these financial vulnerabilities and inequalities in Burkina Faso, one solution would be to achieve universal health coverage.

scholarly journals Ghana’s Journey towards Universal Health Coverage: The Role of the National Health Insurance Scheme

2019 ◽  
Vol 10 (1) ◽  
pp. 94-109 ◽  
Author(s):  
Kipo-Sunyehzi ◽  
Amogre Ayanore ◽  
Dzidzonu ◽  
Ayalsuma Yakubu
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Universal Health Coverage ◽  
National Health Insurance Scheme ◽  
Health Insurance Scheme ◽  
Health Coverage ◽  
Insurance Scheme ◽  
Universal Health

: Background: the main aim of the study is to find if the National Health Insurance Scheme (NHIS) in Ghana is achieving universal health coverage (UHC) or not. The study gives the trajectories of health policies in Ghana and their implications on long term health financing. NHIS in Ghana was implemented in 2004, with the aim of increasing subscribers’ access to health care services and reduce financial barriers to health care. On equity access to healthcare, it addresses two core concerns: (1) enrolling particular groups (persons exempted from annual premium payments) and (2) achieving UHC for all citizens and persons with legal residence. It utilizes a multifactor approach to the conceptualization of UHC. The research question: is Ghana’s NHIS on course to deliver or achieve universal health coverage? Methods: we used qualitative methods. In doing so, the study engaged participants in in-depth interviews, focus group discussions and direct observations of participants in their natural settings, like hospitals, clinics, offices and homes, with purposive and snowball techniques. This data triangulation approach aims to increase the reliability and validity of findings. Results: the empirical evidence shows NHIS performed relatively well in enrolling more exempt groups (particular groups) than enrolling all persons in Ghana (UHC). The biggest challenge for the implementation of NHIS from the perspectives of health insurance officials is inadequate funding. The health insurance beneficiaries complained of delays during registrations and renewals. They also complained of poor attitude of some health insurance officials and health workers at facilities. Conclusions: both health insurance officials and beneficiaries emphasized the need for increased public education and for implementers to adopt a friendly attitude towards clients. To move towards achieving UHC, there is a need to redesign the policy, to move it from current voluntary contributions, to adopt a broad tax-based approach to cover all citizens and persons with legal residence in Ghana. Also, to adopt a flexible premium payment system (specifically ‘payments by installation’ or ‘part payments’) and widen the scope of exempt groups as a way of enrolling more into the NHIS.

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