Equity in Out-of-Pocket Payments for Healthcare Service Delivery in Urban and Rural Households: Evidence from Iran

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Bahman Ahadi Nezhad ◽  
Omid Khosravizadeh ◽  
Ahad Alizadeh ◽  
Zahra Nejatifar ◽  
Milad Mehri
Keyword(s):  
Low Income ◽  
Concentration Index ◽  
Insurance Coverage ◽  
Rural Households ◽  
Healthcare Services ◽  
Medical Services ◽  
Cluster Sampling ◽  
Urban Households ◽  
Out Of Pocket Payments ◽  
Kakwani Index

Background: Out-of-pocket payments for medical services may undermine access to medical services and equity in healthcare financing. Objectives: The present study aimed to determine the distribution of the burden of out-of-pocket payments for healthcare services among the households in Qazvin province, Iran. Methods: This descriptive-analytical study was conducted on the urban and rural households in Qazvin province, Iran during 2019 - 2020. Data were obtained from the Statistics Center of Iran (2019 - 2020). The optimal sample size was calculated to be 992 households, and the households were selected via three-stage random cluster sampling. Data were collected using a valid questionnaire and via face-to-face interviews with the household owners. The fair financial contribution index (FFCI), concentration index, and Kakwani index were estimated in the Stata software. Results: The estimated parameters indicated that during the study period (March 21, 2019-March 20, 2020), the FFCI value of the rural and urban households was 0.782 and 0.854, respectively. The out-of-pocket payment concentration index based on income rank was estimated at 0.188 in rural households (P < 0.05) and 0.031 in the urban households. In addition, the Kakwani index of the urban and rural households was calculated to be -0.165 and -0.84, respectively. Conclusions: According to the results, out-of-pocket payments were unequally distributed among the households in Qazvin province in 2019 - 2020. These payments were mostly concentrated on the 5th - 7th deciles of urban households. On the other hand, the out-of-pocket payments during the study period were regressive. To promote financial equity, Qazvin health policymakers must run payment exemptions for low-income groups and also expand the medical insurance coverage and universal coverage of healthcare services.

scholarly journals Inequalities in out-of-pocket health expenditure among women of reproductive age: after-effects of national health insurance scheme initiation in Ghana

2021 ◽  
Vol 96 (1) ◽  
Author(s):  
Michael Ekholuenetale ◽  
Amadou Barrow
Keyword(s):  
Health Insurance ◽  
Healthcare Utilization ◽  
Health Expenditure ◽  
Concentration Index ◽  
Insurance Coverage ◽  
Healthcare Services ◽  
Socioeconomic Disadvantage ◽  
Reproductive Age ◽  
Women Of Reproductive Age ◽  
Maternal Healthcare

Abstract Background Improvement in maternal healthcare is a public health priority. Unfortunately, in spite of the efforts made over time regarding universal coverage, there remain issues with accessibility and use of healthcare services up to now. In this study, we examined inequalities in out-of-pocket health expenditure among women of reproductive age in Ghana. We analyzed secondary data collected in Ghana Demographic and Health Survey (GDHS) - 2014. A total of 9,002 women of reproductive age were included in this study. Lorenz curves and the concentration index were used to examine neighborhood socioeconomic disadvantage inequalities in out-of-pocket expenditure for maternal healthcare utilization Results About two thirds (66.0%) of women of reproductive age in Ghana were covered by health insurance. In sum, women of high neighborhood socioeconomic disadvantage status had the least out-of-pocket expenditure for total healthcare utilization, laboratory investigations, antenatal care visits, post-natal care visits, care for new born for up to 3 months, and other healthcare services. The converse was however true for family planning service utilization. Using Concentration Index, we quantified the degree of neighborhood socioeconomic disadvantage inequalities in healthcare service utilizations. Conclusion This study showed a gap in health insurance coverage among women of reproductive age. There were also inequalities in out-of-pocket expenditure for healthcare services utilization. It is expedient for stakeholders in the healthcare system to make policies targeted at bridging the neighborhood socioeconomic differences in maternal healthcare use and develop programs to improve women’s financial protection. Moreover, enlightenment on health insurance availability and coverage should focus on women at risk of out-of-pocket expenditure.

scholarly journals The Evolution of Medical Spending Risk

2009 ◽  
Vol 23 (4) ◽  
pp. 25-48 ◽  
Author(s):  
Jonathan Gruber ◽  
Helen Levy
Keyword(s):  
Health Insurance ◽  
Medical Care ◽  
Low Income ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Health Spending ◽  
The United States ◽  
Consumer Expenditure ◽  
Out Of Pocket Payments ◽  
Over Time

How has the economic risk of health spending changed over time for U.S. households? We describe trends in aggregate health spending in the United States and how private insurance markets and public insurance programs have changed over time. We then present evidence from Consumer Expenditure Survey microdata on how the distribution of household spending on health—that is, out-of-pocket payments for medical care plus the household's share of health insurance premiums—has changed over time. This distribution has shifted up over time—households spend more on medical care and insurance than they used to—but for the purposes of measuring change in risk, it is not the mean but the dispersion of this distribution that is of interest. We consider two measures of dispersion that serve as proxies for household risk: the standard deviation of the distribution of household health spending and the ratio of the 90th percentile of spending to the median (the so-called “90/50 gap”). We find, surprisingly, that neither has increased despite the rapid rise in aggregate health spending. This conclusion holds true for broad subgroups of the population (for example, the nonelderly as a group) but not for some narrowly-defined subgroups (for example, low-income families with children). We next consider how much risk households should face, from the perspective of economic efficiency. Household risk may not have changed much over the past several decades, but do we have any evidence that this level represents either too much or too little risk? Finally, we discuss implications for public policy—in particular, for current debates over expanding health insurance coverage to the uninsured.

scholarly journals Out-of-pocket funding of medical services among older adults

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Tur-Sinai
Keyword(s):  
Older Adults ◽  
Health Insurance ◽  
Soviet Union ◽  
Older Adult ◽  
Former Soviet Union ◽  
Insurance Coverage ◽  
Healthcare Services ◽  
Medical Services ◽  
Economic Motives ◽  
Over Time

Abstract Background The current composition of Israeli private funding is inconsistent with the principles of the State Health Insurance Law. According with the aging process, this study identifies and investigates the predictors of out-of-pocket (hereinafter- OOP) funding of medical care and healthcare among the 50+ population. Its three objectives are to profile the healthcare services for which older adults pay out of pocket, profile the older adults who pay OOP for medical services and detect changes over the years, and identify predictors of private healthcare service funding by older adults. Methods The study is based on the SHARE-Israel database. Relating to longitudinal information yielded by the SHARE-Israel, it sheds light on the characteristics of those who reported having paid OOP for medical services. Results A large majority of the 50+ population in Israel that consumes healthcare services is asked to pay for them out of pocket. Their average age is sixty-seven. Possession of supplemental health insurance coverage, state of health and changes in it, and economic resources are found to have the strongest effect on the probability of OOP funding. The motive of financial and/or social support that older adults receive from and/or give to their immediate surroundings makes it more likely that they will pay OOP for healthcare services. The decision on whether to pay out of pocket in advanced age is positively dependent on age but negatively dependent on level of education. The probability of OOP funding varies between Jews and Arabs and between non-immigrant Jews and recent-immigrant Jews from the former Soviet Union. Conclusions The share of OOP funding of healthcare in older adult households' total annual income is trending upward. The funding of older adult healthcare services in Israel is marked by inequality. Furthermore, economic motives are central in determining whether older adults' out-of-pocket expenditure on healthcare services will stabilize over time. Key messages The funding of older adult healthcare services in Israel is marked by inequality. Economic motives are central in determining whether older adults’ out-of-pocket expenditure on healthcare services will stabilize over time.

scholarly journals Helicopter emergency medical services missions to islands and the mainland during a 3-year period in Denmark: a population-based study on patient and sociodemographic characteristics, comorbidity, and use of healthcare services

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Thea Palsgaard Møller ◽  
Annette Kjær Ersbøll ◽  
Thora Majlund Kjærulff ◽  
Kristine Bihrmann ◽  
Karen Alstrup ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Low Income ◽  
Health Care Services ◽  
Healthcare Services ◽  
Population Based ◽  
Medical Services ◽  
Sociodemographic Characteristics ◽  
Helicopter Emergency Medical Services ◽  
Patient Transport ◽  
Emergency Medical

Abstract Background The Danish Helicopter Emergency Medical Services (HEMS) is part of the Danish Emergency Medical Services System serving 5.7 million citizens with 1% living on islands not connected to the mainland by road. HEMS is dispatched based on pre-defined criteria including severity and urgency, and moreover to islands for less urgent cases, when rapid transport to further care is needed. The study aim was to characterize patient and sociodemographic factors, comorbidity and use of healthcare services for patients with HEMS missions to islands versus mainland. Methods Descriptive study of data from the HEMS database in a three-year period from 1 October 2014 to 30 September 2017. All missions in which a patient was either treated on scene or transported by HEMS were included. Results Of 5776 included HEMS missions, 1023 (17.7%) were island missions. In total, 90.2% of island missions resulted in patient transport by HEMS compared with 62.1% of missions to the mainland. Disease severity was serious or life-threatening in 34.7% of missions to islands compared with 65.1% of missions to mainland and less interventions were performed by HEMS on island missions. The disease pattern differed with more “Other diseases” registered on islands compared with the mainland where cardiovascular diseases and trauma were the leading causes of contact. Patients from islands were older than patients from the mainland. Sociodemographic characteristics varied between inhabiting island patients and mainland patients: more island patients lived alone, less were employed, more were retired, and more had low income. In addition, residing island patients had to a higher extend severe comorbidity and more contacts to general practitioners and hospitals compared with the mainland patients. Conclusions HEMS missions to islands count for 17.7% of HEMS missions and 90.2% of island missions result in patient transport. The island patients encountered by HEMS are less severely diseased or injured and interventions are less frequently performed. Residing island patients are older than mainland patients and have lower socioeconomic position, more comorbidities and a higher use of health care services. Whether these socio-economic differences result in longer hospital stay or higher mortality is still to be investigated.

scholarly journals Problems and prospect of development of health insurance system in China

2020 ◽  
pp. 11-16
Author(s):  
Khentsze Lyu
Keyword(s):  
Health Insurance ◽  
Insurance Coverage ◽  
Quality Of Healthcare ◽  
Healthcare Services ◽  
Medical Services ◽  
Health Insurance System ◽  
Insurance System ◽  
Guaranteed Service ◽  
State Subsidies

This article examines the current health insurance system in China. Emphasis is made on determination of the key features and peculiarities of Chinese health insurance system, as well as its flaws and ways for overcoming them. The author believes that resolution of major issues in Chinese health insurance system requires increased state involvement thereof, since the marked-based approach that has been in effect for the past 30 years lead to inequality and deterioration of the quality of healthcare. The following recommendations are made on the improvement of health insurance system: launch the targeted financing projects that would allow the citizens with especially dangerous diseases, such as cardiovascular, oncological, digestive and nervous system, diabetes, to be paid in full by insurance and state subsidies in receiving medical services and medications; forgo the principle of &ldquo;annual limit&rdquo; for medical services and medications under insurance coverage; unify insurance payment systems in different regions in order to improve the quality of rendering healthcare services in poor areas. The author also offers to consider the possibility of implementation of the universal guaranteed service standards that would ensure equal level of the quality of basic services regardless the type of insurance.

Cecilia Tacoli (ed). The Earthscan Reader in Rural-Urban Linkages. London / Sterling, VA: Earthscan. 329 pages. Hardbound. Indian Rs 995.00.

2007 ◽  
Vol 46 (1) ◽  
pp. 102-105
Author(s):  
G. M. Arif
Keyword(s):  
Low Income ◽  
Census Data ◽  
Rural Households ◽  
Cultural Transformation ◽  
Reciprocal Relationship ◽  
Policy Makers ◽  
Urban Households ◽  
Rural And Urban ◽  
The Impact

The linkages between ‘rural’ and ‘urban’ locations, people, and activities contribute significantly to livelihoods and act as engines of economic, social, and cultural transformation. There is an increased interest among officials and policy-makers to better understand the opportunities and constraints that these linkages offer. Divided into five parts, the fifteen chapters, of this book bring special attention to the impact of rural-urban linkages on different aspects of sustainable development. Chapter 1 presents an analysis of recent census data, with special attention to small urban centres. David Satterthwaite argus that the rural and urban divide misses the extent to which rural households rely on urban incomes, while many urban households in low-income nations rely on rural resources and a reciprocal relationship with rural households. There is a need to forget this divide and see all settlements as being within a continuum with regard to both their population size and the extent of their non-agricultural economic base.

Athlete health and safety at large sport events: the development of consensus-driven guidelines

2020 ◽  
pp. bjsports-2020-102771
Author(s):  
Margo Mountjoy ◽  
Jane Moran ◽  
Hosny Ahmed ◽  
Stephane Bermon ◽  
Xavier Bigard ◽  
...  
Keyword(s):  
Knowledge Translation ◽  
Action Plan ◽  
Health And Safety ◽  
Healthcare Services ◽  
International Federation ◽  
Medical Services ◽  
Local Context ◽  
Sporting Events ◽  
Medical Risk ◽  
Sport Events

All sport events have inherent injury and illness risks for participants. Healthcare services for sport events should be planned and delivered to mitigate these risks which is the ethical responsibility of all sport event organisers. The objective of this paper was to develop consensus-driven guidelines describing the basic standards of services necessary to protect athlete health and safety during large sporting events. By using the Knowledge Translation Scheme Framework, a gap in International Federation healthcare programming for sport events was identified. Event healthcare content areas were determined through a narrative review of the scientific literature. Content experts were systematically identified. Following a literature search, an iterative consensus process was undertaken. The outcome document was written by the knowledge translation expert writing group, with the assistance of a focus group consisting of a cohort of International Federation Medical Chairpersons. Athletes were recruited to review and provide comment. The Healthcare Guidelines for International Federation Events document was developed including content-related to (i) pre-event planning (eg, sport medical risk assessment, public health requirements, environmental considerations), (ii) event safety (eg, venue medical services, emergency action plan, emergency transport, safety and security) and (iii) additional considerations (eg, event health research, spectator medical services). We developed a generic standardised template guide to facilitate the planning and delivery of medical services at international sport events. The organisers of medical services should adapt, evaluate and modify this guide to meet the sport-specific local context.

scholarly journals Health insurance coverage and maternal healthcare services utilization in Jordan: evidence from the 2017–18 Jordan demographic and health survey

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Petula Fernandes ◽  
Emmanuel Kolawole Odusina ◽  
Bright Opoku Ahinkorah ◽  
Komlan Kota ◽  
Sanni Yaya
Keyword(s):  
Health Insurance ◽  
Antenatal Care ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Healthcare Services ◽  
Skilled Birth Attendance ◽  
Reproductive Age ◽  
Maternal Healthcare ◽  
Services Utilization ◽  
Birth Attendance

Abstract Background Despite the relationship between health insurance coverage and maternal healthcare services utilization, previous studies in Jordan on the use of maternal healthcare services have mainly focused on patterns and determinants of maternal healthcare services utilization in Jordan. Therefore, this study investigated the relationship between health insurance coverage and maternal healthcare services utilization in Jordan. Methods This study used secondary data published in 2017-18 Jordan Demographic and Health Survey on 4656 women of reproductive age (15–49 years). The independent variable was health insurance coverage and the outcome variable was maternal healthcare services utilization, measured through timing of first antenatal visit, four or more antenatal care visits, and skilled birth attendance. The data were analyzed using descriptive statistics and binary logistic regression. Results Out of the total number of women who participated in the study, 38.2% were not covered by health insurance. With maternal healthcare utilization, 12.5%, 23.2%, and 10.1% respectively, failed to make early first antenatal care visit, complete four or more antenatal care visits and have their delivery attended by a skilled worker. After controlling for the socio-demographic factors, health insurance coverage was associated with increased odds of early timing of first antenatal care visits and completion of four or more antenatal care visits (aOR = 1.33, p < 0.05, aOR = 1.25, p < 0.01, respectively). However, women who were covered by health insurance were less likely to use skilled birth attendance during delivery (aOR = 0.72 p < 0.001). Conclusions Jordanian women with health insurance coverage were more likely to have early first antenatal care visits and complete four or more antenatal care visits. However, they were less likely to have their delivery attended by a skilled professional. This study provides evidence that health insurance coverage has contributed to increased maternal healthcare services utilization, only in terms of number and timing of antenatal care visits in Jordan. It is recommended that policy makers in Jordan should strengthen the coverage of health insurance in the country, especially among women of reproductive age in order to enhance the use of maternal healthcare services in the country.

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