Equity impact of minimum unit pricing of alcohol on household health and finances among rich and poor drinkers in South Africa

IntroductionSouth Africa experiences significant levels of alcohol-related harm. Recent research suggests minimum unit pricing (MUP) for alcohol would be an effective policy, but high levels of income inequality raise concerns about equity impacts. This paper quantifies the equity impact of MUP on household health and finances in rich and poor drinkers in South Africa.MethodsWe draw from extended cost-effectiveness analysis (ECEA) methods and an epidemiological policy appraisal model of MUP for South Africa to simulate the equity impact of a ZAR 10 MUP over a 20-year time horizon. We estimate the impact across wealth quintiles on: (i) alcohol consumption and expenditures; (ii) mortality; (iii) government healthcare cost savings; (iv) reductions in cases of catastrophic health expenditures (CHE) and household savings linked to reduced health-related workplace absence.ResultsWe estimate MUP would reduce consumption more among the poorest than the richest drinkers. Expenditure would increase by ZAR 353 000 million (1 US$=13.2 ZAR), the poorest contributing 13% and the richest 28% of the increase, although this remains regressive compared with mean income. Of the 22 600 deaths averted, 56% accrue to the bottom two quintiles; government healthcare cost savings would be substantial (ZAR 3.9 billion). Cases of CHE averted would be 564 700, 46% among the poorest two quintiles. Indirect cost savings amount to ZAR 51.1 billion.ConclusionsA MUP policy in South Africa has the potential to reduce harm and health inequality. Fiscal policies for population health require structured policy appraisal, accounting for the totality of effects using mathematical models in association with ECEA methodology.

Who Have a Higher Risk of Falling Into 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.

Assessing the effects of disease-specific programs on health systems: An analysis of the Bangladesh Lymphatic Filariasis Elimination Program’s impacts on health service coverage and catastrophic health expenditure

This study presents a methodology for using tracer indicators to measure the effects of disease-specific programs on national health systems. The methodology is then used to analyze the effects of Bangladesh’s Lymphatic Filariasis Elimination Program, a disease-specific program, on the health system. Using difference-in-differences models and secondary data from population-based household surveys, this study compares changes over time in the utilization rates of eight essential health services and incidences of catastrophic health expenditures between individuals and households, respectively, of lymphatic filariasis hyper-endemic districts (treatment districts) and of hypo- and non-endemic districts (control districts). Utilization of all health services increased from year 2000 to year 2014 for the entire population but more so for the population living in treatment districts. However, when the services were analyzed individually, the difference-in-differences between the two populations was insignificant. Disadvantaged populations (i.e., populations that lived in rural areas, belonged to lower wealth quintiles, or did not attend school) were less likely to access essential health services. After five years of program interventions, households in control districts had a lower incidence of catastrophic health expenditures at several thresholds measured using total household expenditures and total non-food expenditures as denominators. Using essential health service coverage rates as outcome measures, the Lymphatic Filariasis Elimination Program cannot be said to have strengthened or weakened the health system. We can also say that there is a positive association between the Lymphatic Filariasis Elimination Program’s interventions and lowered incidence of catastrophic health expenditures.

Impact of Catastrophic Health Expenditures on Chinese Household Consumption

China has built a social medical insurance system that covers the entire population so as to reduce the impact of diseases on individuals and families. Although the decline in the incidence of catastrophic health expenditures (CHEs) in China is encouraging, this issue remains important. On the basis of considering selectivity bias and heterogeneity, we applied propensity score matching (PSM) to analyze the 2018 data from the China Family Panel Studies. We assigned CHE households and non-CHE households to the treatment group and the control group, respectively, and used non-random data to simulate a randomized trial to investigate the impact of CHE on household consumption in China. The results of this study indicate that, when the threshold is set at 40%, the consumption of households experiencing CHEs (CHE household) is significantly lower than that of households not experiencing CHEs (non-CHE households) and that CHEs have a significant negative impact on other household consumption and a significant impact on the household property and debt. This effect still exists when the threshold is set lower, with household essential consumption most affected. The occurrence of CHEs leads to a reduction in household consumption and a significantly worsening financial situation for the CHE households, impacting the basic quality of life of the families. Therefore, it is necessary to further reform the medical and health system to reduce the high medical expenses.

Gasto de bolsillo y gastos catastróficos en salud en hogares mexicanos

The implementation of the System of Social Protection in Health (ssph) had the aim of reaching universal health coverage. However, while this system has been successful on increasing coverage rates, it has not eradicated out-of-pocket expenses nor catastrophic health expenditures. Using the enigh 2018 (the income and expenditures survey), and a series of beta and logistic regression models, this article analyses the fac-tor associated with increases in the proportion of household expenses for health and the likelihood of experiencing a catastrophic health expenditure. Findings indicate that gender and education of household head, household composition, but mainly ru-ral residency, are factors determining the presence of these expenses.

Inequalities in catastrophic health expenditures in conflict-affected areas and the Colombian peace agreement: an oaxaca-blinder change decomposition analysis

Background The present study analyzes inequalities in catastrophic health expenditures in conflict-affected regions of Meta, Colombia and socioeconomic factors contributing to the existence and changes in catastrophic expenditures before and after the sign of Colombian Peace Agreement with FARC-EP guerilla group in 2016. Methods The study uses the results of the survey Conflicto, Paz y Salud (CONPAS) conducted in 1309 households of Meta, Colombia, a territory historically impacted by armed conflict, for the years 2014 and 2018. We define catastrophic expenditures as health expenditures above 20% of the capacity to pay of a household. We disaggregate the changes in inequalities in catastrophic expenditures through the Oaxaca-Blinder change decomposition method. Results The incidence of catastrophic expenditures slightly increased between 2014 to 2018, from 29.3 to 30.7%. Inequalities in catastrophic expenditures, measured through concentration indexes (CI), also increased from 2014 (CI: -0.152) to 2018 (CI: -0.232). Results show that differences in catastrophic expenditures between socioeconomic groups are mostly attributed to an increased influence of specific sociodemographic variables such as living in rural zones, being a middle-aged person, living in conflict-affected territories, or presenting any type of mental and physical disability. Conclusions Conflict-deescalation and the peace agreement may have facilitated lower-income groups to have access to health services, especially in territories highly impacted by conflict. This, consequently, may have led to higher levels of out-of-pocket expenditures and, therefore, to higher chances of experiencing catastrophic expenditures for lower-income groups in comparison to higher-income groups. Therefore, results indicate the importance of designing policies that guarantee access to health services for people in conflict -affected regions but also, that minimize health care inequalities in out-of-pocket payments that may arouse between people at different socioeconomic groups.

Medical service utilization and out-of-pocket spending among near-poor National Health Insurance members in South Korea

Background The public health care system in South Korea is a two-tiered system. The lowest-income population is covered by the Medical Aid program, and the remaining population is covered by the National Health Insurance. The near poor, a relatively low-income population which is excluded from South Korea’s Medical Aid program due to exceeding the income threshold, experiences insufficient use of medical services and incurs high out-of-pocket expenses due to a lack of coverage under the country’s National Health Insurance (NHI) program. This study aims to examine medical utilization, out-of-pocket spending, and the occurrence of catastrophic health expenditures among the near-poor group compared to both Medical Aid beneficiaries and other (higher income) NHI members. Methods A cross-sectional study was conducted drawing upon a nationally representative dataset derived from the 2018 Korea Welfare Panel Study. The study classified people into three groups: Medical Aid beneficiaries; the near-poor population below 50 % of the median income threshold but still not qualifying for Medical Aid and thus enrolled in NHI; and NHI members above the threshold of 50 % of the median income. Using a generalized boosted model to estimate the propensity score weights between study groups, this study examined medical utilization, out-of-pocket spending, and the occurrence of catastrophic health expenditure among the study groups. Results The findings suggest that the utilization of medical services was not significantly different among the study groups. However, out-of-pocket spending and the occurrence of catastrophic health expenditure were significantly higher in the near-poor group compared to the other two groups. Conclusions The study found that the near-poor group was the most vulnerable among the Korean population because of their higher chance of incurring greater out-of-pocket spending and catastrophic health expenditures than is the case among the Medical Aid beneficiary and above-poverty line groups. Health policy needs to take the vulnerability of this near-poor population into account.