out of pocket costs
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2022 ◽  
Vol 2 (1) ◽  
pp. e0000005
Author(s):  
Eleanor Reid ◽  
Arunangshu Ghoshal ◽  
Aisha Khalil ◽  
Jingjing Jiang ◽  
Charles Normand ◽  
...  

Background Globally, there is a rise in chronic disease, including cancer, major organ failure and dementias. Patients and their families in low- and middle-income countries (LMICs) pay a high proportion of medical costs out of pocket (OOP), and a diagnosis of serious illness often has catastrophic financial consequences. We therefore conducted a review of the literature to establish what is known about OOP costs near end of life in LMICs. Aims To identify, organise and report the evidence on out-of-pocket costs in adult end-of-life populations in LMIC. Methods A systematic search of 8 databases and a hand search of relevant systematic reviews and grey literature was performed. Two independent reviewers screened titles and abstracts, assessed papers for eligibility and extracted data. The review was registered with PROSPERO and adhered to the Preferred Reporting items for Systematic Reviews and Meta Analyses. The Mixed Methods Appraisal Tool was used to assess quality. The Wagstaff taxonomy was used to describe OOP. Results After deduplication, 9,343 studies were screened, of which 51 were read and rejected as full texts, and 12 were included in the final review. OOP costs increased with advanced illness and disease severity. The main drivers of OOP were medications and hospitalizations, with high but variable percentages of the affected populations reporting financial catastrophe, lost income, foregone education and other pressures. Conclusion Despite a small number of included studies and heterogeneity in methodology and reporting, it is clear that OOP costs for care near end of life in LMIC represent an important source of catastrophic health expenditures and impoverishment. This suggests a role for widespread, targeted efforts to avoid poverty traps. Financial protection policies for those suffering from incurable disease and future research on the macro- and micro- economics of palliative care delivery in LMIC are greatly needed.


2021 ◽  
pp. 135581962110589
Author(s):  
Menghan Shen ◽  
Linyan Li ◽  
Yushan Wu ◽  
Yuanfan Yang

Objective To determine whether there are significant differences in costs of treatment and readmission rates for hospital consultations undertaken by female versus male physicians in China. Methods Using data from the Urban Employee Basic Medical Insurance program from January 2018 through October 2019, we investigated spending patterns and clinical outcomes for patients at tertiary hospitals in one of the largest cities in China by the gender of the attending physician. Our sample included 79,085 hospitalizations treated by 3993 physicians in internal medicine departments. We examined the association between physician gender and visit cost using a multivariable linear model. We examined the association between physician gender and 30-days readmission rates using a multivariable probability model. We adjusted for a rich set of patient characteristics, primary diagnosis fixed effects, and hospital fixed effects. In addition, we used patient fixed effects in a robustness analysis. Results Adjusting for primary diagnosis fixed effects, spending per visit was 4.1% higher for patients treated by male physicians than for those treated by female physicians, a statistically significant difference (95% CI [1.5%, 6.7%]). This pattern persisted after further adjusting for hospital fixed effects (3.2% [1.2%, 5.2%]), patient characteristics (3.2% [1.2%, 5.1%]), and patient fixed effects (4.2% [1.8%, 6.7%]). The difference is mainly driven by higher spending on drugs (8.7% [3.9%, 13.6%]) and out-of-pocket costs (3.9% [1.7%, 6.0%]). No statistically significant differences were observed in the readmission rates of patients treated by male and female physicians in any of our three model specifications. Conclusions Spending per visit was significantly higher among patients treated by male physicians than among those treated by female physicians, with the difference mainly driven by spending on drugs and out-of-pocket costs. No significant difference was observed in the hospital readmission rates of patients treated by male and female physicians. These findings have important implications for gender equality in medicine and health care quality and efficiency in developing countries.


PEDIATRICS ◽  
2021 ◽  
Vol 149 (1) ◽  
Author(s):  
Cristina Carbonell-Duacastella ◽  
Maria Rubio-Valera ◽  
Sílvia Marqués-Ercilla ◽  
Maria Teresa Peñarrubia-María ◽  
Montserrat Gil-Girbau ◽  
...  

OBJECTIVES To estimate medication noninitiation prevalence in the pediatric population and identify the explanatory factors underlying this behavior. METHODS Observational study of patients (<18 years old) receiving at least 1 new prescription (28 pharmaceutical subgroups; July 2017 to June 2018) in Catalonia, Spain. A prescription was considered new when there was no prescription for the same pharmaceutical subgroup in the previous 6 months. Noninitiation occurred when a prescription was not filled within 1 month or 6 months (sensitivity analysis). Prevalence was estimated as the proportion of total prescriptions not initiated. To identify explanatory factors, a multivariable multilevel logistic regression model was used, and adjusted odds ratios were reported. RESULTS Overall, 1 539 003 new prescriptions were issued to 715 895 children. The overall prevalence of 1-month noninitiation was 9.0% (ranging from 2.6% [oral antibiotics] to 21.5% [proton pump inhibitors]), and the prevalence of 6-month noninitiation was 8.5%. Noninitiation was higher in the youngest and oldest population groups, in children from families with a 0% copayment rate (vulnerable populations) and those with conditions from external causes. Out-of-pocket costs of drugs increased the odds of noninitiation. The odds of noninitiation were lower when the prescription was issued by a pediatrician (compared with a primary or secondary care clinician). CONCLUSIONS The prevalence of noninitiation of medical treatments in pediatrics is high and varies according to patients’ ages and medical groups. Results suggest that there are inequities in access to pharmacologic treatments in this population that must be taken into account by health care planners and providers.


2021 ◽  
Vol 4 (12) ◽  
pp. e2134282
Author(s):  
Sue J. Fu ◽  
Liam Rose ◽  
Aaron J. Dawes ◽  
Lisa M. Knowlton ◽  
Kathryn J. Ruddy ◽  
...  

2021 ◽  
Vol 4 (12) ◽  
pp. e2136798
Author(s):  
A. Mark Fendrick ◽  
Nicole Princic ◽  
Lesley-Ann Miller-Wilson ◽  
Kathleen Wilson ◽  
Paul Limburg

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 324-324
Author(s):  
Marguerite DeLiema ◽  
David Burnes ◽  
Lynn Langton

Abstract Society’s growing reliance on technology to transfer and store private information has created more opportunities for identity thieves to access personal data. Prior work using data from the National Crime Victimization Survey (NCVS) Identity Theft Supplement (ITS) showed that baby boomers were significantly more likely than Millennials to be victims of identity theft and that older people and minorities experience more severe economic and psychological consequences. This study examines how socioeconomic status, demographic characteristics, and incident-specific factors relate to how much money is stolen during identity theft, the likelihood of experiencing out-of-pocket costs, and emotional distress among identity theft victims age 65 and older. Using combined data from the 2014 and 2016 NCVS-ITS, this study examines the correlates of financial and psychological consequences of identity theft among 2,307 victims age 65 and older. Older Black victims are more likely to have greater amounts of money stolen and are more likely feel distressed than older non-Latino white identity theft victims. The most disadvantaged older adults living at or below the federal poverty level are nearly five times as likely to suffer out-of-pocket costs. The length of time information is misused and the hours spent resolving identity theft are significantly associated with emotional distress. More than one-third of older victims experience moderate to severe emotional distress following identity theft, and those who can least afford it suffer out-of-pocket costs. Greater advocacy and psychological support are needed to help older adults recover, in addition to tools to protect their personal information from misuse.


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