Catastrophic health expenditure: the case of households with adults over 60 years of age in Peru – 2019

Within the health sector, it is vitally important to analyze whether households incur catastrophic spending for using such services. In this sense, the study seeks to estimate catastrophic health spending for households with members over 60 years of age. To achieve the objective, the methodology of the World Health Organization was used to find the way in which the household incurs in catastrophic spending, using as an instrument the National Household Survey of Peru, for the year 2019. The main results found were: that families living in urban areas, who have health insurance, who have a higher academic degree, decrease the probability of incurring in catastrophic spending, while being over 60 years old, having a chronic disease, suffering some permanent limitation and not having hygienic services, help to incur in catastrophic spending, so it was concluded that the most vulnerable areas should be attended to achieve a better welfare for older adults. Keywords: catastrophic expense, out-of-pocket expense, health insurance. References [1]J. Alvis, c. Marruco, N. Alvis, F. Gomes, Á. Flores and D. Moreno, «Gasto de bolsillo y gasto catastrófico en salud en los hogares de Cartagena, Colombia,» Salud Publica, 10 2018. [2]E. Giménez, L. Flores, J. Rodriguez, G. Ocampos and N. Peralta, «Gastos catastróficos de salud en los hogares del Paraguay,» Instituto de Investigaciones en Ciencias de la Salud, vol. 16, nº 2, 2018. [3]E. Gonzáles and J. García, «Gastos catastróficos en salud, transferencias gubernamentales y remesas en México, » Papeles de población, vol. 23, nº 91, 2017.[4]A. Hernández, C. Rojas, M. Santero, J. Prado y D.Rosselli, «health-related out-of-pocket expenses in older peruvian adults: analysis of the national householdsurvey on living conditions and poverty 2017,» Rev Peru Med Exp Salud Publica, vol. 35, nº 3, 2017. [5]O. Lazo, J. Alcalde and O. Espinosa, «El sistema de salud en Perú,» Lima , 2016. [6]World Health Organization Geneva, «Distribución del gasto en salud y gastos catastróficos Metodología,» 2005. [7]Organización Mundial de la Salud, «Organización Mundial de la Salud,» 2014. [Online]. Available: https://www.who.int/topics/chronic_diseases/es/. [8]Organización Mundial de la Salud , «Organización Mundial de la Salud,» 2018. [Online]. Available: https://www.who.int/topics/disabilities/es/.

Concentration and Persistence of Healthcare Spending: Evidence from China

One way to reduce healthcare costs is to target the high spenders who remain persistently high in cost over time. Using claims data from China between 2010 to 2014, we sought to identify the level of concentration in spending and the proportion of spenders whose costs remain high over five years. Using a transition matrix and a linear regression strategy, we find that the top 10% of the spenders account for more than 50% of total expenditures. Of the individuals who were in the top 10% in 2010, 33.6% remained in the top 10% one year later and 23.6% were still in that category even four years later. Past spending plays a major role in the dynamic of health spending. A 10% increase in expenditure is associated with an increase of 0.36% to 1.33% of spending in the future. Persistence has some heterogeneity in terms of age, gender, and income level. Many diseases have strong predictive power for future spending. Research on the concentration and persistence of health expenditures will inform policymakers in terms of controlling costs and providing protection for catastrophic spending.

Children and Women’s Health in South East Asia: Gap Analysis and Solutions

In response to the Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs) commitment, eight selected countries in the South East Asia region have made a remarkable reduction in infant and child mortality, while a few have achieved an SDG 3.2 target of 25 and 12 for child and neonatal mortality rate, respectively, well before 2030. Across these eight countries, there is a large variation in the achievement of the nine dimensions of maternal, neonatal, and child health service coverage. The poorest wealth quintiles who reside in rural areas are the most vulnerable and left behind from access to service. The rich rural residents are better off than the poor counterparts as they have financial means for travel and access to health services in urban town. The recent 2019 global Universal Health Coverage (UHC) monitoring produced a UHC service coverage index and an incidence of catastrophic health spending, which classified countries into four quadrants using global average. Countries belonging to a high coverage index and a low incidence of catastrophic spending are good performers. Countries having high coverage but also a high incidence of catastrophic spending need to improve their financial risk protection. Countries having low coverage and a high incidence of catastrophic spending need to boost service provision capacity, as well as expand financial protection. Countries having low coverage and a low incidence of catastrophic spending are the poor performers where both coverage and financial protection need significant improvement. In these countries, poor households who cannot afford to pay for health services may forego required care and instead choose to die at home. This paper recommended countries to spend adequately in the health sector, strengthen primary health care (PHC) and safeguard the poor, mothers and children as a priority in pathways towards UHC.

The household economic burden of non-communicable diseases in 18 countries

BackgroundNon-communicable diseases (NCDs) are the leading cause of death globally. In 2014, the United Nations committed to reducing premature mortality from NCDs, including by reducing the burden of healthcare costs. Since 2014, the Prospective Urban and Rural Epidemiology (PURE) Study has been collecting health expenditure data from households with NCDs in 18 countries.MethodsUsing data from the PURE Study, we estimated risk of catastrophic health spending and impoverishment among households with at least one person with NCDs (cardiovascular disease, diabetes, kidney disease, cancer and respiratory diseases; n=17 435), with hypertension only (a leading risk factor for NCDs; n=11 831) or with neither (n=22 654) by country income group: high-income countries (Canada and Sweden), upper middle income countries (UMICs: Brazil, Chile, Malaysia, Poland, South Africa and Turkey), lower middle income countries (LMICs: the Philippines, Colombia, India, Iran and the Occupied Palestinian Territory) and low-income countries (LICs: Bangladesh, Pakistan, Zimbabwe and Tanzania) and China.ResultsThe prevalence of catastrophic spending and impoverishment is highest among households with NCDs in LMICs and China. After adjusting for covariates that might drive health expenditure, the absolute risk of catastrophic spending is higher in households with NCDs compared with no NCDs in LMICs (risk difference=1.71%; 95% CI 0.75 to 2.67), UMICs (0.82%; 95% CI 0.37 to 1.27) and China (7.52%; 95% CI 5.88 to 9.16). A similar pattern is observed in UMICs and China for impoverishment. A high proportion of those with NCDs in LICs, especially women (38.7% compared with 12.6% in men), reported not taking medication due to costs.ConclusionsOur findings show that financial protection from healthcare costs for people with NCDs is inadequate, particularly in LMICs and China. While the burden of NCD care may appear greatest in LMICs and China, the burden in LICs may be masked by care foregone due to costs. The high proportion of women reporting foregone care due to cost may in part explain gender inequality in treatment of NCDs.