The Risk of Catastrophic Health Expenditures Due to Direct Non-Medical Costs in Patients: A Study of the Outpatients in Qazvin, Iran

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Saeed Asefzadeh ◽  
Bahman Ahadi Nezhad ◽  
Saeed Norouzi
Keyword(s):  
Health Expenditures ◽  
Medical Costs ◽  
Healthcare Services ◽  
Disease Diagnosis ◽  
Cross Sectional Survey ◽  
Diagnostic Laboratory ◽  
Cross Sectional ◽  
Out Of Pocket Payments ◽  
Catastrophic Health Expenditures ◽  
Catastrophic Expenditures

Background: Out-of-pocket payment encompasses the costs that patients pay for healthcare services, which is an inefficient approach to healthcare financing as it may lead to poverty. Objectives: The present study aimed to determine the risk of catastrophic health expenditures due to non-medical costs in the outpatients in Qazvin, Iran. Methods: This cross-sectional survey was conducted on 341 outpatients referring to the internists of Velayat Hospital and Bu-Ali Sina Hospital in Qazvin. The required data were collected using a researcher-made questionnaire and the prescriptions of the patients. Out-of-pocket payments were defined as the direct medical and non-medical costs within one month. Results: The mean out-of-pocket payments of the patients in one month was 49.97 dollars, 75.8% of which covered direct medical cost (disease diagnosis and treatment), and 24.2% covered direct non-medical costs to receive health services. The highest out-of-pocket payments were for diagnostic/laboratory tests (50.3%), medications (21.5%), and transportation (18.2%). In addition, the exposure rate to catastrophic expenditures was estimated at 31%, and the patients with lower income had less exposure compared to those without incomes. Conclusions: According to the results, direct non-medical costs were associated with the increased out-of-pocket payments of the patients, which in turn led to the higher rates of catastrophic expenditures.

scholarly journals Examining the incidence of catastrophic health expenditures and its determinants using multilevel logistic regression in Malawi

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248752
Author(s):  
Atupele N. Mulaga ◽  
Mphatso S. Kamndaya ◽  
Salule J. Masangwi
Keyword(s):  
Public Health ◽  
Logistic Regression ◽  
Health Services ◽  
Health Expenditures ◽  
Free Access ◽  
Public Health Services ◽  
Factors Associated ◽  
Out Of Pocket Payments ◽  
Catastrophic Health Expenditures ◽  
Catastrophic Expenditures

Background Despite a free access to public health services policy in most sub-Saharan African countries, households still contribute to total health expenditures through out-of-pocket expenditures. This reliance on out-of-pocket expenditures places households at a risk of catastrophic health expenditures and impoverishment. This study examined the incidence of catastrophic health expenditures, impoverishing effects of out-of-pocket expenditures on households and factors associated with catastrophic expenditures in Malawi. Methods We conducted a secondary analysis of the most recent nationally representative integrated household survey conducted by the National Statistical Office between April 2016 to 2017 in Malawi with a sample size of 12447 households. Catastrophic health expenditures were estimated based on household annual nonfood expenditures and total household annual expenditures. We estimated incidence of catastrophic health expenditures as the proportion of households whose out-of-pocket expenditures exceed 40% threshold level of non-food expenditures and 10% of total annual expenditures. Impoverishing effect of out-of-pocket health expenditures on households was estimated as the difference between poverty head count before and after accounting for household health payments. We used a multilevel binary logistic regression model to assess factors associated with catastrophic health expenditures. Results A total of 167 households (1.37%) incurred catastrophic health expenditures. These households on average spend over 52% of household nonfood expenditures on health care. 1.6% of Malawians are impoverished due to out-of-pocket health expenditures. Visiting a religious health facility (AOR = 2.27,95% CI:1.24–4.15), hospitalization (AOR = 6.03,95% CI:4.08–8.90), larger household size (AOR = 1.20,95% CI:1.24–1.34), higher socioeconomic status (AOR = 2.94,95% CI:1.39–6.19), living in central region (AOR = 3.54,95% CI:1.79–6.97) and rural areas (AOR = 5.13,95% CI:2.14–12.29) increased the odds of incurring catastrophic expenditures. Conclusion The risk of catastrophic health expenditures and impoverishment persists in Malawi. This calls for government to improve the challenges faced by the free public health services and design better prepayment mechanisms to protect more vulnerable groups of the population from the burden of out-of-pocket payments.

scholarly journals Catastrophic Health Expenditures And Impoverishment In Kenya

2016 ◽  
Vol 12 (15) ◽  
pp. 434 ◽  
Author(s):  
Diana N. Kimani ◽  
Mercy G. Mugo ◽  
Urbanus M. Kioko
Keyword(s):  
Health Care ◽  
Health Care Expenditure ◽  
Health Expenditures ◽  
Chronically Ill ◽  
Health Care Expenditures ◽  
The Poor ◽  
Out Of Pocket Payments ◽  
Catastrophic Health Expenditures ◽  
The Government ◽  
Catastrophic Expenditures

Background: Out-of-pocket health expenditures leave households exposed to the risk of financial catastrophe and poverty whenever they entail significant dissaving or the sale of key household assets. Even relatively small expenditures on health can be financially disastrous for poor households and similarly, large health care expenditures can lead to financial catastrophe and bankruptcy for rich households. Objective: There is increasing evidence that out-of-pocket expenditures act as a financial barrier to accessing health care, and are a source of catastrophic expenditures and impoverishment. This paper estimates the burden of out-of-pocket payments in Kenya; the incidence and intensity of catastrophic health care expenditure and impoverishment in Kenya. Methods: Using Kenya Household Health Expenditures and Utilization Survey data of 2007, the study uses both descriptive and econometric analysis to investigate the incidence and intensity of catastrophic health expenditures and impoverishment as well as the determinants of catastrophic health expenditures. To estimate the incidence and intensity of catastrophic expenditures and impoverishment, the study used both Wagstaff and van Doorslaer, (2002) and Xu et al. (2005) and applied various thresholds to demonstrate the sensitivity of catastrophic measures. For determinants of catastrophic health expenditures, a logit model was employed. Findings: Among those who utilized health care, 11.7 percent experienced catastrophic expenditures and 4 percent were impoverished by health care payments. In addition, approximately 2.5 million individuals were pushed into poverty as a result of paying for health care. The poor experienced the highest incidence of catastrophic expenditures. Conclusion: The paper recommends that the government should establish avenues for reducing the burden of out-of-pocket expenditures borne by households. This could be through a legal requirement for everyone to belong to a health insurance and targeting the poor, the elderly and chronically ill through the devolved system of the government and devolved funds.

scholarly journals Fear of catastrophic health expenditures and unrealistic expectations from supplementary health insurance: ethnic differences

2018 ◽  
Vol 11 (4) ◽  
pp. 283-289
Author(s):  
Neta HaGani ◽  
Samah Hayek ◽  
Jalal Tarabeia ◽  
Mohammad Yehia ◽  
Manfred S Green
Keyword(s):  
Health Insurance ◽  
Health Expenditures ◽  
Health Coverage ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Accessible Information ◽  
Catastrophic Health Expenditures ◽  
Supplementary Health Insurance ◽  
Universal Health ◽  
Unrealistic Expectations

Abstract Background In Israel, the whole population is covered by comprehensive universal health insurance. Despite that, most of the population purchases supplementary health insurance (SHI). It has been shown that individuals purchase more health insurance and preventive medicine when they are uncertain of their state of health, while a majority may not fully understand basic concepts in their health insurance coverage. The purpose of this study was to examine the role of fear of catastrophic health expenditures and unrealistic expectations in purchasing SHI, which does not cover expenses for life-threatening illnesses. Methods A cross-sectional survey was conducted among random samples of 814 Jews and 800 Arabs in Israel. A structured questionnaire was administered by telephone using random digit dialling. Log-linear regression was used to identify factors associated with reasons for purchasing SHI and expectations from SHI. Results The most common reason for purchasing SHI was fear of catastrophic health-related expenditures (41%). The most important service expected from SHI was ‘cancer medications’ (mean 4.68 [standard deviation 0.87]). Differences in the reasons for purchasing SHI and in expectations from SHI were found according to population group, age, gender and education. Conclusions Consumers’ misconceptions and fear of catastrophic health expenditures are major factors leading to the purchase of SHI, despite universal health coverage. Improved and accessible information should help consumers make informed decisions as to whether or not to purchase SHI.

scholarly journals Catastrophic Health Expenditures for Children with Disabilities in Iran: A National Survey

2020 ◽  
Author(s):  
Ghobad Moradi ◽  
Amjad Mohamadi Bolbanabad ◽  
Farman Zahir Abdullah ◽  
Hossein Safari ◽  
Satar Rezaei ◽  
...  
Keyword(s):  
Financial Burden ◽  
Health Expenditures ◽  
World Health ◽  
Health Costs ◽  
Financial Protection ◽  
Disabled Children ◽  
World Health Survey ◽  
Cross Sectional ◽  
Out Of Pocket Payments ◽  
Catastrophic Health Expenditures

Abstract Background: Higher health costs and financial burden are imposed on people with disabilities due to their health status associated with their disability. Measuring the incidence of catastrophic health expenditures (CHE) can provide good evidence for health policymakers to assess the current state of financial protection of the health system. The aim of this study was to investigate the percentage of households with disabled children aged 0 to 8 years who had faced CHE due to the health costs of these children in Iran.Methods: This cross-sectional study was carried out on 2000 households with disabled children aged 0 to 8 years in five provinces of Iran in 2020. Data were collected using the World Health Survey questionnaire and face-to-face interview. Households whose health expenditures for disabled members in the family were more than 40% of the household payment capacity were included in the group of households with CHE. Determinants of CHE were identified using regression analysis.Findings: 32.7% of households with disabled children had faced CHE. Head of household being female, poor economic status of the household, lack of supplementary insurance by a child with disabilities, having a child with mental disability and type of basic health insurance significantly increased the chances of facing CHE.Conclusion: A significant percentage of households with disabled children had faced CHE because of their disabled child's health costs. More financial protection of these households against health costs should be on the agenda of health policy makers. Implementation of payment exemption programs, direct and indirect financial support programs and having prepaid mechanisms are suggested to reduce out-of-pocket payments for health services.

scholarly journals Impoverishment and catastrophic expenditures due to out-of-pocket payments for antenatal and delivery care in Yangon Region, Myanmar: a cross-sectional study

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e022380 ◽  
Author(s):  
Aye Nyein Moe Myint ◽  
Tippawan Liabsuetrakul ◽  
Thein Thein Htay ◽  
Myint Myint Wai ◽  
Johanne Sundby ◽  
...  
Keyword(s):  
Occupation Number ◽  
Cross Sectional Study ◽  
Sampling Procedure ◽  
Cluster Sampling ◽  
Delivery Care ◽  
Catastrophic Expenditure ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Out Of Pocket Payments ◽  
Catastrophic Expenditures

Objectives(1) To assess the levels of impoverishment and catastrophic expenditure due to out-of-pocket (OOP) payments for antenatal care (ANC) and delivery care in Yangon Region, Myanmar; and (2) to explore the determinants of impoverishment and catastrophic expenditure.Design, setting and participantsA community-based cross-sectional survey among women giving birth within the past 12 months in Yangon, Myanmar, was conducted during October to November 2016 using three-stage cluster sampling procedure.Outcome measuresPoverty headcount ratio, normalised poverty gap and catastrophic expenditure incidence due to OOP payments in the utilisation of ANC and delivery care as well as the determinants of impoverishment and catastrophic expenditure.ResultsOf 759 women, OOP payments were made by 75% of the women for ANC and 99.6% for delivery care. The poverty headcount ratios after payments increased to 4.3% among women using the ANC services, to 1.3% among those using delivery care and to 6.1% among those using both ANC and delivery care. The incidences of catastrophic expenditure after payments were found to be 12% for ANC, 9.1% for delivery care and 20.9% for both ANC and delivery care. The determinants of impoverishment and catastrophic expenditure were women’s occupation, number of household members, number of ANC visits and utilisation of skilled health personnel and health facilities. The associations of the outcomes with these variables bear both negative and positive signs.ConclusionsOOP payments for all ANC and delivery care services are a challenge to women, as one of fifteen women become impoverished and a further one-fifth incur catastrophic expenditures after visiting facilities that offer these services.

scholarly journals Strategies for Re-opening Physiotherapy OPDs Post COVID-19 Lockdown – A Cross-sectional Study

2021 ◽  
Author(s):  
Amarjot Singh Gill ◽  
Nistara Singh Chawla ◽  
Sandeep Singh Saini
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Practice Pattern ◽  
Evidence Based ◽  
Sectional Study ◽  
Cross Sectional Survey ◽  
Exclusion Criteria ◽  
Cross Sectional

Background: The practices of various health-care professionals have been improvised to accommodate the on-going covid-19 pandemic situation. Different guidelines have been set in place to ease the process of re-opening of non-elective healthcare services like out-patient physiotherapy clinics. Although the measures taken should be guided by evidence based information, major consensus amongst practicing therapists needs to guide the India physiotherapy clinics. Objective: To identify and present the opinions of different physiotherapists about the various strategies for re-opening the out-patient physiotherapy clinics. Methods: An online cross-sectional survey was conducted. Over 169 participants were selected to participate in the survey according to the pre-decided inclusion and exclusion criteria. The data was collected and saved via google forms. Result and conclusion: A majority of respondents had a consensus over different strategies for re-opening the physiotherapy OPDs. These were regarding different measures to be adapted including modifications in the clinic infrastructure and the practice pattern. This would help in smoothly re-instating the physiotherapy services post the covid-19 lockdown.

Association between socioeconomic status and comorbidities among patients with rheumatoid arthritis: results of a nationwide cross-sectional survey

Rheumatology ◽  
2019 ◽  
Vol 58 (9) ◽  
pp. 1617-1622 ◽  
Author(s):  
Anna Shin ◽  
Seunghwan Shin ◽  
Ji Hyoun Kim ◽  
You-Jung Ha ◽  
Yun Jong Lee ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Low Income ◽  
Suicide Ideation ◽  
Healthcare Services ◽  
Depressive Mood ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Health And Nutrition ◽  
Comprehensive Health ◽  
Musculoskeletal Systems

Abstract Objectives We examined the association between socioeconomic status (SES) and comorbidity distribution among patients with RA. Methods Information on comprehensive health status of 1088 RA patients (weighted n = 612 303) was obtained from the 2007–2015 Korea National Health and Nutrition Examination Survey database. SES components were household equivalence income, education and area of residence. To minimize confounding by age, patients were stratified by median age (63 years). Age-adjusted odds ratio (OR) with 95% confidence interval (95% CI) was estimated, comparing weighted prevalence of individual comorbidities between low and high SES groups in each age stratum. Results Among RA patients aged <63 years (mean 49 years, 70% female), we observed age-adjusted associations of depression (OR 2.13, 95% CI 1.01, 4.53), depressive mood (OR 2.68, 95% CI 1.54, 4.65), suicide ideation (OR 3.01, 95% CI 1.79, 5.07), diabetes (OR 3.09, 95%CI 1.31, 7.29), obesity (OR 2.04, 95% CI 1.30, 3.20), hypertriglyceridemia (OR 2.36, 95% CI 1.28, 4.34) and osteoarthritis (OR 2.12, 95% CI 1.13, 3.99) with low income, of suicide ideation with low education (OR 2.25, 95% CI 1.14, 4.44), but no association of any comorbidities with area of residence. Unhealthy behavior patterns were comparable between low- and high-income groups but patients with low income reported a numerically higher rate of failed access to necessary healthcare services. We did not find any association between SES and comorbidities among those aged ⩾63 years (mean 72 years, 83% female). Conclusion Among Korean RA patients aged <63 years, socioeconomic inequalities of multiple comorbidities in mental, cardiometabolic and musculoskeletal systems were found.

scholarly journals Financial burden of HIV and TB among patients in Ethiopia: a cross-sectional survey

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e036892
Author(s):  
Lelisa Fekadu Assebe ◽  
Eyerusalem Kebede Negussie ◽  
Abdulrahman Jbaily ◽  
Mieraf Taddesse Taddesse Tolla ◽  
Kjell Arne Johansson
Keyword(s):  
Indirect Cost ◽  
Economic Burden ◽  
Financial Burden ◽  
Household Survey ◽  
Income Quintile ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Catastrophic Health Expenditures ◽  
The Mean ◽  
Substantial Economic Burden

ObjectivesHIV and tuberculosis (TB) are major global health threats and can result in household financial hardships. Here, we aim to estimate the household economic burden and the incidence of catastrophic health expenditures (CHE) incurred by HIV and TB care across income quintiles in Ethiopia.DesignA cross-sectional survey.Setting27 health facilities in Afar and Oromia regions for TB, and nationwide household survey for HIV.ParticipantsA total of 1006 and 787 individuals seeking HIV and TB care were enrolled, respectively.Outcome measuresThe economic burden (ie, direct and indirect cost) of HIV and TB care was estimated. In addition, the CHE incidence and intensity were determined using direct costs exceeding 10% of the household income threshold.ResultsThe mean (SD) age of HIV and TB patient was 40 (10), and 30 (14) years, respectively. The mean (SD) patient cost of HIV was $78 ($170) per year and $115 ($118) per TB episode. Out of the total cost, the direct cost of HIV and TB constituted 69% and 46%, respectively. The mean (SD) indirect cost was $24 ($66) per year for HIV and $63 ($83) per TB episode. The incidence of CHE for HIV was 20%; ranges from 43% in the poorest to 4% in the richest income quintile (p<0.001). Similarly, for TB, the CHE incidence was 40% and ranged between 58% and 20% among the poorest and richest income quintiles, respectively (p<0.001). This figure was higher for drug-resistant TB (62%).ConclusionsHIV and TB are causes of substantial economic burden and CHE, inequitably, affecting those in the poorest income quintile. Broadening the health policies to encompass interventions that reduce the high cost of HIV and TB care, particularly for the poor, is urgently needed.

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