Catastrophic Expenditure Research Articles

Determinants of out-of-pocket expenditure on medicines among adults in Saudi Arabia: a cross-sectional study

IntroductionTo achieve universal health coverage consistent with World Health Organization recommendations, monitoring financial protection is vital, even in the context of free medical care. Toward this end, this study investigated out-of-pocket (OOP) expenditure on medicines and their determinants among adults in Saudi Arabia.MethodsThis analysis was based on cross-sectional data derived from the Family Health Survey conducted by the General Authority for Statistics in 2018. Data analyses for this study were based on the total sample of 10,785 respondents. Descriptive statistics were used to identify the sample distribution for all variables included in the study. Tobit regression analysis was used to examine the determinants of OOP expenditure on medicines.ResultsThe average OOP expenditure on medicines was estimated to be 279.69 Saudi Riyal in the sampled population. Tobit regression analysis showed that age, average household monthly income, education level, and suffering a chronic condition were the main determinants of OOP expenditure on medicines. Conversely, being married and employed were associated with a lower probability of OOP expenditure on medicines.ConclusionThis study could assist policy makers to provide additional insurance funding and benefits to reduce the possibility of catastrophic OOP expenditure on medicines, especially for the most vulnerable demographic.

New evidence on household financial protection against out-of-pocket payments for health in Poland

Abstract Background Protecting households against financial hardship when using health care is an integral element of universal health coverage. Previous analysis showed that in Poland, catastrophic spending on health is more common than in many European countries. Over the last decade, several measures were undertaken to reduce the burden of out-of-pocket payments for households in Poland. Methods The study aimed to assess financial protection in Poland using the indicators of catastrophic and impoverishing health spending. It relies on the methodology developed by the WHO Region Office for Europe. Catastrophic expenditure is defined as out-of-pocket payments that are greater than 40% of household capacity to pay. The study uses data from the Polish household budget surveys in 2013-2021. Results The incidence of catastrophic health spending remained relatively constant over the years analyzed, with 9% of households affected. Only in the first year of the COVID-19 pandemic (2020) it reached nearly 10%, although overall household out-of-pocket expenditure declined that year. The share of households impoverished or further impoverished due to out-of-pocket payments decreased from 4% in 2013 to 3% in 2021. Payments on medicines are the main driver of catastrophic spending, particularly among poorer households, although their role has diminished over time. Household’s available resources, gender, age, education, disability status, residence place, number of children, and household’s main source of income are significantly associated with catastrophic health payments. Conclusions Despite the implemented policies, household financial protection against out-of-pocket payments in Poland did not improve significantly between 2013 and 2021. Available evidence should be used to design well-tailored measures to reduce the burden of out-of-pocket payments, targeting the most vulnerable population groups and specific healthcare areas. Key messages • Household financial protection against out-of-pocket payments in Poland did not improve significantly between 2013 and 2021. • Out-of-pocket payments for medicines are the main cause of financial hardship for Polish households.

The International Spinal Cord Injury Survey in Iran (InSCI-IR)

Background and Aim: Spinal cord injury patients are faced with many neglected side effects that threaten the health, wealth, and life of the patients and their families. For this purpose, the international spinal cord injury survey (InSCI) was conducted in 2017 by adding 22 countries to follow up the patients facing spinal cord injury. Iran as a developing country was added to the survey in 2022 focusing on the catastrophic health expenditures of spinal cord injury patients. The survey is named: The International spinal cord injury survey in Iran (InSCI -IR). Methods and Materials/Patients: This study will be performed in Guilan Province, Iran and the primary data of the patients will be gathered from the Poursina Hospital of Rasht and the Iranian National Registry of Spinal Cord Injury Patients. InSCI-IR contains two parts; the general questionnaire which gathers the data for the InSCI and the specific questionnaire which gathers data for calculating catastrophic expenditures. Results: It is estimated that 600 patients will participate in the study and more than 200 cases are faced with paraplegia or tetraplegia. The international questionnaire contains 11 sections on the living situation of patients with SCI, sociodemographic questions, injury characteristics, mental and physical health, feeling and work conditions, environmental factors, and access to health services. The catastrophic expenditure part contains questions about the cost of treatment, medication, caregiving, transportation, and household income loss related to spinal cord injury, wealth index, and household total income. Both parts will be edited in psychometrics processes.

Eradicating Poverty and Unshackling from Illness Expense: The Impact of Targeted Poverty Alleviation Policy on Medical Burden

Health poverty alleviation is a crucial aspect of targeted poverty alleviation policy, with easing the medical burden being its primary goal. This study evaluates China's targeted poverty alleviation policy's impact on reducing the medical burden of impoverished households, using data from the China Health and Retirement Longitudinal Survey (CHARLS) for the years 2011, 2013, 2015, and 2018. Employing Difference-in-Differences (DID) methodology, this paper finds significant reductions in both the out-of-pocket to income ratio and catastrophic medical expenditure among targeted households. The policy's success is attributed to the "income effect", raising household income levels, and the "safety-net effect" increasing the reimbursement ratio for inpatient expenses. These results are valid across several robustness tests including propensity score matching (PSM-DID) and placebo test. The findings have implications for global health policy, suggesting that targeted poverty alleviation interventions can effectively alleviate medical burden and prevent poverty due to health expenses, offering a viable model for other developing countries facing similar challenges.

Changes in work status after cancer diagnosis and their associations with depressive symptoms among cancer survivors: findings from the Korean longitudinal study of ageing1

PurposeCancer survivors encounter significant psychological suffering and are prone to develop depressive symptoms. Work contributes to personal fulfillment and social connections, and by doing so, enhances a cancer survivor’s resilience against adversities. However, maintaining employment can be challenging for some cancer survivors. This research aimed to identify the association between changes in work status and depressive symptoms among cancer survivors in South Korea.MethodsThis study used the panel data from the Korean Longitudinal Study of Ageing (KLoSA) and included 199 cancer survivors–799 observations–aged 65 or younger, between 2005 and 2018. Changes in work status consisted of continuous unemployment or employment, quitting a job, and getting a job. We defined depressive symptoms as a CES-D-10 score of 10 or higher and a cut-off of 4 was utilized for sensitivity analysis. Multivariable generalized estimating equation was employed to estimate the odds ratio (OR), adjusting for the number of household members, education level, sex, age, marital status, occupations, cancer treatment, cancer type, catastrophic healthcare expenditure (CHE), and survivorship. Subgroup analysis and interaction between changes in work and cancer types were further explored.ResultsFor depressive symptoms, the OR of the continuous unemployment group was 2.27 (95% CI = 1.10–4.69), and the OR of the group that quit a job was 2.20 (95% CI = 1.03–4.72), compared to the continuous employment group. As survivorship increased, the odds of depressive symptoms decreased (OR = 0.94, 95% CI = 0.89–1.00). CHE was associated with depressive symptoms (OR = 2.23, 95% CI = 1.18–4.20). In cancer types with a low tendency to depression, continuous unemployment was associated with depressive symptoms (OR = 3.19, 95% CI = 1.12–9.06). In sensitivity analysis, changes in work, survivorship, and CHE were consistently associated with depressive symptoms.ConclusionsCancer survivors who quit a job or continued unemployment were more likely to experience depressive symptoms. The findings of this study imply that assistance for cancer survivors to continue a job or return to employment, including adjustment of workload and hours, may be helpful. Psychological care may be crucial, particularly in the early stage of cancer survivorship. Furthermore, support may be needed to alleviate the burden of healthcare expenditure.

Bridging the Surgical Divide: Addressing Access, Safety, Volume and Financial Burden in Mexico's Healthcare System through Global Surgery Research.

In 2008, Paul Farmer and Jim Yong Kim first referred to surgery as the "neglected stepchild of global health". Their powerful statement highlighted the critical neglect of surgical care within the global health agenda, emphasizing the urgent need for greater attention and resources. Today, this issue remains acutely relevant in Mexico, where inadequate investment, the risk of catastrophic expenditures, and limited surgical capacity continue to compromise the health and economic stability of millions. Surgical diseases remain a major cause of death and disability, particularly among the poor.

Household financial burden associated with out-of-pocket payments for healthcare in Iran: insights from a cross-sectional survey

BackgroundOne of the key functions and ultimate goals of health systems is to provide financial protection for individuals when using health services. This study sought to evaluate the level of financial protection and its inequality among individuals covered by the Social Security Organization (SSO) health insurance between September and December 2023 in Iran.MethodsWe collected data on 1691 households in five provinces using multistage sampling to examine the prevalence of catastrophic healthcare expenditure (CHE) at four different thresholds (10%, 20%, 30%, and 40%) of the household’s capacity to pay (CTP). Additionally, we explored the prevalence of impoverishment due to health costs and assessed socioeconomic-related inequality in OOP payments for healthcare using the concentration index and concentration curve. To measure equity in out-of-pocket (OOP) payments for healthcare, we utilized the Kakwani progressivity index (KPI). Furthermore, we employed multiple logistic regression to identify the main factors contributing to households experiencing CHE.Findings: The study revealed that households in our sample allocated approximately 11% of their budgets to healthcare services. The prevalence of CHE at the thresholds of 10%, 20%, 30%, and 40% was found to be 47.1%, 30.1%, 20.1%, and 15.7%, respectively. Additionally, we observed that about 7.9% of the households experienced impoverishment due to health costs. Multiple logistic regression analysis indicated that the age of the head of the household, place of residence, socioeconomic status, utilization of dental services, utilization of medicine, and province of residence were the main factors influencing CHE. Furthermore, the study demonstrated that while wealthy households spend more money on healthcare, poorer households spend a larger proportion of their total income to healthcare costs. The KPI showed that households with lower total expenditures had higher OOP payments relative to their CTP.ConclusionThe study findings underscore the need for targeted interventions to improve financial protection in healthcare and mitigate inequalities among individuals covered by SSO. It is recommended that these interventions prioritize the expansion of coverage for dental services and medication expenses, particularly for lower socioeconomic status household.

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) after four years of implementation – is it making an impact on quality of inpatient care and financial protection in India?

BackgroundIndia launched a national health insurance scheme named Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) in 2018 as a key policy for universal health coverage. The ambitious scheme covers 100 million poor households. None of the studies have examined its impact on the quality of care. The existing studies on the impact of AB-PMJAY on financial protection have been limited to early experiences of its implementation. Since then, the government has improved the scheme’s design. The current study was aimed at evaluating the impact of AB-PMJAY on improving utilisation, quality, and financial protection for inpatient care after four years of its implementation.MethodsTwo annual waves of household surveys were conducted for years 2021 and 2022 in Chhattisgarh state. The surveys had a sample representative of the state’s population, covering around 15,000 individuals. Quality was measured in terms of patient satisfaction and length of stay. Financial protection was measured through indicators of catastrophic health expenditure at different thresholds. Multivariate adjusted models and propensity score matching were applied to examine the impacts of AB-PMJAY. In addition, the instrumental variable method was used to address the selection problem.ResultsEnrollment under AB-PMJAY was not associated with increased utilisation of inpatient care. Among individuals enrolled under AB-PMJAY who utilised private hospitals, the proportion incurring catastrophic health expenditure at the threshold of 10% of annual consumption expenditure was 78.1% and 70.9% in 2021 and 2022, respectively. The utilisation of private hospitals was associated with greater catastrophic expenditure irrespective of AB-PMJAY coverage. Enrollment under AB-PMJAY was not associated with reduced out-of-pocket expenditure or catastrophic health expenditure.ConclusionsAB-PMJAY has achieved a large coverage of the population but after four years of implementation and an evidence-based increase in reimbursement prices for hospitals, it has not made an impact on improving utilisation, quality, or financial protection. The private hospitals contracted under the scheme continued to overcharge patients, and purchasing was ineffective in regulating provider behaviour. Further research is recommended to assess the impact of publicly funded health insurance schemes on financial protection in other low- and middle-income countries.

Consumer Financial Protection Versus Catastrophic Healthcare Expenditure in Zambia

ABSTRACTBackgroundOut‐of‐pocket (OOP) expenses for healthcare are regarded as catastrophic, especially if they account for a substantial amount of a poor household's effective income. This study looks at the frequency and severity of catastrophic healthcare expenditures (CHE) to evaluate the level of monetary safeguarding provided by the present healthcare system in Zambia.MethodsThe study relied on the 2014 Zambia Household Health Expenditure and Utilization Survey, which was carried out in 10 different provinces. The investigated population is divided into quintiles, which divide family units into five groups, each of which represents 20% of the population. The data were analyzed using descriptive statistics, analysis of variance, and pairwise comparisons among the quintiles.ResultsAt 5% level of significance, pairwise analyses of the average of OOP healthcare expenditures as a proportion of non‐food spending reveal that the quintiles have statistically different means. If 10% limit is employed, the concentration index was −0.41, whereas was −0.67. At a 10% limit, the adjusted headcount () is 0.37, and the adjusted overshoot () is 0.15%.ConclusionThe frequency and severity of CHE were negligible during the study period. However, the less fortunate are more susceptible compared to the wealthy to be subjected to the occurrence and severity of CHE. Therefore, policy changes ought to emphasize the protection of the poor and vulnerable to accomplish the goal of universal healthcare (UHC). Finally, research is suggested to include equity and quality in the use of healthcare services.

A Cross-sectional Study for Examining Catastrophic Healthcare Expenditure Across Socio-demographic Variables among Employees in a Sedentary Occupation.

Health expenditure above a certain threshold level can result in a financial catastrophe by reducing the expenses on necessities. Certain socio-demographic variables have been observed to play a role in influencing catastrophic healthcare expenditure, guiding the present study to examine this scenario for employees in sedentary occupations. A cross-sectional study has been conducted among 370 employees recruited through a random sampling technique. Multinomial logistic regression was used to test the main objective of the study. The factors associated with a higher probability of catastrophic healthcare expenditure were males with increasing age. Years of work experience tend to be associated with a lower likelihood of catastrophic healthcare expenditure. No conclusive evidence could be drawn for BMI, income, marital status and education.

Burden of out-of-pocket payment for maternal healthcare and its catastrophic effects in the era of free maternal and child health policy in Ghana

BackgroundGhana introduced a free maternal healthcare policy within its national health insurance program in 2008. Despite this, there are reports of significant out-of-pocket (OOP) payments for maternal healthcare in Ghana. This study examines OOP payments for maternal healthcare services and their catastrophic effects, including the correlates of catastrophic OOP payments. MethodsCross-sectional quantitative data were collected from 414 mothers through health facility exit interviews in two regions of Ghana. Catastrophic OOP payments were computed by expressing total health expenditure as a percentage of household total expenditure and non-food expenditure at various thresholds (5 %, 10 %, 20 % and 25 %). The correlates of catastrophic OOP payments were assessed using logistic regression models. ResultsThe median OOP payments for maternal healthcare was GH₵866.5(US$109.3). The median non-medical OOP cost (GH₵479[US$ 59.9]) was higher than the median medical OOP cost (GH₵296.5[US$ 37.1]). The median OOP cost was higher for delivery (GH₵454[US$56.8]) compared to ANC (GH₵356.5[US$44.5]) and PNC (GH₵21.5[US$2.6]). Non-medical supplies comprise 58 % of the total OOP payments. About 73 % and 90 % of respondents spent more than 5 % of their annual household total and non-food expenditure on maternal healthcare, respectively. Rural areas and care at private facilities were significantly associated (AORs<1; p-values<0.05) with lower probabilities of incurring catastrophic OOP expenditure. Tertiary education was associated (AORs> 1; p-values<0.05) with a higher probability of incurring catastrophic OOP payments. ConclusionOOP payments for maternal care are still prevalent in Ghana. We call for a reform of Ghana’s free maternal healthcare policy to include non-medical supplies within its benefit package.

Catastrophic healthcare expenditure and caregiver burden in pediatric chronic kidney disease - a mixed methods study from a low resource setting.

Caregivers of children with chronic kidney disease (CKD) in low resource settings must provide complex medical care at home while being burdened by treatment costs often paid out-of-pocket. We hypothesize that caregiver burden in our low resource setting is greater than reported from high income countries and is associated with frequent catastrophic healthcare expenditure (CHE). We conducted a mixed-methods study of primary caregivers of children with advanced CKD (stage 3b-5) in our private-sector referral hospital in a low resource setting. We assessed caregiver burden using the Pediatric Renal Caregiver Burden Scale (PRCBS) and measured financial burden by calculating the proportion of caregivers who experienced CHE (monthly out-of-pocket healthcare expenditure exceeding 10% of total household monthly expenditure). We performed a qualitative reflexive thematic analysis of caregiver interviews to explore sources of burden. Of the 45 caregivers included, 35 (78%) had children on maintenance dialysis (25 PD, 10 HD). Mean caregiver burden score was 141 (± 17), greater than previously reported. On comparative analysis, PRCBS scores were higher among caregivers of children with kidney failure (p = 0.005), recent hospitalization (p = 0.03), non-earning caregivers (p = 0.02), caring for > 2 dependents (p = 0.009), and with high medical expenditure (p = 0.006). CHE occurred in 43 (96%) caregivers of whom 37 (82%) paid out-of-pocket. The main themes derived relating to caregiver burden were severe financial burden, mental stress and isolation, and perpetual burden of concern. Parents of children with CKD experienced severe caregiver burden with frequent CHE and relentless financial stress indicating an imminent need for social support interventions.

Socio-demographic and economic profile of households with catastrophic health expenditures in Muanda, Boma and Matadi in 2022: a household cross-sectional study

Background Catastrophic health expenditures are direct healthcare expenses that exceed 10% or 25% of total household income. The present study aims to measure the proportion of households that fall into catastrophic health expenditure, their socio-demographic and economic characteristics and the factors associated with catastrophic health expenditures. Methods We conducted a secondary data analysis of 205 households from a cross-sectional study in seven health zones in 2022 in DRC. A Clustered Lot Quality Assurance Sampling (LQAS) was used through a 3-stage sampling process. Data were entered into SPSS version 26 and analyzed using the same software. Descriptive analyses included frequencies and percentages, bivariate analyses were performed to see the association between catastrophic health expenditure at 10% and 25% and the independent variables (location, household size, household head occupation, health insurance coverage, and economic well-being). Binary logistic regressions were performed respectively at the 10% and 25% thresholds of income. The association was statistically significant if the p-value was strictly less than 0.05. Results Overall, the extent of catastrophic expenditure at the 10% threshold was 72%, and 47% at the 25% threshold of the monthly household income. Poor households were 1.87 (95% confidence interval, CI=1.06-3.28) times more exposed to catastrophic expenditure than rich households. Conclusions In Kongo Central’s port area, catastrophic health expenditure prevalence is significantly higher than in Sub-Saharan Africa. This exposes the majority to further poverty, highlighting the need for a healthcare coverage system in the country. Registration: ESP/CE/118/2022 of September 12, 2022

Emergency medical services impact evaluation approaches in low and middle-income countries

There is a strong need to critically consider the neocolonial context when discussing the impact evaluation of Eemergency Medical Services (EMS) systems in many low to middle-income countries. Many of these countries have faced exploitation and settler colonialism, and in today’s world the aftermath of these political–economic unequal power dynamics persists through neocolonialism. “Solutions” to prehospital care and related donor-driven development sector aid programs are typically orchestrated by high-income countries in the Global North, many of whom directly benefited from centuries of colonizing the Global South. This perpetuates the financial and technocratic dependency of many low to middle-income countries.Traditional Global North–led impact assessment typically revolves around mortality outcomes. This is problematic because singularly tracking mortality can obscure the influence of important factors at play beyond the emergency response incident itself, such as morbidity and socioeconomic privilege. This is why process indicators such as response times and economic impacts on first responders and communities are crucial. Hence, instead of trying to develop a one-size-fits-all impact assessment criteria for all the diverse prehospital care system contexts across the world, it is important to focus on enabling bottom-up, community-led, and participatory approaches to finding context-tailored solutions. A key element of this should be the co-creation of the measures of success themselves with the community stakeholders.Such a decolonial holistic approach may then help put the spotlight on often neglected important measures, such as the inclusion of underprivileged minorities in emergency response and the level of protection against catastrophic health care expenditure built into EMS systems. In doing so, it can encourage a monitoring and evaluation shift from short-term mortality to long-term wellbeing, taking into account cultural contexts about what “wellbeing” entails. Furthermore, it is important to challenge the taken-for-granted notion that in low to middle-income countries, EMS systems are solely for trauma and medical emergencies. It is also important to consider (with the dialogue led by the local stakeholders) what sustainability would look like, and how resources accordingly should be allocated, in those regions in low to middle-income countries where there is political and economic volatility as a consequence of continuing neocolonial hegemony.

Impact of Fee For Service on the Efficiency and Survival of Seguro Popular's Patients With Acute Lymphoblastic Leukemia in Mexico.

Cost containment and efficiency in the provision of health care are primary concerns for health systems that aim to provide affordable, high-quality care. Between 2005 and 2015, Seguro Poplar's Fund against Catastrophic Expenditures (FPGC) funded ALL treatment in Mexico. Before January 1, 2011, FPGC reimbursed a fixed amount per patient according to risk. In 2011, the per capita reimbursement method changed to fee for service. We used this natural experiment to estimate the impact of the reimbursement policy change on average expenditure and quality of care for ALL treatment in Mexico. We used nationwide reimbursement data from the Seguro Poplar's FPGC from 2005 to 2015. We created a patient cohort to assess 3-year survival and estimate the average reimbursement before and after the fee-for-service policy. We examined survival and expenditure impacts, controlling for patients' and providers' characteristics, including sex, risk (standard and high), the volume of patients served, type of institution (federally funded v other), and level of care. To quantify the impact, we used a regression discontinuity approach. The average reimbursement for standard-risk patients in the 3-year survival cohort was $16,512 US dollars (USD; 95% CI, 16,042 to 17,032) before 2011 and $10,205 USD (95% CI, 4,659 to 12,541) under the fee-for-service reimbursement scheme after 2011. The average annual reimbursement per patient decreased by 136% among high-risk patients. The reduction was also significant for the standard-risk cohort, although the magnitude was substantially smaller (34%). As Mexico's government is currently restructuring the health system, our study provides evidence of the efficiency and effectiveness of the funding mechanism in the Mexican context. It also serves as a proof of concept for using administrative data to evaluate economic performance and quality of care of publicly funded health programs.

Assessing Household Catastrophic Healthcare Expenditure and its Associated Factors: A Study in a North-Eastern State of India

Background: Out-of-pocket expenses (OOPE) are the primary means of funding healthcare costs in developing nations, and when the cost is too high, it leads to catastrophic healthcare expenditures (CHE). Aim &amp; Objective: This study aimed to assess the proportion of households that faced CHE and also examined the associated factors that determine CHE at the household level. Methods and Material: Between September 2020 and February 2021, a cross-sectional study covering a sample of 771 households was conducted in four districts of Assam. A multistage sampling design was employed to select the sample households. Statistical analysis used: Binary logistic regression analysis has been performed to ascertain the factors that could determine household CHE. Results: 23% households had experienced CHE, high dependence on the private healthcare system. Monthly household income, duration of illness, presence of children under five years of age and elderly members, education of household head, and health insurance were the significant factors influencing CHE. Conclusions: The study identified the growing use of private healthcare services as a major concern that contributes to the prevalence of CHE. To make all healthcare services accessible and affordable and to lower OOP on healthcare, it is also crucial to improve the infrastructure and quality of the public healthcare system in rural and remote locations.

IJCM_199A: Out of pocket expenditure and catastrophic expenditure on haemodialysis: a cross sectional study on patients with chronic kidney disease in Palakkad, Kerala

Background: Advances in kidney transplantation and dialysis have helped millions of people with ESRD. However, cost involved in terms of initial investment, maintenance, training, skilled personnel, subsidies on consumables and drugs add to the long-term cost involved with treatment. Objectives: 1. To study the treatment expenditure, out of pocket expenditure and catastrophic expenditure during Haemodialysis. 2) To study sociodemographic characteristics of ESRD patients on Haemodialysis Methodology: It is a cross sectional study conducted in 2 government and 2 private hospitals among patients with chronic kidney disease who were undergoing haemodialysis for a minimum period of 1 month. Data was collected using preformed questionnaire containing data on socio-demographic variables, illness details, dialysis details, medications and other expenditures. Results: 65.7% of participant gave history of having insurance coverage or any assistance for dialysis. But majority of patients used their savings (69.7%), or gifts (60.2%), sold assets (51.2%), made unsecured loans (23.9%), mortgaged their lands (11.9%). In addition, 97.5% had catastrophic expenditure on dialysis. Out of pocket expenditure for dialysis per month was Rs.8,310 in government institutes and Rs.29,655 in private institute. Among private, it was Rs.11,297 rupees in ECHS patients and Rs.18,642 in other social insurance scheme Conclusion: There is a high out of pocket expenditure among dialysis patients for their session with public private disparity

Diabetes, hypertension, and other cardiovascular disease risk factors among adults in an urban underprivileged community in Bangalore city, India.

Diabetes and hypertension are major risk factors of cardiovascular disease, which is known to be the leading cause of global mortality in the world today. Studies have shown that the prevalence of these risk factors is on the rise, with the burden of diabetes alone increasing by 80% in the last two decades. Complications of diabetes and hypertension result in huge public health challenges for the country and catastrophic medical expenditures for families among the urban poor. Our study aims to estimate the prevalence of diabetes, hypertension, and other cardiovascular risk factors among adults in an urban underprivileged community of Bengaluru city. A cross-sectional study was conducted over a period of 6 months where 2245 individuals aged 30 or older were interviewed using a structured interviewer-administered questionnaire used to capture sociodemographic details that assessed modifiable risk factors for diabetes and hypertension. Inclusion criteria for diabetes were considered if the random blood sugar reading was ≥200 mg/dL, whereas a diagnosis of hypertension was taken into consideration if the systolic blood pressure reading was ≥140 mmHg and/or diastolic blood pressure was ≥90 mmHg. Among the 2245 participants that took part in the study, 15.5% were diabetics and 17.2% were hypertensive. There was a strong association of diabetes among consumers of alcohol, with more than one-third having a high prevalence of the disease (odds ratio (OR): 2.09, 95% confidence interval (95% CI): 1.1-3.9). More than half the population were consumers of junk food; the prevalence of diabetes in this group was 1.35 times higher than that in their counterparts (OR: 1.35, 95% CI: 1.0-1.8). A significant association of diabetes was also seen among those identified with central obesity (OR: 1.83, 95% CI: 1.4-2.5). One-third of the population who consumed alcohol were found to be diagnosed with hypertension (OR: 3.08, 95% CI: 1.6-5.9), and one-fifth of individuals who were regular consumers of junk food had a higher prevalence of hypertension (OR: 1.41, 95% CI: 1.1-1.8). A higher prevalence of hypertension was also seen among individuals with central obesity or a body mass index (BMI) of >30 (OR: 1.59, 95% CI: 1.2-2.1; OR: 1.92, 95% CI: 1.4-2.6). The findings from our study conducted in an urban underprivileged area of Bengaluru city shed light on the significant associations between diabetes and hypertension and various demographic and lifestyle factors. Specifically, male gender and lower educational status were found to have a significant association with diabetes, whereas being unmarried and having a high BMI status were strongly linked to hypertension. In addition, the study revealed that elderly individuals, alcohol consumers, junk food eaters, and those with central obesity demonstrated an increased risk for both diabetes and hypertension. By identifying these risk factors, targeted interventions can be developed to address the unique challenges faced by this vulnerable section of society. Strategies can be designed to raise awareness, encourage healthier lifestyle choices, and improve access to healthcare services to effectively prevent and manage diabetes and hypertension in this community.

Domestic Energy Options and Household Health-Care Expenditures: Does Income-Driven Consumption Matter?

Many people who live in rural areas with low disposable income are unable to acquire clean energy. This means that they are exposed to respiratory diseases and are more likely to encounter unbearable healthcare expenditures. But when stakeholders are responsive, they create a healthcare system that offers affordable and accessible and encourages the use of clean energy. When health care expenditure is high, many poor households struggle to access the services, particularly for households not covered by health insurance. Therefore, the current study sought to examine the moderating role of income on the relationship between domestic energy options and healthcare expenditure. The study used a cross-sectional research design and collected data from a random sample osf 384 households from Kisii County. The data was collected using a structured questionnaire. Data was analyzed using descriptive and inferential statistics. Findings show that most of the households were earning less than Ksh. 30,000 a month. Similarly, more than two-thirds of the households relied on solid biomass including firewood and charcoal for cooking. Findings show that domestic energy options have a significant relationship with healthcare expenditure for households in Kisii County. However, income does not moderate the relationship between domestic energy options and healthcare expenditure. The findings help policymakers to improve the uptake of clean energy options among households by subsidizing the cost of clean energy or removing tax on the products. The findings also encourage the uptake of universal healthcare among poor populations to reduce incidences of catastrophic healthcare expenditure.

Out-of-pocket expenditure among patients with diabetic foot ulcer in a tertiary care hospital of south India: A cross-sectional study.

Diabetic foot ulcer is a debilitating complication of long-standing diabetes mellitus. Patients lose their earning potential, face repeated hospitalizations, and are forced to bear heavy treatment costs. This places an enormous financial burden on the patients and their families. This study seeks to ascertain the out-of-pocket expenditure among these patients and correlate it with their risk factor profile. In this hospital-based cross-sectional study, a total of 154 patients with diabetic foot ulcers or amputations have been studied with an elaborate patient questionnaire and relevant clinical examinations. The costs incurred and the risk factors of the patients were analyzed for statistical association. The median total annual out-of-pocket expenditure for the management of diabetic foot ulcers among the study participants was found to be ₹29 775 (₹9650-₹81 120) ($378.14 [$122.56-$1030.22]). Out of the total expenditure, 58.49% went towards direct medical costs, 5.64% towards direct non-medical costs, and 35.88% for indirect costs. Medications, ulcer dressing and periodic debridement have accounted for 79.26% of direct medical costs. Transportation (61.37%) and patient's loss of income (89.45%) account for the major costs under the direct non-medical and indirect cost categories, respectively. A high ulcer grade and area, long ulcer duration, and past history of ulcers have higher expenditure. Patients seeking treatment from private establishments and those engaged in professional/skilled occupations have higher expenses. Adequate dressing of foot ulcers and proper footwear are associated with lower treatment expenditure. 68.8% of the participants have faced catastrophic expenditure due to treatment costs of diabetic foot ulcers. Adequate glycaemic control and proper foot care are necessary. Patients must seek medical care at the earliest in case of foot ulceration. Clinicians must provide proper wound care, institute effective antibiotics, and manage the complications. Government and insurance schemes are required to alleviate the patients' financial burden.