Occurrence Of Catastrophic Health Expenditure Research Articles

Effect of the New Health Care Reform on catastrophic health expenditure in households of patients with chronic diseases in Shaanxi Province: a before-and-after analysis

BackgroundIn 2009, China officially launched the New Health Care Reform. This study aimed to measure the occurrence of catastrophic health expenditure of households with at least one member diagnosed with chronic diseases (hereafter referred to as chronic households) in Shaanxi Province before and after the reform, and explore the influence of the New Health Care Reform on catastrophic health expenditure. MethodsThe data were from the fourth and fifth National Household Health Service Surveys of Shaanxi Province. In total, 1942 chronic households in 2008 (954 in urban areas and 988 in rural areas) and 7704 households in 2013 (2870 in urban areas and 4834 in rural areas) were selected for analysis. WHO's method was used to estimate catastrophic health expenditure, which was defined as an out-of-pocket payment for health care equal to or higher than 40% of a household's capacity to pay. A multilevel logistic regression model was used to explore the influence of the New Health Care Reform on the presence of catastrophic health expenditure. We used the concentration index to measure the income-related inequality in catastrophic health expenditure. FindingsIn rural areas, the proportion of households incurring catastrophic health expenditure dropped (288 [29%] households in 2008 vs 1142 (24%) in 2013; χ2 13·517, p=0·00024). However, in urban areas, the proportion of households suffering from catastrophic health expenditure increased (183 [19%] households in 2008 vs 716 [25%] in 2013; χ2 13.235, p=0·00027). After controlling for confounding variables (eg, commercial insurance, household size, having elderly members, having children, household economic status, and age, gender, education, marital status, and employment status of household head), the random-intercept logistic regression model showed a significant interaction term between year and geographic location, implying that the influence of the New Health Care Reform on catastrophic health expenditure differed between urban and rural areas. From 2008 to 2013, the concentration index of catastrophic health expenditure in rural areas increased from −0·4572 to −0·5499 (difference −0·0927, Z −2·22, p=0·026). InterpretationOur study suggested that the implementation of the New Health Care Reform might not have been effective in reducing catastrophic health expenditure for households of patients with chronic diseases, especially in urban areas. Additionally, the income inequality of catastrophic health expenditure was greater in 2013 than in 2008 in rural areas. Although the reform resulted in higher insurance coverage and higher government expenditure in health care, the financial burden of health care on households did not necessarily improve. Further efforts to develop the current health insurance system and optimise the hierarchical health-care system are required to improve protection against catastrophic health expenditure. FundingXi'an Jiaotong University (grant number GG1K004).

Individual and socioeconomic disparities in health-seeking behaviours and out-of-pocket payments in the Gaza Strip in 2013: results from a household survey

BackgroundDifferent population groups in the Gaza Strip, occupied Palestinian territory, use the services of a pluralistic health system and spend part of their income on health. Nonetheless, little is known about disparities between different populations in seeking and paying for health care. MethodsA random sample of 760 households with 5192 people in July, 2013, in the Gaza Strip, occupied Palestinian territory, were interviewed using a structured questionnaire to inquire about health-seeking behaviour and the out-of-pocket payments. The data were collected over 1 week, and respondents were asked about their use of services with different recall periods. Expenditure was annualised to calculate catastrophic health expenditure as a proportion of income (defined as spending 20% or more of household income on health). χ2 tests were done to compare differences between grouped variables. Statistical Package for Social Sciences (SPSS) version 20.0 was used for statistical analyses. FindingsCatastrophic health expenditure occurred less in households with refugee status (132 [25·1%] of 526) than in those without refugee status (77 [32·9%] of 234); this yielded to a relative risk (RR) of 0·76 (95% CI 0·60–0·96, p=0·026). The occurrence of catastrophic health expenditure in households which live inside refugee camps was less than households which live outside the refugee camps (43 [20·4%] of 209 living inside vs 168 [30·2%] of 551 living outside; RR 0·67, 95% CI 0·50–0·91, p=0·006]). Catastrophic health expenditure occurred in 138 (33·2%) of 416 households that have at least one person with a chronic non-communicable disease, and in 71 (20·6%) of 344 households with no individual with a chronic non-communicable disease (RR 1·61, 95% CI 1·25–2·06). The occurrence of catastrophic health expenditure in the households with the lowest two income quintiles was greater than households with higher income; 129 (35·5%) of 363 households in the lowest-income quintiles compared with 80 (20·15%) of 397 households in other income quintiles (RR 1·76, 95% CI 1·39–2·24; both p=0·0001). People reported having good access to health services, and preferred free-of-charge services and those offered at nominal users fees for medicines and diagnostic tests. 15 (12·3%) of 122 consultations of people who were acutely ill and from the lowest-income quintile were provided by private for profit providers, compared with 72 (28·9%) of 249 consultations from other income quintiles; relative risk of using private providers for the lowest-income quantile was 0·43 (95% CI 0·25–0·71, p=0·0088. However, a proportion of health services users sought the care of second health providers, mostly private, in addition to initially chosen ones, although this proportion did not differ among income quintiles. InterpretationRefugees who were offered free of charge primary health care services were had reduced health expenditures. People in poor households avoided using costly health services; however, they spent a higher proportion of their income on health than those wealthier households. The findings suggest that maintaining health services offered free of charge or on a low-cost basis and improving their quality and responsiveness might decrease financial burden of ill health on the poor in the Gaza Strip. FundingWorld Health Organization.

Definition methods and standards on medical assistance objects of catastrophic diseases systems based on catastrophic health expenditure perspective

Objective To explore the methods and standards of catastrophic health expenditure for China, and improve the operability in defining those impoverished due to diseases. Methods 600 households with inpatients were randomly sampled from 12 villages of three townships in City M in Hubei province for household survey.Literature review and expert consultation methods were used to measure and determine the threshold of catastrophic health expenditure(CHE)of City M, with improvements made by grouping. Results In a uniform standard, the CHE occurrence of the income method and expenditure method is lower than the non-existence expenditure method and WHO method, verifying theoretically that the standard set for the former should be higher than the latter.In addition, the income method and expenditure method present differently in China.Standards set should vary with different measurement methods, maintaining approximate CEH expenditure for the same region.For the income method and expenditure method, the recommended benchmark reference is 25%, with an adjustable range of 35%~45%.Mutual verifications of these methods can further determine a rational CHE value. Conclusions The CHE methods support the definition of people impoverished due to diseases beyond their household payment capacity.Different thresholds however should be set for different methods, and the relative standards should be translated into absolute standards by grouping. Key words: Catastrophic health expenditure; Catastrophic diseases; Medical assistance; Definition; Standards

A Panel Study on Financial Burden and Spending of Health Expenditure of the Elderly Households : Focusing on Age groups

Korea experiences rapid population aging and increase in health expenditure. The elderly made up a record 13.1% of the total population and 37.8% of the total health spending in 2015. And this would be accelerated because the baby boomers are becoming 65 years old and more by 2020. Catastrophic Health Expenditure(CHE) is the index which can represents the households’ burden of health spending. Despite its importance, there has been few studies about CHE of the elderly households and especially no panel study yet. Therefore, this study is carried out. The study used 3-year data from the Korea Welfare Panel Study conducted from 2012 to 2014. We defined CHE if a household’s health expenditure is equal or greater than the threshold value if income remaining after subsistence needs has been met. We used 3 different threshold values which are 10%, 20% and 30%. In order to look at the elderly households which experienced CHE in depth, correspondence analysis and panel logit analysis were conducted. Also, based on the Two-part Model, Panel analysis was conducted in order to define the factors that affect the households which experienced CHE at 10% threshold level to spend health expenditure. This study showed two notable results. First, there has been a difference in CHE occurrence rates among 3 different age groups, which implies that the older people are, the more easily they can experience CHE. Secondly, the households with no private insurance are showed to have a higher CHE occurrence rate, showing that private insurance does not make a significant difference in health spendings. With the results, private insurance can play its role in protecting households from CHE as a supplement of national health insurance. Therefore, this study can be used as evidence to develop healthcare policy for the elderly. Also, it needs to conduct studies on CHE especially about different age groups.

The Role of Health Insurance, Borrowing and Aids to Pay for Health Care on Reducing Catastrophic Health Expenditure in Indonesia

Background: Sizable out of pocket payment for health care make a hardship financing for many families and this will lead to a catastrophic expenditure. To pay health services that exceed the financial capacity of households would aggravate the economic stability of the household, which in economic terms is called catastrophic expenditure. When Households fall under the poverty line, their catastrophic spending threshold is zero. For households whose expenditures are above the poverty line, catastrophic threshold value will be difference between total household expenditure minus total minimum basic needs of the household divided by the total expenditure of the household. Based on this definition of catastrophic health expenditure, the research examines determinants of catastrophic OOP health expenditure in Indonesia.Method: This study is based on quantitative data analytic research that uses two data sources IFLS years 200 and 2007 and SUSENAS 2009 and 2010. Results: Probability of catastrophic health expenditure in such households especially being significantly influenced by economic condition. While health condition did not have significant influence to increase catastrophic health expenditure. A part of potentially catastrophic households in Indonesia (which are poor and have health problems) were not being catastrophic because they reduced health expenditure and did not use appropriate health treatment. Health cost subsidies like health insurance, borrowing money, and health care cost aids did not have influence to reduce the occurence of catastrophic health expenditure in Indonesia. Conclusion: Economic condition is the biggest factor in the occurrence of catastrophic health expenditure. Potentially catastrophic households were not being catastrophic because they reduce health expenditure and did not use health care treatment. Health cost subsidies like health insurance, borrowing money, and health cost aids have not reduced the occurence of catastrophic health expenditure in Indonesia.

중·고령 가구의 과부담 의료비 발생의 결정요인에 관한 패널연구

Background: Korea shows rapid population aging and increase in healthcare service use and expenditure. Also, this would be accelerated because of the baby boomers who will be 65 years old and more in 2020. Chronic disease is another reason that increases the use of healthcare service and expenditure of the middle- and old-aged households. Catastrophic health expenditure (CHE) is the index which can indicate the households' burden of health spending. Despite the importance, there are few studies on CHE of middle- and old-aged households and especially no panel study yet. This is the reason that this study is carried out. Methods: This study used 3-year data from the Korea Welfare Panel Study conducted from 2009 to 2011. We defined CHE if a household's health expenditure is equal or greater than the threshold value if income remaining after subsistence needs has been met. We used 4 different threshold values which are 10%, 20%, 30%, and 40%. In order to look at the households which experienced CHE, we conducted panel logit analysis after correspondence analysis and conditional transition probability analysis. Results: This study showed three notable results. First, there has been a difference among age groups, which implies that the older people are, the more easily they can experience CHE. Second, the households with no private insurance are shown to have a higher CHE occurrence rate. Lastly, there has been a significant difference among the kinds of chronic diseases. The households which have cancer, cerebrovascular disease, and heart disease have a higher CHE occurrence rate. However, the households with diabetes have no significant effects to CHE occurrence. Also, hypertension has a negative effect to the occurrence. Conclusion: With the results, it can be implied that elderly people with chronic disease are more needed in medical coverage and healthcare. Also, private insurance can play its role in protecting households from CHE. Therefore, it needs to conduct studies on CHE especially about different age groups, private insurance, and chronic disease.

Catastrophic health expenditure and entitlement to health services in the occupied Palestinian territory: a retrospective analysis

BackgroundThe proportion of households that have catastrophic health expenditure in the occupied Palestinian territory increased from 1·16% in 1998, to 2·15% in 2007; however, knowledge about the degree to which different groups of the population are exposed to catastrophic health expenditure is scarce. We assessed possible factors that affect the occurrence of catastrophic health expenditure in the occupied Palestinian territory. MethodsWe analysed data from the Palestinian Consumption and Expenditure Survey, which was collected by the Palestinian Central Bureau of Statistics, mainly during 2010. According to the WHO methods, we classed household health payments as catastrophic if they constituted 40% or more of non-food expenditure. Socioeconomic and demographic categories of households, enrolment in health insurance schemes, and individual characteristics of the family head were grouped and compared with χ2 tests. FindingsOf 3754 households, 1609 (42·9%) were headed by a refugee and 2109 (56·2%) were insured. Catastrophic health expenditure occurred in 90 (2·4%) households. It was more common in uninsured versus insured households (52 of 1645 [3·2%] vs 38 of 2109 [1·8%]; p=0·007). Catastrophic health expenditure was less common for insured refugees (15 of 1024 [1·5%]) than for insured non-refugees (23 of 1085 [2·1%]), uninsured refugees (15 of 585 [2·6%]), and uninsured non-refugees (37 of 1060 [3·5%]; p=0·022). Catastrophic health expenditure differed significantly according to place of residence (Gaza Strip and West Bank) and other household characteristics (household income, proportion of expenditure spent on food, and sex, education, and employment status of the household head). InterpretationCatastrophic health expenditure in the occupied Palestinian territory has steadily increased. The protective effect of entitlement to health services offered to refugees through the United Nations Relief and Work Agency and to insured people, mainly through the Ministry of Health, suggests that any effort to decrease catastrophic health expenditure in the occupied Palestinian territory requires universal health coverage. FundingNone.

서울시 가구의 과부담의료비 지출 발생 및 반복적 발생의 영향요인

Graduate School of Public Health, Seoul National University The national health insurance system in Korea is characterized as relatively high out-of-pocket payments, which are the principal source of catastrophic health expenditure (CHE). The objectives of this study are to estimate the incidence of household CHE and to clarify the characteristics that affect the occurrence and recurrence of household CHE using the Seoul Welfare Panel Survey database for 2008 and 2010. Thresholds to estimate CHE were 10% and 20% of the total household income (T/X), and 25% and 40% of the income excluding food share (T/Y). Determinants of the occurrence and recurrence of CHE at the threshold of T/X=10% were analysed using multiple logistic regression models. Out of the 3,665 households that responded in 2008 survey, households with CHE were 12.07% (T/X<TEX>${\geq}$</TEX>10%), 5.34% (T/X<TEX>${\geq}$</TEX>20%), 6.84% (T/Y<TEX>${\geq}$</TEX>25%), and 4.44% (T/Y<TEX>${\geq}$</TEX>40%). Risk factors associated with household CHE included living with a spouse, non-Medicaid beneficiary, householder unemployment, low household income, the number of disabled members, poor subjective health, and the number of chronic diseases. A total of 41.78% of households with CHE in 2008 repeatedly experienced CHE in 2010. Risk factors of CHE recurrence included decreased household income and an increase in chronic diseases over the two time periods, the number of members with disability or chronic diseases, and the presence of cancer patients in 2008. Households with lower socioeconomic and health status had a higher financial burden on health care than do their counterpart households. There is a need to enhance society-wide financial protection from health spending among vulnerable citizens in Seoul, particularly, households with low income, disabled members or cancer patients.

How effectively can the New Cooperative Medical Scheme reduce catastrophic health expenditure for the poor and non-poor in rural China?

China has implemented the New Cooperative Medical Scheme (NCMS) in rural areas since 2003 to provide financial protection to its rural population. This article explores the effect of NCMS on relieving catastrophic health expenditure (CHE) among the poor and non-poor groups. A questionnaire survey was conducted in three counties, with a random sample of 358 poor and 523 non-poor NCMS enrollees who used inpatient services and obtained NCMS reimbursement in 2005. Majority of NCMS enrollees suffered CHE because of using inpatient services; the occurrence and intensity of CHE was greater among poor inpatients. NCMS reimbursement helped relieve CHE to a certain degree. Poor inpatients benefited more from NCMS than non-poor, but the effects varied among counties. Cost control measures and other medical financial assistance (MFA) helped reduce inpatients' economic burden. The objective of NCMS is only partly achieved. However, NCMS has promoted equity in health financing as poor inpatients can acquire more protection than the non-poor. Our analysis suggests that efforts should be made to improve NCMS design, strengthen cost containment and extend other MFA to further relieve economic burden of disease.