Catastrophic Healthcare Expenditure Research Articles

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.

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.

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 & 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.

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.

Rural‒urban disparities in household catastrophic health expenditure in Bangladesh: a multivariate decomposition analysis.

Rural‒urban disparity in catastrophic healthcare expenditure (CHE) is a well-documented challenge in low- and middle-income countries, including Bangladesh, limiting financial protection and hindering the achievement of the Universal Health Coverage target of the United Nations Sustainable Development Goals. However, the factors driving this divide remain poorly understood. Therefore, this study aims to identify the key determinants of the rural‒urban disparity in CHE incidence in Bangladesh and their changes over time. We used nationally representative data from the latest three rounds of the Bangladesh Household Income and Expenditure Survey (2005, 2010, and 2016). CHE incidence among households seeking healthcare was measured using the normative food, housing, and utilities method. To quantify covariate contributions to the rural‒urban CHE gap, we employed the Oaxaca-Blinder multivariate decomposition approach, adapted by Powers et al. for nonlinear response models. CHE incidence among rural households increased persistently during the study period (2005: 24.85%, 2010: 25.74%, 2016: 27.91%) along with a significant (p-value ≤ 0.01) rural‒urban gap (2005: 9.74%-points, 2010: 13.94%-points, 2016: 12.90%-points). Despite declining over time, substantial proportions of CHE disparities (2005: 87.93%, 2010: 60.44%, 2016: 61.33%) are significantly (p-value ≤ 0.01) attributable to endowment differences between rural and urban households. The leading (three) covariate categories consistently contributing significantly (p-value ≤ 0.01) to the CHE gaps were composition disparities in the lowest consumption quintile (2005: 49.82%, 2010: 36.16%, 2016: 33.61%), highest consumption quintile (2005: 32.35%, 2010: 15.32%, 2016: 18.39%), and exclusive reliance on informal healthcare sources (2005: -36.46%, 2010: -10.17%, 2016: -12.58%). Distinctively, the presence of chronic illnesses in households emerged as a significant factor in 2016 (9.14%, p-value ≤ 0.01), superseding the contributions of composition differences in household heads with no education (4.40%, p-value ≤ 0.01) and secondary or higher education (7.44%, p-value ≤ 0.01), which were the fourth and fifth significant contributors in 2005 and 2010. Rural‒urban differences in household economic status, educational attainment of household heads, and healthcare sources were the key contributors to the rural‒urban CHE disparity between 2005 and 2016 in Bangladesh, with chronic illness emerging as a significant factor in the latest period. Closing the rural‒urban CHE gap necessitates strategies that carefully address rural‒urban variations in the characteristics identified above.

The Impact of Social Health Insurance on Household Catastrophic Healthcare Expenditures Associated with Chronic Diseases in Sundarharaincha Municipality, Morang

Introduction: Catastrophic health expenditure (CHE) is the condition of paying for health care that exceeds a defined family income or consumption level. Households who spend CHE may have to forego the consumption of other goods essential to their well-being. Chronic diseases require ongoing and often expensive healthcare services and treatments, which can be financially devastating for households without adequate health insurance coverage. Social health insurance programs can provide financial protection and access to healthcare services for individuals and families with chronic diseases. This study aims to assess the impact of the social health insurance program on household catastrophic healthcare expenditures associated with chronic diseases in Sundarharaincha Municipality, Morang.
 Method: A Retrospective Cross-sectional research design was adopted to collect the data from 424 households by cluster and probability simple random sampling technique. A semi-structured questionnaire was developed based on an intensive literature review. The investigator himself after the approval of the PUSHS- IRC (Purbanchal University School of Health Sciences Institutional review committee) collected data. Before data collection, formal permission was obtained from the Municipality office of Sundarharaincha. Written and verbal consent was obtained from each literate and illiterate household respondent respectively before the interview and observation. The findings were described in descriptive and inferential statistics.
 Results: The data show that various socio-demographic characteristics are associated with catastrophic healthcare expenditures. A significant impact is seen between social health insurance and catastrophic healthcare expenditures associated with chronic diseases. The majority of the respondents (93.4%) stated that health insurance protects their financial crisis from catastrophic healthcare expenditure. Most (93.7%) of the respondents who expressed reduced economic burden and others as benefits of the enrolment, were compared to health service from specialized hospitals (92.9%) among those who were protected from catastrophic healthcare expenditures by the health insurance program. Similarly, 94.7 % of the respondents said the economic burden was a problem if not enrolled in the health insurance program and 83.3 percent said tension and others as problems if not enrolled. This study also shows that 87.8 percent of the insured respondents who were protected against CHE by the health insurance program had less than 5000 NPR costs per visit (<0.001). Out of the total respondents who were protected against CHE by the health insurance program, 93.6 percent were satisfied with health insurance and 92.9 percent want to continue health insurance in the coming days.
 Conclusion: By providing adequate coverage and support for households with chronic illnesses, social health insurance could significantly reduce the incidence of catastrophic healthcare expenditure, contributing to poverty reduction and improved health outcomes. Policymakers related to social health insurance program and the concerned government should implement measures to increase health insurance coverage among households having chronic diseases to reduce the burden of healthcare expenditure.

Investigating catastrophic health expenditure among people living with HIV and AIDS in South Western Nigeria

AbstractBackgroundThis study aimed to determine the catastrophic healthcare expenditure (CHE) among people living with HIV (PLHIV) in Lagos and to identify factors associated with CHE among them.MethodsThe study was a descriptive cross‐sectional survey conducted between January and March 2021 among 578 PLHIVs drawn from various healthcare facilities in Lagos where HIV care and treatment services should be provided free of charge. Data were collected through pretested questionnaires and analyzed using Stata SE 12.ResultsThe mean monthly expenditure on food was N29,282 ($53.2), while expenditure on healthcare averaged N8364 ($15.2). Nearly 60% of respondents experienced CHE, while around 30% had to borrow money to pay for some aspect of their medical treatment. Almost all (96%) had no health insurance plan. Respondents' group, personal income, perception of current health status, and the number of people in their households were significantly associated with catastrophic health expenditure p < 0.05. PLHIV in the racial/ethnic minority/migrants' group and those who earned less than ₦30,000 ($55) were statistically significantly associated with CHE at p < 0.001 with OR of 28.7 and 3.15, respectively.ConclusionsThe study, therefore, highlights the widespread financial hardship faced by PLHIV in accessing healthcare, and the need for policies to increase financial risk protection.

Prevalence and Determinants of Catastrophic Healthcare Expenditures in Iran From 2013 to 2019.

Protecting people against financial hardship caused by illness stands as a fundamental obligation within healthcare systems and constitutes a pivotal component in achieving universal health coverage. The objective of this study was to analyze the prevalence and determinants of catastrophic health expenditures (CHE) in Iran, over the period of 2013 to 2019. Data were obtained from 7 annual national surveys conducted between 2013 and 2019 on the income and expenditures of Iranian households. The prevalence of CHE was determined using a threshold of 40% of household capacity to pay for healthcare. A binary logistic regression model was used to identify the determinants influencing CHE. The prevalence of CHE increased from 3.60% in 2013 to 3.95% in 2019. In all the years analyzed, the extent of CHE occurrence among rural populations exceeded that of urban populations. Living in an urban area, having a higher wealth index, possessing health insurance coverage, and having employed family members, an employed household head, and a literate household head are all associated with a reduced likelihood of CHE (p<0.05). Conversely, the use of dental, outpatient, and inpatient care, and the presence of elderly members in the household, are associated with an increased probability of facing CHE (p<0.05). Throughout the study period, CHE consistently exceeded the 1% threshold designated in the national development plan. Continuous monitoring of CHE and its determinants at both household and health system levels is essential for the implementation of effective strategies aimed at enhancing financial protection.

Lost and Found: A Mixed Methods Study on Treatment Abandonment in Acute Leukemia

Introduction: Acute leukemias represent an important public health problem due to their high morbidity and mortality. Treatment failure due to abandonment or loss of follow-up (LOF) is a contributing factor to poor outcomes. Objective: to determine the causes and outcomes of LOF in a cohort of adults with a diagnosis of acute leukemia and its impact on survival in a limited-resource setting. Materials and Methods: We conducted a prospective, single-center cohort study from 2016 to 2022 in the university hospital; this institution is subsidized with funds from private and public sources. We included patients undergoing induction, consolidation, and maintenance phases of treatment for acute lymphoblastic (ALL) and acute myeloid leukemia (AML). LOF events were defined as discontinuation of follow-up beyond the last documented visit in the electronic medical records, with a timeframe of 2 to 4 weeks during the induction and 4 to 8 weeks in the consolidation or maintenance phases. Patients with LOF were contacted via telephone. Those who responded underwent a structured interview that assessed factors potentially contributing to the discontinuation of treatment. Treatment response, event-free survival (EFS), and overall survival (OS) in patients who lost follow-up were also assessed. Results: From January 1, 2016, to October 31, 2022, a total of 391 patients were treated n=99 patients were found to have lost follow-up during first-line treatment, and 73 patients, (%) answered the phone call, 75.3% had been diagnosed with ALL, and 24.7% with AML. Of the 55 patients diagnosed with ALL, 52.7% were women, the median age was 26 years (range 18-86), and 96.4% were classified as a high-risk disease according to age, white blood cell count at diagnosis, CNS involvement, or steroid response. Most patients lived in an urban area (90.9%), and 74.5% didn't have healthcare coverage. Among the patients diagnosed with AML, 50% were male, the median age of diagnosis was 33 years (range 23-67), 94.4% resided in urban areas, and 83.3% of the patients did not have healthcare coverage, thus and molecular risk could not be determined due to the high cost of comprehensive genetic analysis. All patients were classified as low socioeconomic status, with a median income of $130 US dollars per month, (range, 81 -378 USD) for the ALL cohort and $180 USD for the AML group. Based on the findings of the telephone survey, it was evident that economic constraints were the primary driver of treatment abandonment in both ALL and AML patients, accounting for 92.8% and 94.4% of cases, respectively. Specifically, 92.7% of the ALL group expressed difficulties in covering the costs of treatment, while 83.3% in the AML group faced similar challenges. For ALL patients LOF was more frequent during the maintenance phase, (61.8%) compared to consolidation in AML patients (44%). Despite telephone contact, 76.4% of those with ALL and 77.8% of those with AML, could not continue follow-up. Concerning disease status, 11.1% of patients diagnosed with ALL and 34.5% of patients with AML that resumed follow-up after the phone call were diagnosed with relapsed disease. OS at 2 years from the time LOF was identified 49.1% for ALL and 61.1% for AML. Additionally, the 2-year EFS rates were 43.6% for ALL and 44.4% for AML. Conclusions: Lack of access to financial resources and catastrophic healthcare expenditures were the main reason for abandoning treatment in patients with acute leukemia. Despite the loss of follow-up, the overall survival in both groups of patients showed favorable long-term outcomes; however, risk assessment strategies should be employed, and support programs implemented to improve outcomes in vulnerable populations.

Facilitators and Barriers of Integrated Care for Older Adults with Multimorbidity: A Descriptive Qualitative Study.

A lack of coordinated care leads to multiple adverse effects for older adults with multimorbidity, including high treatment burdens, adverse health outcomes, reduplicated healthcare service utilization, and catastrophic healthcare expenditure. To foster healthy aging, person-centered integrated care that is responsive to older adults has been proposed by the World Health Organization. The objective of this study was to identify factors that impact the successful implementation of integrated care for older adults with multimorbidity in China. From July 2022 to May 2023, 33 healthcare providers and managers involved in the delivery and management of healthcare services for older adults with multimorbidity were recruited from Zhejiang Province, China using purposeful and maximum variation sampling methods. Semi-structured, face-to-face in-depth interviews were conducted by the same interviewer in the participants' native Chinese language until data saturation was reached. Inductive thematic analysis was used to analyze the data, and then, themes were mapped onto six dimensions using the Rainbow Model of Integrated Care to allow for a comprehensive view of the study's findings. Eleven themes were generated as facilitators and barriers to integrated care for older adults with multimorbidity in China. These themes include (1) clinical integration: patient-centered care, (2) professional integration: interdisciplinary teams and training, (3) organizational integration: resources and accessibility, (4) system integration: community and funds, incentives, and health insurance, (5) functional integration: electronic health record systems, workforce, and guidelines, and (6) normative integration: shared mission. Guided by the Rainbow Model of Integrated Care, various factors at both micro, meso, and macro levels that impact the implementation of integrated care for older adults with multimorbidity in the Chinese context have been identified in this study. The strategies for future interventions and policies should focus on promoting facilitators and addressing barriers.

Are outpatient costs for hypertension and diabetes care affordable? Evidence from Western Kenya.

Diabetes and hypertension pose a significant socio-economic burden in developing countries such as Kenya, where financial risk-protection mechanisms remain inadequate. This proves to be a great barrier towards achieving universal health care in such settings unless mechanisms are put in place to ensure greater access and affordability to non-communicable disease (NCD) management services. This article aims to examine outpatient management services costs for patients with diabetes and hypertension attending public primary healthcare facilities. The study was conducted in Busia and Trans-Nzoia counties in Western Kenya in facilities supported by the PIC4C project, between August 2020 and December 2020. This cross-sectional survey included 719 adult participants. Structured interviewer-administered questionnaires were used to collect information on healthcare-seeking behaviour and associated costs. The annual direct and indirect costs borne by patients were computed by disease type and level of healthcare facility visited. Patients with both diabetes and hypertension incurred higher annual costs (KES 13 149) compared to those with either diabetes (KES 8408) or hypertension (KES 7458). Patients attending dispensaries and other public healthcare facilities incurred less direct costs compared to those who visited private clinics. Furthermore, a higher proportionate catastrophic healthcare expenditure of 41.83% was noted among uninsured patients. Despite this study being conducted in facilities that had an ongoing NCDs care project that increased access to subsidised medication, we still reported a substantially high cost of managing diabetes and hypertension among patients attending primary healthcare facilities in Western Kenya, with a greater burden among those with comorbidities.Contribution: Evidenced by the results that there is enormous financial burden borne by patients with chronic diseases such as hypertension and diabetes; we recommend that universal healthcare coverage that offers comprehensive care for NCDs be urgently rolled out alongside strengthening of lower-level public healthcare systems.

Catastrophic Out-of-Pocket Expenditure on Health: Evidence from the Regions in the Philippines

This study estimates Filipino’s catastrophic and impoverishing out-of-pocket (OOP) healthcare expenditures on a regional perspective to measure the effectiveness and progress of Philippines’ healthcare financing system in ensuring population protection from excessive and unequal healthcare costs. Observations are drawn from the most recent household-based survey in the Philippines, 2018 and 2021 Family Income and Expenditure Survey, and grouped by four major regions: National Capital Region, the rest of Luzon, Visayas, and Mindanao region. From 2018 to 2021, results showed that the distribution of catastrophic OOP healthcare expenditures decreases while depth of these payments increases across the four major regions. The highest incidences of these catastrophic payments were found in the rest of Luzon and Visayas regions, while the highest intensities were found in Mindanao region. Despite medicines and pharmaceuticals products dominance on OOP healthcare expenditures, payment on inpatient medical services drives the catastrophic expenditures of households. Aside, deepening poverty caused by healthcare payments were more evident in households residing in Mindanao regions, thus exposing this Filipino families to financial risk and poverty threats. Logistic regression analysis showed that aging households head, employment, and socio-economic status are significant and common factors affecting the likelihood of incurring excessive health expenditures across the regions. The risk of catastrophic and impoverishing effects of healthcare expenditures persists in the country. Low levels of catastrophic OOP healthcare expenditures may indicate that disadvantaged households focused on spending on basic necessities and struggle to afford healthcare due to high costs amid COVID 19, leading to foregone treatment. Thus, continuous implementation of fair and innovative ways of financing the healthcare system to reduce the financial burden of OOP payments on Filipino households is recommended.

Determinants of Out-of-Pocket Health Expenditure and Catastrophic Health Spending among Households with Elderly Individuals in Iran: An Application of the Heckman Model to Control Sample Selection

Introduction: Universal health coverage is a critical goal for low- and middle-income countries, with equitable access to healthcare services being essential to achieving this objective. With the elderly population requiring greater healthcare services, it is crucial to plan for their healthcare needs. This study aims to evaluate the determinants of out-of-pocket payment (OOP) and catastrophic healthcare expenditure among households with elderly individuals in Iran.
 Methods: This study analyzed the 2018 Household Income-Expenditure Survey in Iran to examine the socio-economic factors affecting OOP (per purchasing power parity International Doller – PPP. Int $) and catastrophic healthcare expenditure in households with elderly members. Using survey probit regression model with Heckman selection, the study identified determinants of OOP and catastrophic healthcare expenditures. A survey probit regression model with Heckman selection has been applied to identify the determinants of out-of-pocket (OOP) and catastrophic healthcare expenditures. The approach allowed for the examination of variables that may have impacted the likelihood of incurring OOP and catastrophic healthcare expenditures, while accounting for potential selection bias.
 Results: Rural households (with difference 60.78 PPP. Int$) and non-owning homes (with difference 98.83 PPP.Int$) had higher OOP than their urban and owning counterparts, respectively. Larger households also had higher OOP, with those with five or more members having the highest. High-income households also had higher OOP. Additionally, smaller households had a lower chance of facing catastrophic healthcare expenses. Lastly, the Mills ratio was negative.
 Conclusion: Our study reveals insufficient observed out-of-pocket (OOP) payments for healthcare in Iran to cover the "needed" OOP, indicating a possible financial burden on households. This highlights the need to address inequalities in healthcare access and expenditure for households with elderly individuals, particularly in rural areas and larger households. Policymakers should implement targeted interventions to reduce OOP for these vulnerable groups. Future research should include socio-economic factors that affect access to healthcare services.

PERFORMANCE OF MUTUAL FUNDS ON SUSTAINABLE MICRO-HEALTH INSURANCE SCHEMES IN GHANA: The Role of Fast Adaptive Neural Network Classifier

Micro-health insurance models have emerged (in different forms) as a more reliable source of seeking financial protection for a significant proportion of Ghanaians against the downside of medical cost. Most micro-health insurance contributions end up with mutual funds hence the performance of the mutual fund determines to a large extent the sustainability of the scheme. This makes the mutual fund market an indispensable factor in stimulating or stifling healthcare access in Ghana with health equity implications. Recently, machine learning performance evaluation approaches such as Artificial Neural Networks (ANN) have proven valuable in evaluating the performance of mutual funds due to superior forecasting and calculating abilities relative to native algorithms. We applied a novel Fast Adaptive Neural Network Classifier (FANNC) to publicly available historical financial performance data from the Ghana Stock Exchange. We benchmarked our results against the outcome of a backpropagation neural network model (BPN) and measured speed of processing performance information for micro-health insurance managers looking for high earning but less risky investment destination for their vulnerable funds. The FANNC tool proved superior in terms of prediction error and processing time to existing robust models such as the Backpropagation neural network. Employing effective tools such as FANNC tools can quicken the pace of investment performance assessment, rank a hierarchy of desirable investment options for micro-health insurance schemes to explore. This can guarantee fast processing time and accurate investment decision of micro-health insurance to enable it play the essential role of enhancing health risk management of the members of the general public especially the poor and vulnerable that are often the victims of catastrophic healthcare expenditure.

Predictors of Financial Toxicity Among United States Prostate Cancer Survivors: Results From a National Survey.

Despite increasing attention to financial toxicity associated with prostate cancer, national rates of subjective and objective financial toxicity have not been well characterized, and it remains unknown which prostate cancer survivors are at highest risk for undue financial burden. Men with a history of prostate cancer were identified from the Medical Expenditure Panel Survey. The proportion of men reporting catastrophic health care expenditures (out-of-pocket spending >10% of income) and other measures of financial toxicity were assessed. Multivariable logistic regression was used to identify independent predictors of financial toxicity. Of a weighted estimate of 2,349,532 men with a history of prostate cancer, 13.5% reported catastrophic health care expenditures, 16% reported subjective worry about ability to pay medical bills, and 15% reported work changes due to their cancer diagnosis. Significant predictors of catastrophic expenditures included private insurance (OR 4.62, 95% CI 1.29-16.49) and medical comorbidities (OR 1.38, 95% CI 1.05-1.82), while high income was protective (>400% vs <100% federal poverty level, OR 0.06, 95% CI 0.02-0.19). Each year of older age was associated with decreased odds of subjective worry about medical bills. Only 12% of men reported their doctor discussed the costs of care in detail. Nearly 1 in 7 prostate cancer survivors experience catastrophic health care expenditures, and a larger proportion report subjective manifestations of financial toxicity. Many men report their physicians did not address the financial side effects of treatment. These results highlight the patient characteristics associated with this important side effect of prostate cancer care.

Out-of-pocket costs and catastrophic healthcare expenditure for families of children requiring surgery in sub-Saharan Africa

BackgroundOut-of-pocket healthcare costs leading to catastrophic healthcare expenditure pose a financial threat for families of children undergoing surgery in Sub-Saharan African countries, where universal healthcare coverage is often insufficient. MethodsA prospective clinical and socioeconomic data collection tool was used in African hospitals with dedicated pediatric operating rooms installed philanthropically. Clinical data were collected via chart review and socioeconomic data from families. The primary indicator of economic burden was the proportion of families with catastrophic healthcare expenditures. Secondary indicators included the percentage who borrowed money, sold possessions, forfeited wages, and lost a job secondary to their child’s surgery. Descriptive statistics and multivariate logistic regression were performed to identify predictors of catastrophic healthcare expenditure. ResultsIn all, 2,296 families of pediatric surgical patients from 6 countries were included. The median annual income was $1,000 (interquartile range 308–2,563), whereas the median out-of-pocket cost was $60 (interquartile range 26–174). Overall, 39.9% (n = 915) families incurred catastrophic healthcare expenditure, 23.3% (n = 533) borrowed money, 3.8% (n = 88%) sold possessions, 26.4% (n = 604) forfeited wages, and 2.3% (n = 52) lost a job because of the child’s surgery. Catastrophic healthcare expenditure was associated with older age, emergency cases, need for transfusion, reoperation, antibiotics, and longer length of stay, whereas the subgroup analysis found insurance to be protective (odds ratio 0.22, P = .002). ConclusionA full 40% of families of children in sub-Saharan Africa who undergo surgery incur catastrophic healthcare expenditure, shouldering economic consequences such as forfeited wages and debt. Intensive resource utilization and reduced insurance coverage in older children may contribute to a higher likelihood of catastrophic healthcare expenditure and can be insurance targets for policymakers.

The Risk of Catastrophic Healthcare Expenditures Among Prostate and Bladder Cancer Survivors in the United States

IntroductionLittle is known about the rates of catastrophic health care expenditures among survivors of prostate and bladder cancer or the factors that place patients at highest risk for undue cost. Materials and MethodsThe Medical Expenditure Panel Survey was utilized to identify prostate and bladder cancer survivors from 2011 to 2019. Rates of catastrophic health care expenditures (out-of-pocket health care spending >10% household income) were compared between cancer survivors and adults without cancer. A multivariable regression model was used to identify risk factors for catastrophic expenditures. ResultsAmong 2620 urologic cancer survivors, representative of 3,251,500 (95% CI 3,062,305-3,449,547) patients annually after application of survey weights, there were no significant differences in catastrophic expenditures among respondents with prostate cancer compared to adults without cancer. Respondents with bladder cancer had significantly greater rates of catastrophic expenditures (12.75%, 95% CI 9.36%-17.14% vs. 8.33%, 95% CI 7.66%-9.05%, P = .027). Significant predictors of catastrophic expenditures in bladder cancer survivors included older age, comorbidities, lower income, retirement, poor health status, and private insurance. Though White respondents with bladder cancer had no significantly increased risk of catastrophic expenditures, among Black respondents the risk of catastrophic expenditures increased from 5.14% (95% CI 3.95-6.33) without bladder cancer to 19.49% (95% CI 0.84-38.14) with bladder cancer (OR 6.41, 95% CI 1.28-32.01, P = .024). ConclusionsThough limited by small sample size, these data suggest that bladder cancer survivorship is associated with catastrophic health care expenditures, particularly among Black cancer survivors. These findings should be taken as hypothesis-generating and warrant further investigation with larger sample sizes and, ideally, prospective investigation.

Cost of wound dressing: Implication for enrollment into the National Health Insurance scheme, Nigeria.

Enrollment into the National Health Insurance scheme (NHIS) still poses a challenge in Nigeria despite the established Group, Individual and Family Social Health Insurance Programme (GIFSHIP) during the coronavirus disease 2019 (COVID-19) pandemic. This study examined the direct cost of wound dressing and enrollment into the health insurance scheme among hospitalised patients. A descriptive cross-sectional research design was utilised to investigate the cost of wound dressing and enrollment into health insurance scheme among hospitalised patients in three selected hospitals of South-West Nigeria. The study was conducted from March 2021 to June 2021, and 190 patients were recruited via an interviewer-administered questionnaire. Ethical approvals were obtained from the hospitals while COVID-19 preventive protocols and ethical principles of autonomy, confidentiality and non-maleficence were observed. Majority of the respondents (91%) were not on any healthcare insurance scheme, only 4.2% were enrolled in NHIS while over 70% could not personally pay for their wound dressing. The minimum average cost of wound dressing materials per week and per acute care episode was ₦10 000.00 (Nigerian naira) and ₦50 000.00, respectively, while the minimum average cost for hospitalisation per week and per acute care episode was ₦18 000.00 and ₦130 000.00, respectively, ($1.00 equaled ₦600.00, June 2022). A lack of health insurance coverage is a precursor of 'out of pocket' payment. A political will is required to scale up enrollment of the indigenous population into the NHIS in Nigeria.Contribution:Many hospitalised patients are not enrolled in the NHIS and they are at a higher risk of catastrophic healthcare expenditure.

Has South Korea achieved the goals of national health insurance? Trends in financial protection of households between 2011 and 2018

This study aims to investigate the evolution of financial protection of households against OOP in South Korea, where subsequent policies of expanding benefit coverage have been implemented primarily focusing on several severe diseases, by measuring catastrophic healthcare expenditure (CHE) and the characteristics of households vulnerable to CHE. Using the Korea Health Panel 2011–2018, this study analyzed CHE trends by the targeted severe diseases and other health problems and household income and examined the determinants of CHE using binary logistic regression. Our findings showed that CHE decreased in households with the targeted severe diseases but increased in households experiencing hospitalization that were not related to the targeted diseases, which appeared to have a significantly higher likelihood of CHE in 2018 than households with the targeted severe diseases. In addition, CHE was more prevalent and increased or remained stagnant among households whose heads had health problems than others. Inequalities in CHE also increased, showing increased Concentration Index (CI) and increased incidences of CHE in the lower income quartile during the study period. These results suggest that the current policies are insufficient to achieve its financial protection goals against healthcare expenditure in South Korea. In particular, benefit expansions targeting a specific disease may cause inequitable distribution of resources and may not enhance protection against households' financial burden.