Catastrophic Healthcare Expenditure Research Articles

Household Catastrophic Health Care Expenditure: Evidence on the Effects of Out-of-pocket Health Care Payments on Household Income in East African Region

Out Of Pocket Payments (OOPP) refers to the amount of money a patient pays for medical expenses that are not covered by a health insurance plan (National Cancer Institute, 2022). The World Health Organization (WHO) defines OOPP as the individuals’ direct payments to healthcare providers at the time of service use (Kalantari, 2012). Developing countries are exposed to considerable socio-economic vulnerabilities. Catastrophic out-of-pocket spending has adverse effects on individual and household income, especially where policies on healthcare financing does not favor the poor. Heath care funding and the quality of healthcare outcomes in development are inseparable. The World Health Organization Assembly resolution of 2005 on universal coverage and sustainable health financing, the Paris Declaration of 2001 on greater Investments in the Health Sector, Health Insurance and Financing, and the Sustainable Development Goal number 1 on ending all forms of poverty forms the basis of this study. African Governments committed through the Abuja Declaration, to allocate and spend at least 15 percent of government funds of their National GDP on health. In June 2015, Countries in the East African Community concurrently released their National budgets for the Financial Years 2015/2016. None of the countries had fulfilled the Abuja declaration promise on healthcare investment in East African Community. This study examined how different countries in East Africa have invested in healthcare and the state of out-of-pocket spending on household income. Related literature review will be analyzed, and conclusions and the way forward in relation to household healthcare spending in East African Countries will be discussed.

Out-of-pocket expenditures, catastrophic household finances, and quality of life among hemodialysis patients in Kerala, India.

Kidney replacement therapy in chronic kidney disease patients can result in catastrophic health costs, pushing them into poverty in lower middle-income countries. There are only limited studies from India focusing on the financial hardship of these patients. Data on direct nonmedical and indirect cost of hemodialysis (HD) are also limited. This study aims to find the different components of cost for HD and its association with quality of life (QOL) among HD patients. Primary objective was to find the cost of HD, which include direct medical, direct nonmedical and indirect cost. Secondary objective was to study whether the ratio of out-of-pocket (OOP) payments for HD to household income can affect the QOL. The QOL was assessed using EQ-5D-5L instrument. Catastrophic health care expenditure was defined as OOP health care expenditure exceeding 40% of the household income and distress financing as borrowing money or selling assets to meet the OOP expenditure for treatment. Of the 152 patients enrolled for the study, 103 (67.8%) were males. Mean age was 60.9 ± 12.5 years. Monthly OOP expenditure for dialysis was USD 478.4 (362.6-663.6) of which direct nonmedical and indirect expenses constitute USD 115.6 (88.4-292.4). Median percentage of household income spent for dialysis was 194.5 (IQR 128-297). One hundred and forty-two (93.4%) had catastrophic healthcare expenditure and 76 (50%) had distressing health care expenditure. On multivariable linear regression, proportion of total household income spend for dialysis was associated with poor QOL in patients undergoing HD; coefficient=-0.04 (95% CI -0.008 - 0.092), p=0.039. Nonmedical direct and indirect cost is substantial among patients undergoing HD. Nine of 10 patients had catastrophic health care expenditure, which pushed 50% of the patients to distress financing.

Analysis of US Household Catastrophic Health Care Expenditures Associated With Chronic Disease, 2008-2018

Analysis of US Household Catastrophic Health Care Expenditures Associated With Chronic Disease, 2008-2018

Household Catastrophic Health Expenditure from Oral Potentially Malignant Disorders and Oral Cancer in Public Healthcare of Malaysia.

Objective:Oral cancer causes a significant disease burden and financial distress, especially among disadvantaged groups. While Malaysia has achieved universal health coverage via its highly subsidized public healthcare, patient and family expenditure for treatment of oral potentially malignant disorders (OPMD) and oral cancer remains a concern in the equitability of care. This study thus aims to estimate household out-of-pocket (OOP) expenditures and the extent of catastrophic healthcare expenditure (CHE) while identifying its predictors. Methods:This three-part study consists of a cross-sectional survey to collect sociodemographic and health utilization data of patients, a retrospective medical record abstraction to identify resources consumed, and cost modeling to simulate expenditures in two tertiary public hospitals. Loss of productivity was calculated based on absenteeism related to disease management in the hospital. OOP payments for transport, care in public healthcare facilities, and other healthcare expenditures were tallied. A CHE was defined as OOP spendings of more than 10% from total annual household income. Multivariable logistic regression was further applied to identify the association between sociodemographic factors and the incidence of CHE. Results:A total of 52 patients with OPMD and 52 with oral cancer were surveyed and medical records were abstracted. A Kruskal-Wallis test showed a statistically significant difference in OOP share over household income between OPMD, early- and late-stage cancer, χ2(2)=51.05, p<0.001, with the mean percentage of 9%, 22%, and 65% respectively. This study found that the prevalence of CHE in the first year of diagnosis was 86.5% for oral cancer and 19.2% for OPMD. Indian ethnicity (OR=6.24, p=0.046) and monthly income group ‘less than USD 2,722’ (OR=14.32, p=0.023) were shown as significant predictors for CHE. Conclusions:Our study demonstrated the provision of subsidies may not be adequate to shield the more vulnerable group from CHE when they are diagnosed with OPMD and oral cancer.

Potential Impact of the Insurance on Catastrophic Health Expenditures Among the Urban Poor Population in India

Background: Urban poor face a disproportionate burden of ill health and high out-of-pocket expenditure (OOPE), creating a severe unmet need for affordable and quality health care. This article highlights the impact of health insurance on OOPE and catastrophic healthcare expenditure among the urban poor of India. Methods: The study uses randomly collected household data from a baseline survey conducted in the states of Rajasthan and Uttar Pradesh. Separate Insurance impact models have been generated for the analysis. Results: Mean out-of-pocket health expenses is higher in the private health facility for the inpatient care but in case of outpatient care, the expenditure was more in public. Expenditure on medicine constitutes the largest part of the total OOPE. Insurance impact model shows that coverage on medicine alone can reduce medical impoverishment by 85% in the case of Outpatient Deparment (OPD) and 71% in the case of Inpatient Department (IPD). The urban poor preferred private facility for treatment in case of illness, albeit when it comes to delivery, they prefer public facility Conclusions: Study findings indicate overt reliance on private health care must be regulated, to reduce OOPE among the urban poor. Also, effective universal health insurance can go a long way in reducing the OOPE with availability of free medicines and diagnostics in the public health facilities.

Equity in Out-of-Pocket Payments for Healthcare Services: Evidence from Malaysia.

Background: Out-of-pocket (OOP) payments are an inequitable mechanism for health financing as their high share of total health expenditures poses a risk of catastrophic healthcare expenditures. This study aimed to assess the distribution and progressivity of OOP payments made by Malaysian households for various group of healthcare services. Methods: This study utilized data from the Malaysian Household Expenditure Survey (HES) between 2014 and 2015, which involved 14,473 households. Distribution and progressivity of OOP payments were measured through their proportion of household consumption, a concentration curves plot and the Kakwani Progressivity Index (KPI). Results: The mean proportion of Malaysian OOP payments for healthcare of household consumption was 1.65%. The proportion increased across households’ consumption quintiles, from 1.03% made by the poorest 20% to 1.86% by the richest 20%. The OOP payments in Malaysia were progressive with a positive KPI of 0.0910. The OOP payments made for hospital-based services were the most progressive (KPI 0.1756), followed by medical products, appliances and equipment (KPI 0.1192), pharmaceuticals (0.0925) and outpatient-based services (KPI 0.0394) as the least progressive. Conclusions: Overall, the OOP payments for healthcare services in Malaysia were progressive and equitable as they were more concentrated among the richer households.

Exploring dynamics in catastrophic health care expenditure in Nigeria

BackgroundThe Nigeria’s National Health Insurance Scheme aimed at making health care accessible and affordable since it’s became operational in 2005. However, many Nigerians still pay out of pocket for medical expenses, and this drive them to incurring catastrophic health expenditures. Although monitoring progress towards UHC is crucial, one single study exploring the dynamics in catastrophic health expenditure proportion, associated factors, inequality concentration, inequality size, together with decomposition using a longer period Nigeria panel household survey datasets is very scarce.MethodsData was drawn from three rounds of the Nigeria General Household Survey. The fixed percentage and rank-dependent thresholds were used to calculate and compare the proportion of households that incur catastrophic health expenditures. The logistic regression model was employed in analyzing the factors associated with catastrophic health expenditures. The concentration of catastrophic health expenditures inequality was assessed using the concentration curve, whereas the inequality size was determined using the concentration index. The decomposition method was used to decompose the concentration index into determining components.ResultsRelative to the fixed threshold value, the rank-dependent threshold revealed a higher share of households facing catastrophic health expenditures i.e., from 27% in 2010/2011 to 48% in 2015/2016. The two thresholds reveal similar trend, but differ in percentage points. The key factors associated with catastrophic health expenditures were economic status and geopolitical zone. Inequality in catastrophic health expenditures was found to be concentrated among the poor. The household economic status was uncovered as the major positive contributor to catastrophic health expenditures inequality across the sample periods.ConclusionThe findings of the study imply that narrowing economic status gap across households, and increasing the depth of insurance are crucial mechanisms to reduce the probability of incurring catastrophic health expenditures among the poor in Nigeria.

A study on the utilisation of Ayushman Bharat Arogya Karnataka (ABArK) among COVID patients admitted in a Tertiary Care Hospital

BackgroundOut of pocket and catastrophic healthcare expenditures are leading households to financial hardships in India. The covid-19 pandemic has further added up in the loss of jobs, savings, and lives. The inclusion of covid-19 treatments in health insurance schemes like Ayushman Bharat Arogya Karnataka by the Government has helped families from financial hardships and catastrophic healthcare expenditures. ObjectivesTo estimate the utilization of the Ayushman Bharat insurance scheme among covid-19 positive patients in a tertiary care hospital, Dakshina Kannada District. MethodologyIt was a record-based, cross-sectional study. The study was conducted by collecting data from the hospital medical records department by taking prior permission at a Tertiary Care Hospital of Dakshina Kannada District, Karnataka. The data was collected and entered into an excel sheet, analyzed, and presented in percentage in the tabular form. ResultsIn the present study total 1367 covid-19 positive cases were admitted. Majority of the patients were from Karnataka accounting for 93.92%. The eligible subjects for ABArK were 906 (66.27%), Out of which 714 (78.8%) had utilized the scheme. Among the 714 patients who utilized the ABArK scheme 443 (62.04%) were men and 271 (37.95%) were women. ConclusionThe utilization of this scheme requires further improvement by creating awareness activities among general public. This helps in reducing the out-of-pocket expenditure and burden in accessing the healthcare facility.

Factors associated with health insurance enrolment among Ghanaian children under the five years: analysis of secondary data from a national survey

BackgroundHealth insurance enrolment provides financial access to health care and reduces the risk of catastrophic healthcare expenditure. Therefore, the objective of this study was to assess the prevalence and correlates of health insurance enrolment among Ghanaian children under five years.MethodsWe analysed secondary data from the 2017/18 Ghana Multiple Indicator Cluster Survey. The survey was a nationally representative weighted sample comprising 8,874 children under five years and employed Computer Assisted Personal Interviewing to collect data from the participants. In addition, Chi-square and Logistic Regression analyses were conducted to determine factors associated with health insurance enrolment.ResultsThe results showed that a majority (58.4%) of the participants were insured. Health insurance enrollment was associated with child age, maternal educational status, wealth index, place of residence and geographical region (p < 0.05). Children born to mothers with higher educational status (AOR = 2.14; 95% CI: 1.39–3.30) and mothers in the richest wealth quintile (AOR = 2.82; 95% CI: 2.00–3.98) had a higher likelihood of being insured compared with their counterparts. Also, children residing in rural areas (AOR = 0.75; 95% CI: 0.61–0.91) were less likely to be insured than children in urban areas.ConclusionThis study revealed that more than half of the participants were insured. Health insurance enrolment was influenced by the child's age, mother's educational status, wealth index, residence, ethnicity and geographical region. Therefore, interventions aimed at increasing health insurance coverage among children should focus on children from low socio-economic backgrounds. Stakeholders can leverage these findings to help improve health insurance coverage among Ghanaian children under five years.

Factors associated with catastrophic health care expenditure in South Wollo province, Ethiopia: A cross-sectional study.

Ethiopia is an underfinanced country when compared to the Sub-Saharan average. Direct payment has a high account in Ethiopia and inhibits access to health services for the poor. We aimed to identify the factors associated with catastrophic health expenditure (CHE) in the South Wollo Zone, Ethiopia. A community-based cross-sectional study was conducted. A two-stage sampling technique was used to get a total of 494 households. The data were entered using Epi data version 4.6 and analysed using STATA version 14.1 software for binary logistic regression analysis. A multivariable logistic regression analysis was done to identify the factors associated with CHE. The total magnitude of CHE was found to be 33.97% at the 10% threshold of total household expenditure and 14.98% at the 40% threshold of non-food expenditure. Insured households (adjusted odds ratio=0.02, 95% CI: 0.01-0.10) were statistically associated with CHE with total household and non-food measures. Catastrophic health expenditure was found to be decreased among insured households and increased among households had children less than 5years of age, members with chronic illness, and poor health status. Therefore, encouraging insurance and health promotion activities to improve the health status of the community are important.

Developing Malawi's Universal Health Coverage Index.

The inclusion of Universal Health Coverage (UHC) in the Sustainable Development Goals (target 3.8) cemented its position as a key global health priority and highlighted the need to measure it, and to track progress over time. In this study, we aimed to develop a summary measure of UHC for Malawi which will act as a baseline for tracking UHC index between 2020 and 2030. We developed a summary index for UHC by computing the geometric mean of indicators for the two dimensions of UHC; service coverage (SC) and financial risk protection (FRP). The indicators included for both the SC and FRP were based on the Government of Malawi's essential health package (EHP) and data availability. The SC indicator was computed as the geometric mean of preventive and treatment indicators, whereas the FRP indicator was computed as a geometric mean of the incidence of catastrophic healthcare expenditure, and the impoverishing effect of healthcare payments indicators. Data were obtained from various sources including the 2015/2016 Malawi Demographic and Health Survey (MDHS); the 2016/2017 fourth integrated household survey (IHS4); 2018/2019 Malawi Harmonized Health Facility Assessment (HHFA); the MoH HIV and TB data, and the WHO. We also conducted various combinations of input indicators and weights as part of sensitivity analysis to validate the results. The overall summary measure of UHC index was 69.68% after adjusting for inequality and unadjusted measure was 75.03%. As regards the two UHC components, the inequality adjusted summary indicator for SC was estimated to be 51.59% and unadjusted measure was 57.77%, whereas the inequality adjusted summary indicator for FRP was 94.10% and unweighted 97.45%. Overall, with the UHC index of 69.68%, Malawi is doing relatively well in comparison to other low income countries, however, significant gaps and inequalities still exist in Malawi's quest to achieve UHC especially in the SC indicators. It is imperative that targeted health financing and other health sector reforms are made to achieve this goal. Such reforms should be focused on both SC and FRP rather than on only either, of the dimensions of UHC.

POS-742 HEALTH RELATED QUALITY OF LIFE (HRQOL) IN PAEDIATRIC CHRONIC KIDNEY DISEASE (CKD) AND CAREGIVER BURDEN (CB) – A PROSPECTIVE MIXED-METHODS STUDY

CKD reduces the HRQoL of affected children and is associated with burden on caregivers. Data on HRQoL and CB in CKD from high income countries may not reflect realities of patients and families in low resource settings. Despite our centre’s expertise in providing paediatric CKD care, families frequently discontinue treatment for their child, resulting in poor patient outcomes and ethical challenges to the healthcare team. There is no data regarding HRQoL and CB for paediatric CKD in India. We aimed to measure HRQoL in children with advanced CKD and assess CB in primary caregivers by quantitative scoring and qualitative analysis of novel factors pertinent to our low resource setting. A prospective study conducted at a stand-alone, low-cost, tertiary paediatric nephrology centre with a large referral base. Patients: All children (1-18 yrs) with CKD (Stage 4,5) on treatment >3 months. Caregivers: The parent/grandparent identified by family as patient’s primary medical caregiver. HRQoL Tool: validated PedsQL™ Version 4.0. Patient scores were compared with published control data mean scores [Indian (87.4 ± 11.1) and international (83.9 ± 12.5)]. PedsQL ESRD Module, Version 3.0 was used and compared with previous reported data (69.2 ± 23.2). HRQoL scores were standardised by minimum-maximum normalization (range 0 – 1). ‘Worse’ HRQoL = standardized score </= 0.5. CB Tool: validated Pediatric Renal Caregiver Burden Scale and compared with previous data (120 ± 16.4). ‘High’ CB = CB scores>our study population mean. Reflexive thematic analysis of qualitative data (in-depth audiotaped interviews) was performed to capture family-prioritized factors affecting HRQoL and CB. Patients: 40 CKD patients (26 male, median age 11 yrs, 30 on dialysis) and caregivers (38 mothers) were included. Families (65% lower middle/upper lower SES) had median income of INR 18000/month. Patient HRQoL mean scores (63.1 ± 16.7) were lower than controls and previous high income country paediatric CKD data (73.72 ± 17.42). The physical domain contributed significantly to worse Qol. ‘Worse’ HRQoL was associated with inability to attend school (65% vs 13%, p = 0.001), anaemia (57% vs 23%, p=0.031), longer duration of illness (55% vs 15%, p=0.008) and dialysis (58% vs 18%, p=0.034) but not with low SES (p>0.5). Mean scores in ESRD module (57.2 ± 13.2) were low and social life (family/peer interaction) was the worst affected domain (39.9 ± 18.2). Low ESRD module scores were associated with school absence but not with modality or duration on dialysis. Primary Caregiver burdenmean (143.9 ± 17.1) was higher than previously reported. ‘High’ CB was associated with CKD Stage 5 vs stage 4 but was similar for HD vs CAPD. Parent CB inversely correlated with child’s HRQoL (r= - 0.58, p=0.001). Qualitative analysis themes generated were “catastrophic healthcare expenditure”, “mental stress and sleep disturbance” and “extreme social isolation” especially in those doing dialysis. Identified themes and illustrative quotes are depicted in figure 1. Fig1: Thematic schema derived from analysis of in-depth caregiver interviews Children with CKD have low HRQoL and their caregivers, high CB. Factors contributing to CB were unique to our low resource settings, and not elucidated by scoring tools alone. We intend to use these findings to improve counseling and provide better social and financial support to families.

The out-of-pocket cost of breast cancer care at a public tertiary care hospital in Nigeria: an exploratory analysis.

Introductionin Nigeria, the incidence of breast cancer has increased by over 80% in the last four decades. This study quantifies the out-of-pocket (OOP) cost of breast cancer management and the associated rate of catastrophic healthcare expenditure (CHE) at a public tertiary care facility in Ile-Ife, Nigeria.Methodspatients treated between December 2017 - August 2018 were identified from a prospective breast cancer database. A questionnaire was developed to capture the total cost of care, including direct and indirect expenses. Three commonly used thresholds for a CHE were used in this analysis. The cost of radiotherapy and targeted therapy were captured separately.Resultsdata was collected from 22 eligible patients. Sixty-eight percent had no form of health insurance. The mean cost of diagnosis and treatment was $2,049 (SD $1,854). At a threshold of 10% and 25% of annual income, 95% and 86% of households experienced a CHE. Based on a household´s capacity-to-pay, 90% experienced a CHE. The mean cost of radiotherapy was $462 (SD $223) and the mean cost of trastuzumab was $6,568 (SD $2,766). Cost precluded surgery in 14% of patients with resectable disease. As a result of accessing treatment, 72% of households had to borrow money and 9% of households interrupted a child´s education.Conclusionthe out-of-pocket cost of breast cancer care in Nigeria is significant. This results in a CHE for 68-95% of households, which has significant health and economic sequelae. Greater financial protection is essential as the burden of breast cancer increases in Nigeria.

Direct Cost of Wound Dressing in Nigeria: Implications for Catastrophic Healthcare Expenditure

Direct Cost of Wound Dressing in Nigeria: Implications for Catastrophic Healthcare Expenditure

The economic burden of rotavirus hospitalization among children < 5 years of age in selected hospitals in Bangladesh

BackgroundRotavirus is a common cause of severe acute gastroenteritis among young children. Estimation of the economic burden would provide informed decision about investment on prevention strategies (e.g., vaccine and/or behavior change), which has been a potential policy discussion in Bangladesh for several years. MethodsWe estimated the societal costs of children <5 years for hospitalization from rotavirus gastroenteritis (RVGE) and incidences of catastrophic health expenditure. A total of 360 children with stool specimens positive for rotavirus were included in this study from 6 tertiary hospitals (3 public and 3 private). We interviewed the caregiver of the patient and hospital staff to collect cost from patient and health facility perspectives. We estimated the economic cost considering 2015 as the reference year. ResultsThe total societal per-patient costs to treat RVGE in the public hospital were 126 USD (95% CI: 116–136) and total household costs were 161 USD (95% CI: 145–177) in private facilities. Direct costs constituted 38.1% of total household costs. The out-of-pocket payments for RVGE hospitalization was 23% of monthly income and 76% of households faced catastrophic healthcare expenditures due to this expense. The estimated total annual household treatment cost for the country was 10 million USD. ConclusionsA substantial economic burden of RVGE in Bangladesh was observed in this study. Any prevention of RVGE through cost-effective vaccination or/and behavioural change would contribute to substantial economic benefits to Bangladesh.

Indian Outpatients with Idiopathic Chronic Pancreatitis Have Catastrophic Healthcare Expenditure, Malnutrition, Anxiety/Depression and Work-Impairment.

There is paucity of data regarding economic burden, employment affection, psychological and nutritional status of CP patients, of non-alcoholic etiology, especially during their periods of stable disease, i.e., without any complications and/or recent endoscopic/surgical interventions. In a prospective cohort study, conducted in outpatient clinic of a tertiary-care hospital, 66 consecutive adults with Idiopathic CP (± diabetes) and 152 matched (by age, socioeconomic status and monthly income) healthy controls were assessed for: (1) healthcare expenses in previous month by recall (catastrophic if > 40% of income); (2) nutritional status by anthropometry and food frequency questionnaire; (3) psychological status by Hospital Anxiety and Depression Scale (HADS); and (4) work-impairment by work productivity and activity impairment questionnaire: general health (WPAI-GH). CP patients were again reassessed for the above parameters after 6 and 12month, respectively. Seventy-six percent CP patients (vis-à-vis 0% controls) had catastrophic healthcare expenditure. Forty-nine percent of CP patients(vis-à-vis 0% controls) met their healthcare expenses by either selling assets or obtaining loans at high-interest or from charitable donations. CP patients had lower BMI, were more likely to be malnourished and had a lower calorie intake vis-à-vis controls (median (IQR) recommended daily allowance (RDA): 71(19)% vs 97(23)%; [p < 0.0001]). Their median HADS Anxiety and depression scores were significantly higher than controls. Thirty-one (47%) CP patients were employed vis-a-vis 102 (67%) controls (p = 0.006); they had significantly higher work impairment. After one year, there was improvement in some of these above parameters in CP patients. Idiopathic CP outpatients had catastrophic healthcare expenditure, malnutrition, abnormal psychological scores and work-impairment vis-à-vis healthy controls. Some of these parameters improved on follow-up.

Economic burden of comorbid chronic conditions among survivors of stroke in China: 10-year longitudinal study

BackgroundThe coexistence of chronic diseases among people with stroke is common. However, little is known about the extent of incremental healthcare expenditures associated with having physically and psychologically chronic conditions among stroke survivors.MethodsWe used the nationally representative data from the China Health and Nutrition Survey, including 36,076 participants enrolled as our analytic cohort of ten years of follow-up visits (2006, 2009, 2011, 2015). Chronic conditions include hypertension, diabetes, obesity, and impaired cognitive function. Two-part models were used to estimate the effect of comorbid chronic conditions on total annual healthcare expenditure, out-of-pocket (OOP) healthcare expenditure, and incidence of catastrophic healthcare expenditure (CHE).ResultsAmong survivors of stroke during 2006 to 2015, the prevalence rates of hypertension, diabetes, obesity and impaired cognitive function were 75.5, 9.8, 12.7 and 65.1%, significantly higher than those among adults without stroke history (27.9, 2.7, 10.0 and 41.2%). Having hypertension ($794.5, p = 0.004), diabetes ($3978.5, p < 0.001) were associated with the largest incremental total healthcare expenditures. Stroke survivors with diagnosed hypertension and diabetes had additional 5.7 (p < 0.001) and 10.4 (p < 0.001) percentage point of CHE rate, respectively. Total healthcare expenditures were $2413.0 (P < 0.001) and $5151.7 (P < 0.001) higher among patients with 2, and ≥ 3 chronic conditions, respectively, than those individuals with no chronic conditions.ConclusionsExcess expenditures associated with chronic diseases were substantial among stroke survivors. These results highlight the needs for both prevention and better management of multimorbidity among stroke survivors, which in turn may lower the financial burden of treating these concurrent comorbidities.

Changes in Out-of-Pocket Spending and Catastrophic Health Care Expenditures Associated With Medicare Eligibility

This study examines whether becoming eligible for Medicare is associated with less out-of-pocket health care spending and lower catastrophic health care expenditure risk.

Catastrophic Healthcare Expenditures and Household Poverty in Kenya: The Case of Cancer, Hypertension, and Diabetes

It is estimated that non-communicable diseases account for 27% of all deaths suffered by Kenyans, equivalent to almost 100,000 people per year. Kenya is experiencing an upsurge in the prevalence of non-communicable diseases (NCDs), with current estimates showing that NCDs account for a third of the disease burden. This promoted the basis of the study to examine the effects of catastrophic healthcare expenditures due to cancer, hypertension, and diabetes on household poverty in Kenya. The study used the latest Kenya Household Health Expenditure and Utilization Survey (KHHEUS) 2018 dataset. Data analysis was undertaken by employing STATA Software. A significance level of p of &lt;0.05 was used. The results indicated catastrophic health expenditure, education level, working status, household size, and locality are significant determinants of household poverty. The presence of chronic illnesses such as hypertension, cancer, and diabetes increases the probability of being poor as a result of high out-of-pocket expenditures. It was noted that the households with catastrophic health expenditure of 40 percent and above are classified to be poor. The study recommended that the reliance on out-of-pocket expenses to finance medical services needs to be reduced because it leads to catastrophic health expenditures even as the country gears towards universal healthcare coverage. County governments are encouraged to be innovative in trying to come up with social health insurance schemes to lessen the burden of financing NCDs. Keywords: Catastrophic healthcare expenditures, out of pocket expenditures, cancer, hypertension, diabetes, household poverty, Kenya DOI: 10.7176/JESD/12-16-09 Publication date: August 31 st 2021

Rate of catastrophic healthcare expenditure in cancer patients

Rate of catastrophic healthcare expenditure in cancer patients