Catastrophic Payments Research Articles

Out-of-pocket cost of drug abuse consequences: results from Iranian National Mental Health Survey.

Drug abuse has significant cost to the individual, the family and the society. This study aimed to assess out of-pocket costs of consequences of drug use disorder. Data were drawn from the Iranian Mental Health Survey (IranMHS) through face-to-face interviews with 7841 respondents aged 15-64 years. We used a bottom-up cost-ofillness method for economic analysis. Out-of-pocket costs for treatment of mental and drug problems, treatment of medical illnesses, as well as costs of crimes were assessed. The average of total annual expense was US$ 2120.6 for those with drug use disorder, which was 23.5% of annual income of an average Iranian family in the year 2011. The average of total out-of-pocket cost was US$ 674.6 for those with other mental disorder and US$ 421.9 for those with no mental disorder. Catastrophic payment was reported in 47.6% of the patients with drug use disorder and 14.4% of those with other mental disorder. Thus, considerable amount of family resources are spent on the consequences of drug use.

Out-of-pocket Payments for Healthcare in India

This paper examines the impact of out-of-pocket (OOP) health payment on impoverishment of poorest households using unit-level records of latest (68th: 2011–2012) round data of National Sample Survey Organisation (NSSO). This is examined by estimating the prevalence, intensity and incidence of catastrophic health payments across different economic stratum households, rural-urban residents and states. Estimates show that high OOP expenditure on healthcare has serious repercussions for households’ well-being in India, as it plunges a sizeable section of the society even the well-off to abysmal poverty levels. It pushes 3.5 per cent (50.6 million) people below poverty line and also causes further deepening of poverty for already poor people. The rural, lowest above poverty line (APL) quintile and households from low-income states (like Uttar Pradesh and Bihar) experienced a large increase in poverty headcounts and poverty deepening impacts. Any health policy initiative directed towards these groups and regions may lower down the catastrophic burden.

Assessing the impoverishing effects, and factors associated with the incidence of catastrophic health care payments in Kenya

BackgroundMonitoring the incidence and intensity of catastrophic health expenditure, as well as the impoverishing effects of out of pocket costs to access healthcare, is a key part of benchmarking Kenya’s progress towards reducing the financial burden that households experience when accessing healthcare.MethodsThe study relies on data from the nationally-representative Kenya Household Expenditure and Utilization Survey conducted in 2013 (n =33,675). We undertook health equity analysis to estimate the incidence and intensity of catastrophic expenditure. Households were considered to have incurred catastrophic expenditures if their annual out of-pocket health expenditures exceeded 40% of their annual non-food expenditure. We assessed the impoverishing effects of out of pocket payments using the Kenya national poverty line. We distinguished between direct payments for healthcare such as payments for consultation, medicines, medical procedures, and total healthcare expenditure that includes direct healthcare payments and the cost of transportation to and from health facilities. We used logistic regression analysis to explore the factors associated with the incidence of catastrophic expenditures.ResultsWhen only direct payments to healthcare providers were considered, the incidence of catastrophic expenditures was 4.52%. When transport costs are included, the incidence of catastrophic expenditure increased to 6.58%. 453,470 Kenyans are pushed into poverty annually as a result of direct payments for healthcare. When the cost of transport is included, that number increases by more than one third to 619,541. Unemployment of the household head, presence of an elderly person, a person with a chronic ailment, a large household size, lower household social-economic status, and residence in marginalized regions of the country are significantly associated with increased odds of incurring catastrophic expenditures.ConclusionsKenyan policy makers should prioritize extending pre-payment mechanisms to more vulnerable groups, specifically the poor, the elderly, those suffering from chronic ailments and those living in marginalized regions of the country. The range of services covered under these mechanisms should also be extended such that the proportion of direct costs paid to access care is reduced. Policy makers should also prioritize reducing supply side bottlenecks such as availability of healthcare facilities in close proximity to the population, especially in rural and marginalized areas, and improvements in quality of care. For the poor and the vulnerable, initiatives to cover the cost of transport to and from a health facility, such as transport vouchers could also be explored.

Out-of-pocket health spending and equity implications in Tunisia

Using data from 2000, 2005 and 2010 national household budget and consumption surveys, this paper examines the scope of catastrophic out-of-pocket (OOP) health expenditures in Tunisia and their distribution. It analyses their evolution since 2000 in relation to policy reforms in Tunisia especially since a new national health insurance fund (Caisse Nationale d’Assurance Maladie (CNAM)) became effective in 2007. The paper assesses the catastrophic dimension of OOP payments by calculating their incidence and their intensity at several thresholds and by analyzing their distribution throughout concentration indices. Estimating a probit model, the paper explores the determinants of catastrophic payments and identifies the characteristics of households coping with higher risk of catastrophic health expenditures. Finally, questioning whether the catastrophic payments have impoverishing effects on households, the paper estimates the percentage of households who move below the poverty line when accounting for OOP health payments. The paper concludes that the lasting importance of health OOP expenditures in Tunisia, their catastrophic dimension and their impoverishing effect make it necessary to look for a better allocation of the existing resources through more efficient financing mechanisms and better institutional arrangements.

Assessing the catastrophic effects of out-of-pocket healthcare payments prior to the uptake of a nationwide health insurance scheme in Ghana

ABSTRACT Background: Financial risk protection against the cost of unforeseen healthcare has gained global attention in recent years. Although Ghana implemented a nationwide health insurance scheme with a goal of reducing financial barriers to accessing healthcare and addressing impoverishing effects of out-of-pocket (OOP) healthcare payments, there is a paucity of knowledge on the extent of financial catastrophe of such payments in Ghana. Thus, this paper assesses the catastrophic effect of OOP healthcare payments in Ghana. Methods: Ghana Living Standard Survey (GLSS 5) data collected in 2005/2006 are used in this study. Catastrophic effect of OOP healthcare payments is assessed using various thresholds of total household expenditure and non-food expenditure. Furthermore, four indices, namely the catastrophic payment headcount, catastrophic payment gap, weighted catastrophic payment headcount and weighted catastrophic payment gap, are defined and computed. Results: As at 2005/2006, it was estimated that 11.0% of households in Ghana spent over 5% of their total household expenditure on healthcare OOP. However, after adjusting for the concentration of such spending, it decreased to 10.9%. Also 10.7% of households spent more than 10% of their non-food consumption expenditure on OOP healthcare payments. Furthermore, about 2.6% of households are observed to have spent in excess of 20% of their total household income on healthcare OOP. With the exception of the 5% threshold of household expenditure, because the concentration indices of these expenditures are negative, the burden of such expenditures rests more on the poor. Conclusions: Significant levels of financial catastrophe existed in Ghana prior to the uptake of the national health insurance scheme. Poorer households were at a higher risk than the relatively well-off households. The results of this study present baseline assessment of the impact of Ghana’s health insurance policy on catastrophic healthcare payments. Thus, there is a need for continuous monitoring of financial catastrophe in the system to ensure that households are adequately protected.

Does cost sharing do more harm or more good? - a systematic literature review.

BackgroundThere are positive and negative consequences of the implementation of out of pocket (OOP) payments as a source of the healthcare financing. On the one hand, OOP burden increases awareness of treatment costs and limits unnecessary use of healthcare services. On the other hand, it may prevent the sick from accessing needed care. Consequently there are several aspects that ought to be taken into consideration while defining the optimal structure of OOP payments. The objective of this study was twofold. Firstly, it was to understand what actions are taken to decrease the OOP burden. Secondly, it was to address the question whether the implementation of any form of formal OOP payments may impact negatively upon fairness in financial contribution.MethodsThe literature search was conducted using the Pubmed, Embase, Cochrane Library and Center of Review and Dissemination databases. Only studies which measured the Kakwani index of progressivity in at least two time points were included. Articles written in English published between January 2004 and September 2015 were searched. No geographical restriction was imposed. An increment of more than 0.10 in the Kakwani index was considered as a significant health policy impact.ResultsIn total 16 publications were included, of which nine studied attempts to decrease the OOP burden, four described the consequences of the introduction of formal fees, and three covered both topics. Overall, a significant health policy impact was noted in four cases. All of them related to a reduction in the OOP burden, with three and one noting a change towards the progressivity and regressivity of direct healthcare payments respectively. Among jurisdictions which introduced formal fees, none study noted a significant impact on the regressivity of OOP spendings.ConclusionsIn the majority of cases, a health policy impact on the distribution of OOP health payments was insignificant. The reduction of OOP burden cannot be achieved successfully without adequate extension of healthcare coverage or engagement of other sources of healthcare financing. When formal fees are being introduced, protection against catastrophic healthcare payments is needed for the most vulnerable groups.

Financial protection from health spending in the Philippines: policies and progress.

The objective of this article is to assess the progress of the Philippines health sector in providing financial protection to the population, as measured by estimates of health insurance coverage, out-of-pocket spending, catastrophic payments and impoverishing health expenditures. Data are drawn from eight household surveys between 2000 and 2013, including two Demographic and Health Surveys, one Family Health Survey and five Family Income and Expenditure Surveys. We find that out-of-pocket spending increased by 150% (real) from 2000 to 2012, with the sharpest increases occurring in recent years. The main driver of health spending is medicines, accounting for almost two-thirds of total health spending, and as much as three-quarters among the poor. The incidence of catastrophic payments has tripled since 2000, from 2.5% to 7.7%. The percentage of people impoverished by health spending has also increased and, in 2012, out-of-pocket spending on health added 1.5 percentage points to the poverty rate, pushing more than 1.5 million people into poverty. In light of these findings, recent policies to enhance financial risk protection-such as the expansion of government-subsidized health insurance from the poor to the near-poor, a policy of zero copayments for the poor, a deepening of the benefit package and provider payment reform aimed at cost-containment-are to be commended. Indeed, between 2008 and 2013, self-reported health insurance coverage increased across all quintiles and its distribution became more pro-poor. To speed progress toward financial protection goals, quick wins could include issuing health insurance cards to the poor to increase awareness of coverage and limiting out-of-pocket spending by clearly defining a clear copayment structure for non-poor members. An in-depth analysis of the pharmaceutical sector would help to shed light on why medicines impose such a large financial burden on households.

Out-of-pocket health payments: a catalyst for agricultural productivity growth, but with potentially impoverishing effects in Senegal

This paper analyzes the relationship between health expenditures and productivity in Senegal by using a dynamic recursive computable general equilibrium (CGE) model that has been run from 2011 to 2020. This model links the growth rate of agricultural productivity to household investment in health goods taking into account catastrophic health payments considered as barriers to achieve maximal productivity gains. In fact, despite being a potential catalyst for productivity, out-of-pocket health expenditures can be a burden after a critical threshold has been crossed and might potentially decrease household resources and place constraints on the productivity-generating process. Results show a positive impact on poverty reduction when the Government reduces the burden on households by financing catastrophic payment overshoots. Lower health costs also appear to improve households’ well-being, especially in the case of agricultural households. These results suggest the need for policies which will reduce the health system’s reliance on out-of-pocket payments and demonstrate that health programs should reach the most vulnerable households. The effectiveness of poverty-orientated interventions can be increased by targeting households incurring catastrophic health expenditures.

Catastrophic Health Expenditure After the Implementation of Health Sector Evolution Plan: A Case Study in the West of Iran.

One of the main objectives of health systems is the financial protection against out-of-pocket (OOP) health expenditures. OOP health expenditures can lead to catastrophic payments, impoverishment or poverty among households. In Iran, health sector evolution plan (HSEP) has been implemented since 2014 in order to achieve universal health coverage and reduce the OOP health expenditures as a percentage of total health expenditures. This study aimed to explore the percentage of households facing catastrophic health expenditures (CHE) after the implementation of HSEP and the factors that determine CHE. A total of 663 households were selected through a cluster sampling based on the census framework of Sanandaj Health Center in July 2015. Data were gathered using face-to-face interviews based on the household section of the World Health Survey questionnaire. In this study, according to the World Health Organization (WHO) definition, if household health expenditures were equal to or more than 40% of the household capacity to pay, household was considered to be facing CHE. The determinants of CHE were analyzed using logistic regression model. The rates of households facing CHE were 4.8%. The key determinants of CHE were household economic status, presence of elderly or disabled members in the household and utilization of inpatient or rehabilitation services. The comparison of our findings and those of other studies carried out using a methodology comparable with ours in different parts of Iran before the implementation of HSEP suggests that the implementation of recent reforms has reduced CHE at the household level. Utilization of inpatient and rehabilitation services, the presence of elderly or disabled members in the household and the low economic status of the household would increase the likelihood of facing CHE. These variables should be considered by health policy-makers in order to review and revise content of recent reform, thus financially protecting public against CHE.

Assessing the Distribution of Household Financial Contribution to Health System: A Case Study of Iran.

Throughout the world, financing the healthcare system through households' financial contribution is a challenging issue in evaluating performance of healthcare systems. The purpose of this paper is illustrating the consequences of Iranian household to health system financial contribution in terms of burden and incomes approaches. The Data derived from an annual survey by Statistics Center of Iran (SCI) on expenditure-income of 36,551 households in 2012 was used to analyze countrywide distribution indicators of households' medical expenses by measuring indices of Income and burden approaches based on World Health Organization (WHO) and World Bank recommended methodologies. The fairness in financial contribution index was 0.85 and 0.82, and the income redistributive effect index was 0.54 and 0.3 in urban and rural areas, respectively. The fairness in financial contribution index was found 0.84 and 0.83 and the income redistributive effect index was 0.48 and 0.25 for households with and without medical insurance, respectively.The percentages of household with catastrophic health payments were 2.4% and 4% and the change in the number of household falling below the poverty line due to health system payments was 0.4% and 2% in urban and rural areas, respectively. The percentages of household with catastrophic health payments were 2.8% and 3% and the change in the number of household falling below the poverty line due to health system payments was 0.008 and 0.011 for households with and without medical insurance, respectively. Distribution indicators of medical expenses were more favorable in urban areas compared to rural areas and Medical insurance has declined impoverishment risks and number of people suffered due to catastrophic health expenditure. In addition, the result showed that there are different approaches for analyzing the distribution of out of pocket payments which used to complement each other in respect of formulation and development policy making in health system.

Exit from catastrophic health payments: a method and an application to Malawi.

This paper proposes three measures of average exit time from catastrophic health payments; the first measure is non-normative in that the weights placed on catastrophic payments incurred by poor and nonpoor households are the same. It ignores the fact that the opportunity cost of health spending is different between poor and nonpoor households. The other two measures allow for distribution sensitivity but differ in their conceptualization of inequality; one is based on socioeconomic inequalities in catastrophic health payments, and the other uses pure inequalities in catastrophic health payments. The proposed measures are then applied to Malawian data from the Third Integrated Household Survey. The empirical results show that when the threshold of pre-payment income is increased from 5 to 15%, the average exit time decreases from 2.1 to 0.2 years; and as the catastrophic threshold rises from 10 to 40% of ability to pay, the average exit time falls from 3.6 to 0.1 years. It is found that adjusting for socioeconomic inequality leads to small changes in the exit times, however, using pure inequality leads to large reductions in the exit time.

Household Catastrophic Health Expenditure Due To Tuberculosis: Analysis From Particularly Vulnerable Tribal Group, Central India

Tuberculosis (TB) is disproportionately affects the most economically disadvantaged strata of society. Many studies have assessed the association between poverty and TB, but only a few have assessed the direct financial burden TB treatment and care can place on households. Patient costs can be catastrophic health expenditure for TB affected households in particularly vulnerable tribal groups (PVTGs). A survey of pulmonary tuberculosis (PTB) was carried out in Saharia dominated Pohri block of Shivpuri district of Madhya Pradesh state in central India during the period 2013 to 2014. Of 9964 surveyed, 280 PTB cases identified formed the study population for the present study. Among 280 TB patients identified, 220 (79%) cases interviewed at their residence by trained field investigators after obtaining written informed consent. This study demonstrates the economic burden in terms of direct, indirect and total costs for both diagnosis and treatment. In our sample, majority getting treatment free of costs and those who incurred costs, they faced catastrophic TB care expenditure amounted to 10%, which is the proportion of various costs in relation to annual family income. TB is a major cause of impoverishment, as it puts a heavy burden on the family budget, which can force families to absolute poverty. Our results suggest that policies to decrease direct and indirect TB patient costs are urgently needed to prevent chances of catastrophic payments to PVTGs. Also a high priority should be given to research that focuses on economic effects in different kind, in different time, in particular, among low-income

Catastrophic Economic Consequences of Healthcare Payments: Effects on Poverty Estimates in Egypt, Jordan, and Palestine

Healthcare payments could drive households with no health insurance coverage into financial catastrophe, which might lead them to cut spending on necessities, sell assets, or use credit. In extreme cases, healthcare payments could have devastating consequences on the household economic status that would push them into extreme poverty. Using nationally representative surveys from three Arab countries, namely, Egypt, Jordan, and Palestine, this paper examines the incidence, intensity and distribution of catastrophic health payments, and assesses the poverty impact of out-of-pocket health payments (OOP). The OOP for healthcare were considered catastrophic if it exceeded 10% of a household’s total expenditure or 40% of non-food expenditure. The poverty impact was evaluated using poverty head counts and poverty gaps before and after OOP. Results show that OOP exacerbate households’ living severely in Egypt, pushing more than one-fifth of the population into a financial catastrophe and 3% into extreme poverty in 2011. However, in Jordan and Palestine, the disruptive impact of OOP remains modest over time. In the three countries, the catastrophic health payment is the problem of the better off households. Poverty alleviation policies should help reduce the reliance on OOP to finance healthcare. Moving toward universal health coverage could also be a promising option to protect households from the catastrophic economic consequences of health care payments.

Correlation Between New Cooperative Medical Scheme Policy Design and Catastrophic Medical Payment: Evidence From 25 Counties in Rural China.

Few studies have examined the association between the New Cooperative Medical Scheme (NCMS) policy design and its achievement of providing financial protection to rural residents. This study collected data on NCMS policy design and health care spending from 25 counties and rural households in their catchment areas. It shows that on average, NCMS has a growing but small effect on the reduction of catastrophic medical payment (CMP) incidence. If outpatient spending can be reimbursed from an NCMS pooled account, the incidence of CMP before a reimbursement and that after a reimbursement will be reduced. Higher nominal reimbursement rate for inpatient spending at provincial hospitals is correlated with higher incidence of CMP before a reimbursement. Higher ceiling for annual reimbursement from NCMS is associated with lower incidence of CMP after a reimbursement. Thus, NCMS policy design can be improved to strengthen its effects on the reduction of CMP incidence.

Preconception and Prenatal Health of Women of Mexican Origin Who Reside in Texas and Mexico

s / Annals of Epidemiology 25 (2015) 702e719 719 Conclusions: Inadequate rate of GWG doubles the odds of stillbirth. Future analyses will use cubic splines to model continuous GWG rate. P70. Preconception and Prenatal Health of Women of Mexican Origin Who Reside in Texas and Mexico Thelma Carrillo MPH, Kyle A. Biggs DO, Roberta J. Ruiz PhD, Lewis P. Rubin MD, Ghulam Murtaza MD, Zuber D. Mulla PhD. Brookdale Hospital and Medical Center Purpose: Acculturation has been associated to favorable and unfavorable health outcomes in the United States. In relation to birth outcomes, studies are finding that less acculturated women have relatively more favorable or as favorable outcomes as populations with greater material resources. We conducted a pilot study in El Paso, Texas, to describe the prenatal health of women of Mexican origin. Methods: A cross-sectional questionnaire was conducted using a simple stratified sampling design among post-partum inpatient women. The three strata consisted of women born in the U.S. and residents of the U.S. (S1), women born in Mexico and residents of the U.S. (S2), and women born in Mexico and residents of Mexico, (S3). The questionnaire included questions from the Quality of Life SF-36, the Medical Outcomes Study Social Support Survey and other validated questions from U.S. national surveys. Results: Preliminary results for some indicators of preconception or prenatal health for 216 women are the following means: pre-pregnancy weight, S1 156.1 (141.6, 170.6), S2 150.2 (142.1, 158.3), S3 146.5 (139.6, 153.5), self-rated health, S1 70.0 (62.3, 77.7), S2 71.7 (66.5, 76.9), S3 72.8 (68.5, 77.0), and emotional well-being, S1 75.6 (70.7, 80.5), S2 78.4 (74.7, 82.2), and S3 78.7 (75.3, 82.0). Conclusions: The preliminary results indicate that a greater proportion of women who were born and resided in Mexico had better health indicators than their more acculturated counterparts. These select and preliminary findings may be worthy of further study to identify the mechanisms through which a culture’s protective factors affect health. P71. High Cost of Pregnancy and Child Birth in India Srinivas Goli PhD. Jawaharlal Nehru University (JNU) Purpose: This paper has twofold objectives: first, to measure the catastrophic payments in the medical care of pregnancy and childbirth. Second is to analyze if the type of hospital, utilization of JSY and family income made a difference in the spending pattern of pregnancy and childbirth. Methods: Our analysis uses unique data from 230 pregnant women that we interviewed in Uttar Pradesh, which is the largest state in India and has among the poorest health outcomes for women and children. In addition to detailed demographic and socioeconomic characteristics of the respondents, we collected information on the type of hospital for ANCs and delivery, pregnancy and childbirth costs, including hospitalization costs, doctor’s fees, medication costs, transportation costs, and access to government programs such as JSY and so on. We have used bivariate and multivariate regression analyses. Results: Our analysis reveals that the percentage share of the total cost of pregnancy and childbirth in annual income of the couples is above 40% for below poverty line families which is a huge catastrophic payment for them. It also shows strong and statistically positive associations between higher levels of education, private hospital and higher costs during pregnancy and childbirth. Conclusions: Although, ANCs and delivery care is highly sponsored in maternal and child health scheme of ongoing National HealthMission (NHM) andmost of the services should be free of cost, but we observed a high cost of pregnancy and child birth even in the government hospitals.

Catastrophic health expenditure and 12-month mortality associated with cancer in Southeast Asia: results from a longitudinal study in eight countries.

BackgroundOne of the biggest obstacles to developing policies in cancer care in Southeast Asia is lack of reliable data on disease burden and economic consequences. In 2012, we instigated a study of new cancer patients in the Association of Southeast Asian Nations (ASEAN) region – the Asean CosTs In ONcology (ACTION) study – to assess the economic impact of cancer.MethodsThe ACTION study is a prospective longitudinal study of 9,513 consecutively recruited adult patients with an initial diagnosis of cancer. Twelve months after diagnosis, we recorded death and household financial catastrophe (out-of-pocket medical costs exceeding 30 % of annual household income). We assessed the effect on these two outcomes of a range of socio-demographic, clinical, and economic predictors using a multinomial regression model.ResultsThe mean age of participants was 52 years; 64 % were women. A year after diagnosis, 29 % had died, 48 % experienced financial catastrophe, and just 23 % were alive with no financial catastrophe. The risk of dying from cancer and facing catastrophic payments was associated with clinical variables, such as a more advanced disease stage at diagnosis, and socioeconomic status pre-diagnosis. Participants in the low income category within each country had significantly higher odds of financial catastrophe (odds ratio, 5.86; 95 % confidence interval, 4.76–7.23) and death (5.52; 4.34–7.02) than participants with high income. Those without insurance were also more likely to experience financial catastrophe (1.27; 1.05–1.52) and die (1.51; 1.21–1.88) than participants with insurance.ConclusionsA cancer diagnosis in Southeast Asia is potentially disastrous, with over 75 % of patients experiencing death or financial catastrophe within one year. This study adds compelling evidence to the argument for policies that improve access to care and provide adequate financial protection from the costs of illness.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-015-0433-1) contains supplementary material, which is available to authorized users.

Does the National Health Insurance Scheme provide financial protection to households in Ghana?

BackgroundExcessive healthcare payments can impede access to health services and also disrupt the welfare of households with no financial protection. Health insurance is expected to offer financial protection against health shocks. Ghana began the implementation of its National Health Insurance Scheme (NHIS) in 2004. The NHIS is aimed at removing the financial barrier to healthcare by limiting direct out-of-pocket health expenditures (OOPHE). The study examines the effect of the NHIS on OOPHE and how it protects households against catastrophic health expenditures.MethodsData was obtained from a cross-sectional representative household survey involving 2,430 households from three districts across Ghana. All OOPHE associated with treatment seeking for reported illness in the household in the last 4 weeks preceding the survey were analysed and compared between insured and uninsured persons. The incidence and intensity of catastrophic health expenditures (CHE) among households were measured by the catastrophic health payment method. The relative effect of NHIS on the incidence of CHE in the household was estimated by multiple logistic regression analysis.ResultsAbout 36% of households reported at least one illness during the 4 weeks period. Insured patients had significantly lower direct OOPHE for out-patient and in-patient care compared to the uninsured. On financial protection, the incidence of CHE was lower among insured households (2.9%) compared to the partially insured (3.7%) and the uninsured (4.0%) at the 40% threshold. The incidence of CHE was however significantly lower among fully insured households (6.0%) which sought healthcare from NHIS accredited health facilities compared to the partially insured (10.1%) and the uninsured households (23.2%). The likelihood of a household incurring CHE was 4.2 times less likely for fully insured and 2.9 times less likely for partially insured households relative to being uninsured. The NHIS has however not completely eliminated OOPHE for the insured and their households.ConclusionThe NHIS has significant effect in reducing OOPHE and offers financial protection against CHE for insured individuals and their households though they still made some out-of-pocket payments. Efforts should aim at eliminating OOPHE for the insured if the objective for establishing the NHIS is to be achieved.

Does the New Rural Cooperative Medical System with higher reimbursement rates reduce catastrophic health expenditures in rural China?

We used recently available data from the China Health and Nutrition Survey (CHNS) from 2004 to 2011 to re-examine the impact of the New Rural Cooperative Medical System (NRCMS) in the People’s Republic of China on exposure to catastrophic health expenditures. We found that the NRCMS with universal coverage and higher reimbursement rates in 2011 did not reduce the incidence and intensity of out-of-pocket catastrophic payments. Moreover, there were important distributional implications with the poorest protected to the least extent. As such, we suggest policymakers should consider using the NRCMS to shelter rural residents, especially the poorest, from catastrophic medical expenses.

Impact of the policy of expanding benefit coverage for cancer patients on catastrophic health expenditure across different income groups in South Korea

To increase financial protection for catastrophic illness, South Korean government expanded the National Health Insurance (NHI) benefit coverage for cancer patients in September 2005. This paper investigated whether the policy has reduced inequality in catastrophic payments, defined as annual out-of-pocket (OOP) health payments exceeding 10% annual income, across different income groups. This study used the NHI claims data from 2002 to 2004 and 2006 to 2010. Triple difference estimator was employed to compare cancer patients as a treatment group with those with liver and cardio-cerebrovascular diseases as control groups and the low-income with the high-income groups. While catastrophic payments decreased in cancer patients compared with those of two diseases, they appeared to decrease more in the high-income than the low-income group. Considering that increased health care utilization and poor economic capacity may lead to a smaller reduction in catastrophic payments for the low-income than the high-income patients, the government needs to consider additional policy measures to increase financial protection for the poor.

Catastrophic Healthcare Expenditures of Hospitalized Patients in the Hospitals of Shiraz in 2013

Patients and Methods: This study was conducted on 376 patients hospitalized in similar wards of a public and a semi-private hospital in Shiraz, Iran. The study data were collected using World Health Organization questionnaire, the Persian version of which it was validated in a previous study. Catastrophic health expenditures payments were calculated based on the households’ capacity. Data were analyzed using chi-square test, T-test, Mann-Whitney, and logistic regression by SPSS. Results: Based on the findings of the present study, 175 (47.3%) of the hospitalized patients were exposed to catastrophic healthcare expenditures in 2013. Additionally, the results of regression analysis indicated that the type of hospital, ward, supplemental insurance status of the head of household, duration of diagnosis, duration of hospitalization, and ability to pay, and not the household's economic status, were effective in reducing the exposure to catastrophic healthcare expenditures. Conclusions: The high percentage of households, facing catastrophic expenditure in hospitalized patients, revealed an expenditure bottleneck in the health system. Therefore, when planning to reduce excessive expenditures in the health system, a crucial point is to consider hospitalizations.