Health Care Expenditures Research Articles

End-of-life emergency department use and healthcare expenditures among older adults: A nationally representative study.

Emergency department (ED) visits at end-of-life may cause financial strain and serve as a marker of inadequate access to community services and health care. We sought to examine end-of-life ED use, total healthcare spending, and out-of-pocket spending in a nationally representative sample. Using Medicare Current Beneficiary Survey data, we conducted a pooled cross-sectional analysis of Medicare beneficiaries aged 65+ years with a date of death between July 1, 2015 and December 31, 2021. Our primary outcomes were ED visits, total healthcare spending, and out-of-pocket spending in the 7, 30, 90, and 180 days preceding death. We estimated a series of zero-inflated negative binomial models identifying patient characteristics associated with the primary outcomes. Among 3812 older adult decedents, 610 (16%), 1207 (31.7%), 1582 (41.5%), and 1787 (46.9%) Medicare beneficiaries had ED visits in the final 7, 30, 90, and 180 days, respectively, of life. For Medicare beneficiaries with at least one ED visit in the final 30 days of life, the median total and out-of-pocket costs were, respectively, $12,500 and $308, compared, respectively, with $278 and $94 for those without any ED visits (p < 0.001 for both comparisons). Having a diagnosis of dementia (odds ratio [OR] 0.71; 95% confidence interval [CI] 0.51-0.99; p = 0.04) and being on hospice status during the year of death (OR 0.56; 95% CI 0.48-0.66; p = <0.001) were associated with a decreased likelihood of having an ED visit. Having dementia was associated with a decreased likelihood of having any healthcare spending (OR 0.50; 95% CI 0.36-0.71; p = 0.001) and any out-of-pocket spending (OR 0.51; 95% CI 0.36-0.72; p = <0.001). One in three older adults visit the ED in the last month of life, and approximately one in two utilize ED services in the last half-year of life, with evidence of associated considerable total and out-of-pocket spending.

Evaluation Method of Residents’ Satisfaction with Healthcare Consumption Based on Data Mining and Knowledge Mapping

Residents’ healthcare consumption involves many aspects such as residents’ expectations, medical institutions’ reputation, and residents’ trust, resulting in a large difference between the evaluation results and the actual value, and low residents’ satisfaction. Therefore, a method for evaluating residents’ satisfaction with healthcare consumption based on data mining and knowledge mapping is proposed. Under the framework and connotation of evaluation indicators, the evaluation indicator system of residents’ satisfaction with healthcare consumption is constructed to obtain evaluation indicators; the AHP method was used to calculate the weight of the above indicators of residents’ satisfaction with healthcare consumption; combined with the index weight, the improved hierarchical clustering method in data mining is used to cluster the evaluation indexes of residents’ satisfaction with healthcare consumption; according to the clustering results, an evaluation model was built through the knowledge map to evaluate the residents’ satisfaction with healthcare consumption. The experimental results show that the evaluation value of residents’ satisfaction with healthcare consumption is basically consistent with the actual value, and residents’ satisfaction is high.

Abstract C001: Global disparities in prostate cancer burden: An analysis of the GLOBOCAN 2020 database

Abstract Background: Prostate cancer (PCr) is one of the most common cancers among men globally, with considerable variations in incidence and death rates between racial/ethnic groups and geographical regions. With more than 1.4 million new cases reported in 2020, the global burden of PCr is predicted to double over the next two decades, to 2.9 million new cases and approximately 700,000 fatalities. Understanding the disparities in PCr is crucial for designing targeted treatments, and interventions and addressing health inequities. This study seeks to provide a comprehensive analysis of the recent global trends in PCr, focusing on incidence, mortality, and disparities in disease burden. Methods:This study analyzed age-standardized PCr incidence and mortality rates from the GLOBOCAN 2020 database for 174 countries, categorized by region and income level. Descriptive statistics and regression analyses were used to investigate the relationships between PCr rates and socioeconomic factors like the Human Development Index (HDI) and healthcare expenditure (HE). The study evaluated PCr distribution across age and geography, with statistical significance set at p &amp;lt; 0.05. Results:PCr incidence rates were highest in developed regions like Northern America (73.8/100,000), Western Europe (69.1/100,000), and Australia/New Zealand (88.2/100,000), and lowest in Eastern Asia (10.5/100,000) and Northern Africa (9.7/100,000). Mortality patterns were similar, with highest rates in the Caribbean (29.3/100,000) and Sub-Saharan Africa (26.6/100,000), and lowest in Eastern Asia (4.1/100,000) and Northern Africa (8.3/100,000). While incidence correlated positively with the HDI (p&amp;lt;0.001), mortality showed no significant association after adjusting for HE. Conclusion:This global analysis revealed major disparities in PCr incidence and mortality rates. Incidence was higher in developed regions, while mortality was elevated in economically disadvantaged areas. Further research is needed to understand the complex genetic, environmental, and socioeconomic factors driving these disparities. Key Takeaways: There is a continued need for targeted interventions to reduce the global burden of PCr and address disparities in disease burden. Citation Format: Olumide Arigbede, Sarah G. Buxbaum, Sara Falzarano, Suhn K. Rhie. Global disparities in prostate cancer burden: An analysis of the GLOBOCAN 2020 database [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C001

Abstract A001: Health expenditure trajectory and gastric cancer incidence in the National Health Insurance Senior Cohort: A nested case-control study

Abstract Background: Gastric cancer is the fourth most common cancer and highly prevalent in South Korea. Given its prolonged disease progression, understanding the impact of health expenditure patterns over time is crucial. This nested case-control study aimed to identify the association between health expenditure trajectory and incidence of gastric cancer. Methods: Data from the National Health Insurance Service Senior Cohort of South Korea were used. Individuals diagnosed with gastric cancer (N = 14,873) were matched to a non-diagnosed group (N = 44,619) in a 1:3 ratio using a nested case-control design. A latent class trajectory analysis was performed to identify the patterns of health expenditure among the matched participants. Furthermore, conditional logistic regression analysis was conducted to examine the relationship between healthcare expenditure trajectories and gastric cancer incidence. Results: Seven distinct health expenditure trajectories over a 5-year period were identified: consistently lowest (13.9%), rapidly increasing (6.4%), gradually increasing (14.1%), consistently second-highest (22.1%), middle-low (17.8%), gradually decreasing (12.8%), and consistently highest (12.9%). Compared to the Middle-low group, individuals in the rapidly increasing (OR = 2.07; 95% confidence interval [CI], 1.90–2.25), consistently lowest (OR = 1.43; 95% CI, 1.33–1.55), gradually increasing (OR = 1.23; 95% CI, 1.15–1.32), and consistently highest (OR = 1.08; 95% CI, 1.01–1.17) groups exhibited a higher risk of developing gastric cancer. Conclusion: Our findings emphasize the importance of monitoring health expenditures to prevent gastric cancer. The categorization of health expenditure by trajectories allowed the identification of specific risk groups that may be targeted by appropriate interventions. Citation Format: Minjee Lee, Ki-Bong Yoo, Woo-Ri Lee. Health expenditure trajectory and gastric cancer incidence in the National Health Insurance Senior Cohort: A nested case-control study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A001.

Health Care–Related Savings Accounts, Health Care Expenditures, and Tax Expenditures

Health Care–Related Savings Accounts, Health Care Expenditures, and Tax Expenditures

Anticipated benefit termination and health care consumption responses: Evidence from a quasi-experiment

This study is among the first attempts to explore the behavioral responses of anticipated preferential treatment retraction from low-income individuals in the context of health insurance. Utilizing a unique quasi-experimental setting in China, we capture health care demand responses to anticipated benefit termination using a difference-in-differences design. We find a significant increase in individuals’ inpatient health care consumption in anticipation of losing generous insurance benefits. We further investigate the increased consumption and the results suggest that it is largely associated with providing necessary treatments. Additionally, we do not find evidence of supplier-induced demand. In terms of heterogeneity, we find that individuals with chronic disease history, more education, and higher income tend to be more responsive in increasing their health care consumption. While policy evaluations usually focus on the effects upon implementation, our findings shed light on the end-of-benefit responses, and the importance of providing education sessions and liquidity support on individuals’ dynamic decision-making, these findings are meaningful in fully evaluating the impact of insurance contractions.

Epidemiology and socioeconomic correlates of brain and central nervous system cancers in Asia in 2020 and their projection to 2040

Brain and central nervous system (CNS) cancers constitute a heterogeneous group of cancers with poor 5-year survival rates. We aimed to report the epidemiology of brain and CNS cancers in Asia in 2020 and their projections up to 2040 by age, sex, and country, as well as their correlation with socioeconomic status. We extracted data from the 2020 Global Cancer Observatory (GLOBOCAN). Numbers, age-standardized incidence rates (ASIRs) and mortality rates (ASMRs), 5-year prevalent cases and rates, mortality-to-incidence ratios (MIRs), and crude rates were calculated. The human development index (HDI) and current healthcare expenditure (CHE)-to-gross domestic product (GDP) ratio were included as indicators of socioeconomic status. Additionally, the numbers of new cases and deaths were predicted from 2025 to 2040 by multiplying the anticipated population during this period by age-standardized rates. In 2020, there were 166,925 new cases of brain and CNS cancers in Asia, indicating a 5-year prevalence rate of 9.40 per 100,000. We also estimated the total ASIR, ASMR, and MIR as 3.20, 2.60, and 0.83, respectively. There were significant negative correlations between HDI and MIR (correlation coefficient: − 0.538, p value < 0.001) and significant positive correlations between CHE/GDP% and ASIR (correlation coefficient: 0.388, p value: 0.010) and ASMR (correlation coefficient: 0.373, p value: 0.014). In 2040, there will be 232,000 new cases of brain and CNS cancers and 200,000 subsequent deaths in Asia. Our study revealed higher brain and CNS cancer rates in Western Asia among males and elderly individuals. These findings can aid policymakers in enhancing cancer care and suggest the consideration of risk factors in future research.

Does environmental degradation matter for healthcare expenditure and health outcomes? Evidence from the Caucasus region and Russia (2000–2020)

Does environmental degradation matter for healthcare expenditure and health outcomes? Evidence from the Caucasus region and Russia (2000–2020)

Healthcare and economic burden of adverse childhood experiences in Lahore, Pakistan

ObjectivesStrong evidence links ACEs to adverse health outcomes, such as an increased risk of developing many chronic diseases. This study aimed to find the association between exposure to adverse childhood experiences (ACEs) and chronic health diseases and their healthcare and economic burdens in Lahore city. MethodsThe Study involved 385 participants from Lahore, Pakistan. Eligible participants who were 18 or older and below 18 years old were excluded. A cross-sectional study was conducted and the sample was collected using a stratified random sampling method. Cross-tabulation and Chi-Square tests were conducted to examine the relationship between exposure to ACEs and the outcomes of chronic diseases. Risk profiles including relative risk, attributable risk, and population attributable risk were calculated to determine the healthcare burden. The economic burden was calculated using DALYs and healthcare costs. ResultsThe sample had a 59.8 % male predominance, and the average age was 29. 67 % of participants had at least one ACE-related chronic disease such as anxiety, depression, and stroke. A significant association was found between them (p < 0.05). Due to ACEs, study participants lost 1388 years of a healthy life. At the same time, ACE-related healthcare costs were roughly 4200 million PKR (15.14 million USD). ConclusionThe results revealed an elevated risk of chronic health outcomes connected with experiencing one or more ACEs. Addressing ACEs may improve health, reduce healthcare expenditures, and increase resilience.

A Cost-Utility Analysis of Ferric Derisomaltose Versus Ferric Carboxymaltose in Patients with Iron Deficiency Anemia in China.

Intravenous (IV) iron is the recommended treatment for patients with iron deficiency anemia (IDA) unresponsive to oral iron treatment, in whom oral iron is contraindicated, or where rapid iron replenishment is required. Ferric derisomaltose (FDI) and ferric carboxymaltose (FCM) are high-dose, rapid-infusion, IV iron formulations that have recently been compared in three head-to-head randomized controlled trials (RCTs), which showed significantly higher incidence of hypophosphatemia after administration of FCM than FDI. The present study objective was to evaluate the cost-utility of FDI versus FCM in a population of patients with IDAin China. A previously-published patient-level simulation model was used to model the cost-utility of FDI versus FCM in China. The number of infusions of FDI and FCM was modeled based on the approved posology of the respective formulations using simplified tables of iron need in a population of patients with body weight and hemoglobin levels informed by a Chinese RCT of FCM. Data on the incidence of hypophosphatemia was obtained from the PHOSPHARE-IDA RCT, while data on disease-related quality of life were obtained from SF-36v2 data from the PHOSPHARE-IBD RCT. Over the 5-year time horizon, patients received 3.98 courses of iron treatment on average, requiring 0.90 fewer infusions of FDI than FCM (7.69 vs. 6.79). This resulted in iron procurement and administration cost savings of renminbi (RMB) 206 with FDI (RMB 3,519 vs. RMB 3,312). Reduced incidence of hypophosphatemia-related fatigue resulted in an increase of 0.07 quality-adjusted life years and further cost savings of RMB 782 over 5years, driven by reduced need for phosphate testing and replenishment. FDI was therefore the dominant intervention. The results showed that FDI would improve patient quality of life and reduce direct healthcare expenditure versus FCM in patients with IDA in China.

Measuring the Impact of Medical Cannabis Law Adoption on Employer-Sponsored Health Insurance Costs: A Difference-in-Difference Analysis, 2003-2022.

Recent studies suggest that medical cannabis laws may contribute to arelative reduction in health insurance costs within the individual health insurance markets at the state level. We investigated the effects of adopting a medical cannabis law on the cost of employer-sponsored health insurance in the United States. We analyzed state-level data from the Medical Expenditure Panel Survey-Insurance Component (MEPS-IC) Private Sector spanning from 2003 to 2022. The outcomes included log-transformed average total premiumcosts per employee for single, employee-plus-one, and family coverage plans. We utilized the Sun and Abraham (J Econometr 225(2):175-199, 2021) difference-in-difference (DiD) method, looking at the overall DiD and event-study DiD. Models were adjusted for various state-level demographics and dichotomous policy variables, including whether a state later adopted recreational cannabis, as well as time and unit fixed effects and population weights. For states that adopted a medical cannabis law, there was a significant decrease in the log average total premium per employee for single (-0.034, standard error [SE] 0.009(-$238)) and employee-plus-one (-0.025, SE 0.009(-$348)) coverage plans per yearconsidering the first 10 years of policy change compared with states without such laws. Looking at the last 5years of policy change, we saw increases in effect size and statistical significance. In-time placebo testing suggested model robustness.Under a hypothetical scenario where all 50 states adopted medical cannabis in 2022, we estimated that employers and employees could collectively save billions on healthcare coverage, potentially reducing healthcare expenditure's contribution to GDP by 0.65% in 2022. Adoption of a medical cannabis law may contribute to decreases in healthcare costs. This phenomenon is likely a secondary effect and suggests positive externalities outside of medical cannabis patients.

Economic Evaluation of a Novel Lung Cancer Diagnostic in a Population of Patients with a Positive Low-Dose Computed Tomography Result

Background: Early detection of lung cancer is crucial for improving patient outcomes. Although advances in diagnostic technologies have significantly enhanced the ability to identify lung cancer in earlier stages, there are still limitations. The alarming rate of false positives has resulted in unnecessary utilization of medical resources and increased risk of adverse events from invasive procedures. Consequently, there is a critical need for advanced diagnostics after an initial low-dose computed tomography (LDCT) scan. Objectives: This study evaluated the potential cost savings for US payers of CyPath® Lung, a novel diagnostic tool utilizing flow cytometry and machine learning for the early detection of lung cancer, in patients with positive LDCT scans with indeterminate pulmonary nodules (IPNs) ranging from 6 to 29 mm. Methods: A cost offset model was developed to evaluate the net expected savings associated with the use of CyPath® Lung relative to the current standard of care for individuals whose IPNs range from 6 to 29 mm. Perspectives from both Medicare and private payers in a US setting are included, with a 1-year time horizon. Cost calculations included procedure expenses, complication costs, and diagnostic assessment costs per patient. Primary outcomes of this analysis include cost savings per cohort and cost savings per patient. Results: Our analysis showed positive cost savings from a private payer’s perspective, with expected savings of $895 202 311 per cohort and $6460 per patient, across all patients. Scenario analysis resulted in cost savings of $890 829 889 per cohort, and $6429 per patient. Similarly, savings of $378 689 020 per cohort or $2733 per patient were yielded for Medicare payers, across all patients. In addition, scenario analysis accounting for false negative patients from a Medicare payer perspective yielded savings of $376 902 203 per cohort and $2720 per patient. Discussion: The results suggest substantial cost savings, primarily due to reductions in follow-up diagnostic assessments and procedures, and highlight the importance of accurate diagnostic tools in reducing unnecessary healthcare expenditures. Conclusion: CyPath® Lung utilization yields savings for private and Medicare payers relative to the current standard of care in a US setting for individuals with 6 to 20 mm IPNs.

Health expenditure trajectory and gastric cancer incidence in the National Health Insurance Senior Cohort: a nested case-control study

BackgroundGastric cancer is the fourth most common cancer and highly prevalent in South Korea. As one of the predictors of gastric cancer, we focused on health utilization patterns and expenditures, as the surrogate variables of health conditions. This nested case-control study aimed to identify the association between health expenditure trajectory and incidence of gastric cancer.MethodsData from the National Health Insurance Service Senior Cohort of South Korea were used. Individuals diagnosed with gastric cancer (N = 14,873) were matched to a non-diagnosed group (N = 44,619) in a 1:3 ratio using a nested case-control design. A latent class trajectory analysis was performed to identify the patterns of health expenditure among the matched participants. Furthermore, conditional logistic regression analysis was conducted to examine the relationship between healthcare expenditure trajectories and gastric cancer incidence.ResultsSeven distinct health expenditure trajectories for five years were identified; consistently lowest (13.8%), rapidly increasing (5.9%), gradually increasing (13.8%), consistently second-highest (21.4%), middle-low (18.8%), gradually decreasing (13.1%), and consistently highest (13.2%). Compared to the middle-low group, individuals in the rapidly increasing [odds ratio (OR) = 2.11, 95% confidence interval (CI); 1.94–2.30], consistently lowest (OR = 1.40, 95% CI; 1.30–1.51), and gradually increasing (OR = 1.26, 95% CI; 1.17–1.35) groups exhibited a higher risk of developing gastric cancer.ConclusionsOur findings suggest that health expenditure trajectories are predictors of gastric cancer. Potential risk groups can be identified by monitoring health expenditures.

The evolution of animal-based dietary structure has contributed to the increase of healthcare expenditures in China

The trends of diversified diets in China have generated a growing number of nutritional health problems, and healthcare investment is bearing a large burden from the diets, hindering the economic progress of the country and its residents toward affluence. This study linked the evolution of the Chinese dietary structure to changes in health expenditures and predicts future dietary patterns and their impact on health costs over the next 30 years. We found that in the past 30 years, the Chinese dietary structure has shifted towards a nutritional surplus type, and the structure of health expenditures has also shown a trend of two increases and one decrease. The consumption of plant-based foods is significant correlated with lower health expenditures, and animal-based foods show a significant impact on increase of health expenditures. Among nutrients, fat is significant correlated with increased health expenditures, whereas calorie intake is significant correlated with lower health expenditures. By 2030, the Chinese dietary structure will still evolve to a high-protein and high-fatty type. This shift will result in a decrease in per capita healthcare expenditure by 41.66 yuan and increases in household, state, personal, and total healthcare expenditures by 76.83 yuan, 18.76 billion yuan, 95.28 billion yuan, and 17.67 billion yuan, respectively. These findings demonstrate that adjusting dietary structures will bring the dual benefits of improved national health status and a favorable cycle of health expenditures.

Healthcare Expenditure, Health Outcomes and Economic Growth: A Study of BRICS Countries

This study examines the relation of health spending, health indicators and macroeconomic variables of the BRICS economies with economic growth by using panel data that span the years 2000–2019. According to the panel data analysis, the amount of government spending on healthcare has a positive effect on the gross domestic product (GDP) and gross national income per capita of the BRICS countries. Indicators of healthcare are positively related to GDP and GDP/capita. The exceptions are neonatal mortality and life expectancy at birth, both of which do not exhibit a statistically significant positive relation. The two dependent variables, GDP and GDP/capita, have a positive relation with the rate of population growth; however, GDP has a negative relation with inflation. When GDP and GDP/capita are used as dependent variables, the Hausman test indicates that the cross-section random-effect model is more significant than other models. Due to the positive relationship between GHE, GDP and GDP/capita, the government should play a major role in ensuring high-quality healthcare. Out-of-pocket expense increases in BRICS indicate a reduction in healthcare funds, limiting medical services for all citizens. There is a need to focus on healthcare infrastructure.

Assessing the Impact of Environmental Quality on Public Health Expenditure Central Asia

This study utilizes panel data from 2002 to 2022 in Central Asia to analyze the impact of environmental quality on public health expenditures. This study employs the ARDL model to examine the short-run and long-run relationships between healthcare expenditure and pollution levels, namely carbon dioxide (CO2), sulfur dioxide (SO2), and nitrogen dioxide (NO2). The data indicate a robust positive correlation between greenhouse gases and healthcare expenditures, demonstrating the effect of environmental pollution on public health. The study examines the relationship between socioeconomic variables, including GDP, death rates, and healthcare expenditures. This study concludes that reversing this trend hinges on improving environmental policy in the energy and industrial sectors. This research contributes to the existing knowledge by analyzing how various environmental elements and economic structures persistently impact health policy evolution in the region.

Trends in the Treatment of Chronic Wounds.

Chronic wounds remain one of the significant burdens to health across the world, mainly in view of diabetes and its natural consequences. This category of lesions includes pressure ulcers, vascular diseases, and surgery-related wounds, which affect millions and pose a major challenge to the healthcare industry. The paper reviews the various physiological mechanisms of wound healing, factors that impede it, and some new treatments emerging at this moment. In contrast, current developments include surgical and non-surgical alternatives like topical dressings, medicated formulations, and skin substitutes. Advanced wound care today covers tissue-engineered skin substitutes, 3D-printed wound dressings, topical medicated formulations, and growth factor-based therapies. These are non-invasive, biocompatible methods that are cost-effective, userfriendly, and more conducive to natural healing than traditional therapies. Hydrogel dressings have high water content to create a moist environment that encourages healing. They also reflect excellent physicochemical and biological properties, which enhance autolytic debridement and reduction of pain due to the moisture retention, biocompatibility, and non-toxicity conferred. Tissue-engineered skin substitutes, comprising allogeneic or autologous cells, wound-healing enhancement bioengineered allogeneic cellular therapies are like the natural skin and encourage regeneration. 3D printing allows the production of customized dressings to aid in better treatment. Newer therapies, including bioengineered allogeneic cellular therapies and fish skin grafting, require more clinical trials to confirm safety and efficacy. With such innovations in wound healing technologies and therapies, the future looks quite promising in managing chronic wounds, enhancing healing, reducing healthcare expenditure, and promoting a better quality of life for patients.

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

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

Magnitude and determinants of the catastrophic out-of-pocket healthcare expenditure in rural and urban areas: lessons from Tanzania panel data survey

Out-of-pocket (OOP) healthcare costs can impose a strain, their consequences are regressive, they may result into disaster and bankruptcy. These health expenses that surpass a certain percentage of total households income compelling the household to bear the cost of the illness is considered as catastrophic health expenditure (CHE). Using the national panel data collected in 2008/09, 2010/11 and 2012/13 waves in Tanzania, the study sampled a total of 1476 households with at least one member who had an experience of visiting a healthcare provider 4 weeks before the survey and she or he covered costs for treatment from own pocket. The logistic model was used to analyse the determinants of CHE in both rural and urban areas. The two most commonly thresholds were used, such as 10% and 40% of the overall income and non-food revenue, respectively. OOP healthcare costs are strongly and positively linked to catastrophic costs as well as household poverty. For both thresholds, income, household size, and age of the household's head above 60 years significantly influenced CHE at a 5% level. We support the literature pointed out that OOP healthcare expenses inflict financial catastrophe to the poor households and they even expose them to more hardship.

The impact of a mobile geriatric acute team on healthcare consumption.

This study describes the effects of a mobile geriatric acute team (GAT) treating acutely ill geriatric patients in their homes. GAT offered more advanced diagnostic and treatment options than are normally available to primary-care led mobile teams. The aim of this study was to evaluate if interventions by GAT had effect on the number of emergency department (ED) visits, hospitalisations, and length of stay in hospital. This is a before-after study, with outcomes recorded for each participant during the 3months prior to the first visit by GAT and compared to the same outcomes for each participant during the 3months after the first visit. The participant's mean age was 84.6years, 56% were women. There was no observed difference in ED visits, hospitalisations, and length of stay in hospital for all participants (n = 102). However, for the 27 participants living in nursing homes; ED-visits reduced on average by 0.5/participant (p = 0.002), the number of hospitalisations reduced by 0.3/participant (p = 0.018) and length of stay in hospital reduced by 4.3days/participant (p = 0.045). For the 13 participants referred by ambulance, the number of hospitalisations reduced by 0.7/participant (p = 0.044) and length of stay in hospital reduced by 4.1days/participant (p = 0.028). The participants who got intravenous antibiotics also had less hospital care. This geriatric acute mobile team did not cause reduced hospital care among the participants overall. However, it might have reduced hospitalization in some subgroups, such as patients living in nursing homes or those who got intravenous antibiotics.