Incidence Of Catastrophic Payments Research Articles

New measure of catastrophic health expenditures with application on rural Egypt

ABSTRACT Reducing Out-of-pocket (OOP) health payments is an essential element to protect households from financial risks and eradicate extreme poverty. This paper aimed to provide a new approach for measuring catastrophic health expenditure (CHE) by redefining subsistence spending to comprise the minimum acceptable level of all necessities. The new approach defined OOP health expenditures as catastrophic payments if they undermine a household’s ability to maintain essential needs that are not limited to food needs as assumed by the Capacity to pay (CTP) approach. The equivalence scale is estimated to reflect the dominant consumption patterns and the Cost of Basic Need Approach (CBN) is employed to measure the subsistence spending. We estimated the burden of OOP health payment on household living standards in rural Egypt using data from Household Income, Expenditure, and Consumption Survey in 2015. Rural areas exhibited a considerable incidence of catastrophic payments. Redefining subsistence spending better detected the incidence of catastrophic health expenditure among poor households. The distribution of CHE became highly regressive and demonstrated that catastrophic payments are more concentrated among poor households. Although poor households have incurred relatively small health payments compared to wealthy ones, this has threatened their standard of living. The highest incidence rates of CHE were also observed among uneducated, unemployed, female, elderly heads, among households with chronically ill members, and those who experienced outpatient services. The poor performance of the health insurance system in protecting vulnerable groups from catastrophic payments creates a critical need to redesign its policies and improve its service quality.

The catastrophic and impoverishing effects of out-of-pocket healthcare payments in Kenya, 2018

IntroductionProgress towards effective service coverage and financial protection—the two dimensions of Universal Health Coverage (UHC)—has been limited in Kenya in the last decade. The government of Kenya has embarked on...

Progress on catastrophic health spending in 133 countries: a retrospective observational study.

The goal of universal health coverage (UHC) requires inter alia that families who get needed health care do not suffer undue financial hardship as a result. This can be measured by the percentage of people in households whose out-of-pocket health expenditures are large relative to their income or consumption. We aimed to estimate the global incidence of catastrophic health spending, trends between 2000 and 2010, and associations between catastrophic health spending and macroeconomic and health system variables at the country level. We did a retrospective observational study of health spending using data obtained from household surveys. Of 1566 potentially suitable household surveys, 553 passed quality checks, covering 133 countries between 1984 and 2015. We defined health spending as catastrophic when it exceeded 10% or 25% of household consumption. We estimated global incidence by aggregating up from every country, using a survey for the year in question when available, and interpolation and model-based estimates otherwise. We used multiple regression to explore the relation between a country's incidence of catastrophic spending and gross domestic product (GDP) per person, the Gini coefficient for income inequality, and the share of total health expenditure spent by social security funds, other government agencies, private insurance schemes, and non-profit institutions. The global incidence of catastrophic spending at the 10% threshold was estimated as 9·7% in 2000, 11·4% in 2005, and 11·7% in 2010. Globally, 808 million people in 2010 incurred catastrophic health spending. Across 94 countries with two or more survey datapoints, the population-weighted median annual rate of change of catastrophic payment incidence was positive whatever catastrophic payment incidence measure was used. Incidence of catastrophic payments was correlated positively with GDP per person and the share of GDP spent on health, and incidence correlated negatively with the share of total health spending channelled through social security funds and other government agencies. The proportion of the population that is supposed to be covered by health insurance schemes or by national or subnational health services is a poor indicator of financial protection. Increasing the share of GDP spent on health is not sufficient to reduce catastrophic payment incidence; rather, what is required is increasing the share of total health expenditure that is prepaid, particularly through taxes and mandatory contributions. Rockefeller Foundation, Ministry of Health of Japan, UK Department for International Development (DFID).

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.

Assessing the economic burden of illness for tuberculosis patients in Benin: determinants and consequences of catastrophic health expenditures and inequities.

To inform policy-making, we measured the risk, causes and consequences of catastrophic expenditures for tuberculosis and investigated potential inequities. Between August 2008 and February 2009, a cross-sectional study was conducted among all (245) smear-positive pulmonary tuberculosis patients of six health districts from southern Benin. A standardised survey questionnaire covered the period of time elapsing from onset of tuberculosis symptoms to completion of treatment. Total direct cost exceeding the conventional 10% threshold of annual income was defined as catastrophic and used as principal outcome in a multivariable logistic regression. A sensitivity analysis was performed while varying the thresholds. A pure gradient of direct costs of tuberculosis in relation to income was observed. Incidence (78.1%) and intensity (14.8%) of catastrophic expenditure were high; varying thresholds was insensitive to the intensity. Incurring catastrophic expenditure was independently associated with lower- and middle-income quintiles (adjusted odd ratio (aOR) = 36.2, 95% CI [12.3-106.3] and aOR = 6.4 [2.8-14.6]), adverse pre-diagnosis stage (aOR = 5.4 [2.2-13.3]) and less education (aOR = 4.1[1.9-8.7]). Households incurred important days lost due to TB, indebtedness (37.1%), dissaving (51.0%) and other coping strategies (52.7%). Catastrophic direct costs and substantial indirect and coping costs may persist under the 'free' tuberculosis diagnosis and treatment strategy, as well as inequities in financial hardship.

Measuring incidence of catastrophic out-of-pocket health expenditure: with application to India

The present paper attempts to provide a new measure of catastrophic out-of-pocket health expenditure based on consumption of necessities. In literature, catastrophic expenditure is measured as out-of-pocket health expenditure that exceeds some fixed proportion of household income or household's capacity to pay. According the new measure proposed in this paper, OOP health expenditure is catastrophic if it reduces the non-health expenditure to a level where household is unable to maintain consumption of necessities. Based on this measure of catastrophic health expenditure, the paper examines determinants of catastrophic out-of-pocket health expenditure in India. The results show that, incidence of catastrophic OOP health expenditure increases with income, when we use the earlier measures. However, results based on the revised measure show that, the incidence of catastrophic payments goes down as income increases. Therefore, the analysis suggests that the findings are sensitive to the method used. The findings from multivariate analysis show economic and social status of Indian households are important determinants of incidence of catastrophic health expenditure. Education reduces the probability of incurring catastrophic health expenditure. Moreover, these findings are sensitive to measure of catastrophic OOP health expenditure and therefore, it is important to consider appropriate measure of catastrophic OOP health expenditure.