OOP Health Expenditure Research Articles

Modelling unbalanced catastrophic health expenditure data by using machine‐learning methods

SummaryThis study aims to compare the performances of logistic regression and random forest classifiers in a balanced oversampling procedure for the prediction of households that will face catastrophic out‐of‐pocket (OOP) health expenditure. Data were derived from the nationally representative household budget survey collected by the Turkish Statistical Institute for the year 2012. A total of 9,987 households returned valid surveys. The data set was highly imbalanced, and the percentage of households facing catastrophic OOP health expenditure was 0.14. Balanced oversampling was performed, and 30 artificial data sets were generated with sizes of 5% and 98% of the original data size. The balanced oversampled data set provided accurate predictions, and random forest exhibited superior performance in identifying households facing catastrophic OOP health expenditure (area under the receiver operating characteristic curve, AUC = 0.8765; classification accuracy, CA = 0.7936; sensitivity = 0.7765; specificity = 0.8552; F1 = 0.7797).

Contemporary relationship between medical expenditures and quality of life among adults with epilepsy in the United States

AimsEpilepsy exacts substantial adverse economic and quality of life (QoL) costs. Clarifying the quantitative and qualitative relationships between total and out-of-pocket (OOP) healthcare expenditures and QoL could shed insights into how they influence each other, and have done so over recent times. MethodsWe used the Medical Expenditure Household Components 2003–2014 to identify a total of 2450 adults with epilepsy, representing a weighted population of 1,942,413. Quality of life was assessed using the Physical Component Summary (PCS) and the Mental Component Summary (MCS) derived from the Short-form 12 Version 2 (SF-12 V2), converted into quartiles of equal distribution, with higher quartiles indicating a better QoL. We computed unadjusted mean and adjusted (through a generalized linear model (GLM)) total and OOP healthcare expenditures by QoL categories among adults with epilepsy (reported as dollars in 2016). ResultsThe pooled estimates of total healthcare expenditures decreased as PCS and MCS quartiles of QoL increased [PCS: costs for quartile 1 = $21,792 (95% confidence interval (CI): $18,416–$25,168 vs. costs for quartile 4 = $6057 (95% CI: $4648–$7466) and MCS: costs for quartile 1 = $19,040 (95% CI: $15,544–$22,535) vs. quartile 4 = $12,939 (95% CI: $8450–$17,429)]. Similarly, the pooled estimates of OOP healthcare expenditures and QoL were inversely related [PCS: costs for quartile 1 = $1849 (95% CI: $1583–$2114) vs. costs for quartile 4 = $948 ($709–$1187) and MCS: costs for quartile 1 = 1812 (95% CI: $1483–2141) vs. quartile 4 = $1317 (95% CI: $982–$1652)]. The association between QoL and total and OOP healthcare expenditures was unchanged after adjusting for socioeconomic and healthcare system related confounders in the GLM. Overall, healthcare expenditures were stable across years independently of the QoL; only OOP expenditures decreased between 2003–2006 and 2011–2014 for quartile 1 of PCS and MCS. ConclusionQuality of life and OOP health expenditures are independently and inversely related to each other among adults with epilepsy. Over the decade studied in the United States, there was a decrease in OOP health expenditures among those patients with epilepsy with the lowest QoL, possibly reflecting a rise in insurance coverage after the Affordable Care Act.

The Economic Impacts of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome in an Australian Cohort.

Objectives: This study aims to estimate direct and indirect health economic costs associated with government and out-of-pocket (OOP) expenditure based on health care service utilization and lost income of participants and carers, as reported by Australian Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) patient survey participants.Design: A cost of illness study was conducted to estimate Australian cost data for individuals with a ME/CFS diagnosis as determined by the Canadian Consensus Criteria (CCC), International Consensus Criteria (ICC), and the 1994 CDC Criteria (Fukuda).Setting and participants: Survey participants identified from a research registry database provided self-report of expenditure associated with ME/CFS related healthcare across a 1-month timeframe between 2017 and 2019.Main outcome measures: ME/CFS related direct annual government health care costs, OOP health expenditure costs, indirect costs associated with lost income and health care service use patterns.Results: The mean annual cost of health care related expenditure and associated income loss among survey participants meeting diagnostic criteria for ME/CFS was estimated at $14.5 billion. For direct OOP and Government health care expenditure, high average costs were related to medical practitioner attendance, diagnostics, natural medicines, and device expenditure, with an average attendance of 10.6 referred attendances per annum and 12.1 GP visits per annum related specifically to managing ME/CFS.Conclusions: The economic impacts of ME/CFS in Australia are significant. Improved understanding of the illness pathology, diagnosis, and management, may reduce costs, improve patient prognosis and decrease the burden of ME/CFS in Australia.

Catastrophic health expenditure and health facility access among rural informal sector families

BackgroundThe extension of industrialization in rural India during previous decade has opened wide employment opportunities. As a result, the per-capita income and expenditure capability of these individuals and their families have raised. However informal sectors in rural areas, particularly with restricted public health care facilities and lack of social security scheme coverage, out-of-pocket (OOP) health expenditure could result in catastrophic health expenditure (CHE). AimTo study the relation of sociodemographic and occupational factors with CHE among rural informal sector families. Methodology: All 13 villages of Gangad (Gujarat state, India) primary health care catchment area was cross sectionally investigated. After informed written consent, data regarding sociodemographic profile, total health expenditure and health facility access were collected from 429 representative households through pre-tested semi-structured questionnaire. The sample was categorized based on the major source of income (occupation). SPSS software was used to execute the statistical analysis. ResultsAbout 61.8% families accessed government health facilities. While 71% of families were from lower-middle and lower socioeconomic class experiencing the brunt of CHE (i.e. 57.9% of families in this sociodemographic group experienced CHE). The proportion of CHEs among families accessing public health care facilities had substantially lower (13.2%); whereas higher proportion of CHEs were reported among families of factory workers (45.5%) and agricultural labor (25.5%). ConclusionIn the interest of reducing the OOP health expenditure (thereby reducing the incidence of CHE) and sustainable growth, the vulnerable informal sector is recommended to be adequately protected under social security schemes by either government or employer.

PNS66 HEALTH INSURANCE PROGRAMS FOR THE POOR AND OUT-OF-POCKET HEALTH CARE COSTS: EVIDENCE USING NATIONAL SAMPLE SURVEY DATA

In India, Out-of-Pocket (OOP) expenses accounts for about 62.6% of total health expenditure. There are many Public Health Insurance Programs offered by the Government of India that cover the cost of hospitalization for the people below poverty line (BPL), but their coverage is still not complete. The objective is to examine the effect of Public Health Insurance Programs for the Poor on hospitalizations and inpatient OOP health expenditures.

An observational study to find the patterns of out-of-pocket expenditure for oral healthcare among sanitary workers in Coimbatore, India

Background: Out-of-pocket (OOP) expenditure for health care and dental care has been steadily increasing. The OOP expenditure may precipitate existing financial distress in the households and lead to unmet dental needs. In India, OOP health expenditure is on the higher side due to low public spending on health. Aim: To find the patterns of oral health-care expenditure, factors associated with catastrophic dental health expenditure (CDHE), and knowledge about health insurance of sanitary workers in Coimbatore, India. Materials and Methods: The study employed a cross-sectional design based on an interview schedule. The final sample consisted of 246 study participants, randomly selected from sanitary workers presently working in Coimbatore Municipal Corporation. Data were collected regarding demographic information, and the interview schedule oral health-care expenditure inventory consisting of 48 questions was administered. Data were coded and analyzed using the Statistical Package for the Social Sciences (SPSS, ver. 20.0), and Chi-square test was applied for categorical variables. Results: The reported prevalence of CDHE was 15.4%. For dental care, 5.3% of the participants have spent more than Rs. 5000/month, and for dental medications, 11% have spent more than Rs. 2000/month. Respondent's monthly income (P < 0.05), number of family members (P < 0.001), socioeconomic status (P < 0.001), monthly expenditure (P < 0.001), duration of work (P < 0.001), dental problems (self-assessment) (P < 0.001), irregular dental visits (P < 0.001), self-medication (P < 0.001), and postponement of dental care (P < 0.001) were significantly associated with CDHE. Conclusions: This study provides evidence that OOP payments for dental care were high among the sanitary workers in Coimbatore putting burden on the financial security of their families, and 15.4% of the respondents were affected by CDHE.

Inequity in healthcare needs, health service use and financial burden of medical expenditures in China: results from a consecutive household monitoring study in Jiangsu Province

BackgroundAlthough public medical insurance covers over 95% of the population in China, disparities in health service use and out-of-pocket (OOP) health expenditure across income groups are still widely observed. This study aims to investigate the socio-economic disparities in perceived healthcare needs, informal care, formal care and payment for healthcare and explore their equity implication.MethodsWe assessed healthcare needs, service use and payment in 400 households in rural and urban areas in Jiangsu, China, and included only the adult sample (N = 925). One baseline survey and 10 follow-up surveys were conducted during the 7-month monitoring period, and the Affordability Ladder Program (ALP) framework was adopted for data analysis. Negative binomial/zero-inflated negative binomial and logit regression models were used to explore factors associated with perceived needs of care and with the use of self-treatment, outpatient and inpatient care respectively. Two-part model and logit regression modeling were conducted to explore factors associated with OOP health expenditure and with the likelihood of incurring catastrophic health expenditure (CHE).ResultsAfter adjusting for covariates, rural residence was significantly associated with more perceived healthcare needs, more self-treatment, higher probability of using outpatient and inpatient service, more OOP health expenditure and higher likelihood of incurring catastrophic expenditure (P < 0.05). Compared to the Urban Employee Basic Medical Insurance (UEBMI), enrollment in the New Rural Cooperative Medical Scheme (NRCMS) or in the Urban Resident Basic Medical Insurance (URBMI) was correlated with lower probability of ever using outpatient services, but with more outpatient visits when people were at risk of using outpatient service (P < 0.05). NRCMS/URBMI enrollment was also associated with higher likelihood of incurring CHE compared to UEBMI enrollment (OR = 2.02, P < 0.05); in stratified analysis of the rural and urban sample this effect was only significant for the rural population.ConclusionsThe rural population in Jiangsu perceived more healthcare needs, had a higher probability of using both informal and formal healthcare services, and had more OOP health expenditure and a higher likelihood of incurring CHE. The inequity mainly exists in health care financing, and may be partially addressed through improving the benefit packages of NRCMS/URBMI.

Out of pocket health expenditures in Turkey following introduction of co-payments along with improved primary care services.

In 2002, Turkey started to implement reforms in health care aiming to improve access and increase efficiency. Reforms increased health insurance coverage and resulted in higher number of outpatient and inpatient treatments at both public and private hospitals. Later, to change preference towards the use of secondary and tertiary care over primary care and rein in increasing health expenditures, a series of co-payments were instituted along with an extension of primary care services through a family-medicine system that provided free access to all. This work aims to measure the impact of these two simultaneous policy measures on out-of-pocket expenditures. We find that while contributory payments resulted in higher OOP health expenditures, especially for lower income households, the impact was small. We also observe that inability to consult a physician and to visit a hospital, especially for monetary reasons, was reduced after the policy change.

Increase of catastrophic health expenditure while it does not have socio-economic anymore; finding from a district on Tehran after recent extensive health sector reform

BackgroundEnsuring financial protection of the community against health care expenditures is one of the fundamental goals of the health system. Catastrophic health expenditures (CHE) occurs when out-of-pocket health expenditures due to health care expenses considerably affect family life. The main purpose of this study was to analyze CHE trend over time and to determine its determinants.MethodsThe last round of a three part study over time was conducted in June to September 2015 on 600 households in a non-affluent area of Tehran. The World Health Survey questionnaire was used to collect information. Health expenditure was considered to be catastrophic when OOP health expenditures exceed 40% of household’s capacity to paysubsistence expenditures. After calculating the amount of households’ exposure to CHE, determinants resulting in CHE using logistic regression and the amount of economic inequality in the exposure of households to CHE using the concentration index were calculated. Then, performing a decomposition analysis, the contribution of each of the studied variables to the observed economic inequality was determined. All the findings were compared with the results of studies carried out in the years 2003 and 2008.ResultsIn the year 2015, 29.9% of households incurred CHE. This amount was 12.6 and 11.8% in the 2003 and 2008 studies, respectively. The concentration index was - 0.017(confidence interval; − 0.086 to 0.051), which, unlike the CI calculated in the years 2003 and 2008, was not significant. The most important determinant affecting the exposure to CHE was inpatient service utilization (OR = 1.64).ConclusionComparing to the whole national wide findings in sum, in 2015, the amount of the exposure of the studied households to CHE was significant, and it in comparison with the results of the previous studies was increased. However, there was no significant economic inequality and the observed levels of inequalityin comparison with the results of the previous studies conducted in 2003 and 2008 were decreased.

Determinants of out of pocket healthcare expenditures: The case of Mugla province in Turkey

As the share of health care financing from public funds was increasing in Turkey, the utilization of the health care services has also increased, dramatically. Despite of universal health coverage, the result of this trend causes to increase the incidence of making out of pocket expenditures. The aim of this study is to evaluate the determinants of households' health expenditures in Mugla province of Turkey. A total of 204 households living in the central district of Mugla were surveyed and questioned both for their total consumption and health expenditures, as well as their health status, demographic and socio-economic characteristics. Ordinary least square method was used for the multiple regression analysis to identify the factors that affect the out of pocket health care expenditures. In addition to other empirical studies in Turkey, the effects of relative poverty and types of income and occupation on oop expenditures were estimated. Results identify that consumption expenditure of the household, poverty, wage/income status, education, household size, having chronic disease and having elderly in the households have significant effects on the amount of out of pocket (oop) health expenditure of the households. Keywords: Health care financing; Out of pocket payments; Ordinary least square method; Turkey

Impact of community-based rehabilitation for mental illness on 'out of pocket' expenditure in rural South India.

To describe impact of Community Based Rehabilitation (CBR) on OOP expenditure incurred by families of persons with severe mental illness (PSMI). The sample comprised 95 PSMI who switched from treatment from other mental health facilities to CBR at Jagaluru, India. The PSMI were predominantly male (52%) with mean age 41 years and diagnosed with psychosis (75%). Most of them (84%) were earlier taking treatment from private sector and spent on an average Rs. 15,074 (US $ 215) per PSMI per annum in availing treatment. After availing CBR, the annual expenditure reduced to Rs 492 (US $ 7) on an average per PSMI. OOP expenditure on medicines (largest head of expenditure) and psychiatrist consultation fee dropped to zero. After excluding costs incurred to run the CBR, the net savings for the system for 95 PSMI included in study alone was Rs 3,83,755 (US $ 5,482) per annum. The amount would be much higher on including savings for PSMI initiated on treatment for the first time and PMI on regular follow-up in CBR. Provision of CBR in partnership with public health system and NGO's leads to dramatic fall in OOP health expenditure of families of PSMI. It is also cost-effective to the system.

Use of high-level health facilities and catastrophic expenditure in Vietnam: can health insurance moderate this relationship?

BackgroundOvercrowding of high-level health facilities is a major concern in a Vietnamese health system. This may increase an economic burden to the households since health insurance is still insufficient in providing financial risk protection. This paper sought to examine the association between the use of high-level health facilities and household-level expenditure status such as out-of-pocket (OOP), and catastrophic expenditure on health, as well as a moderating effect of health insurances in rural and urban districts of Vietnam.MethodsData utilized a health system community survey collected between 2015 and 2017 in two districts of Vietnam (one from rural area in northern part, and the other one from urban area in sourthern part). The world Health Organization’s definition of catastrophic expenditure was used. Multivariate tobit and logistic regression were employed for catastrophic expenditure and OOP respectively. Interaction term between health insurance status and visit frequency in high-level facilities was included to investigate the moderating effect of health insurance.ResultsHealth insurance status was associated with neither OOP health expenditure nor catastrophic expenditure occurrence, whereas visit frequency of high-level health facilities was strongly associated with both outcomes in both districts(e.g., for catastrophic expenditure, ORs are 1.77 and 1.30 in northern and southern district respecitvely. P values are < 0.001). Significant interaction between health insurance status and use of high-level facilities on catastrophic expenditure occurrence was found in Quoc Oai district (OR = 0.68, p < 0.05).ConclusionsThe present study demonstrated negative financial impact of utilizing high-level facility on household financial status and weak role of health insurance in decreasing this impact. Multi-faceted approach is called for to mitigate the patient’s financial burden.

Burden of out-of-pocket health expenditure and its impoverishment impact in India: evidence from National Sample Survey

ABSTRACT In low- and middle-income countries like India, financing of health-care expenditure is predominantly characterized by out-of-pocket (OOP) spending. Given this context, the current study examined the economic burden of OOP health expenditure and resultant impoverishment in India. The study employed nationally representative survey on ‘Health and Morbidity’ conducted by National Sample Survey Organization (NSSO) in 2014 in India. Standard catastrophic, inequality and impoverishment measures were used to analyse the burden and impact of OOP health expenditure. Findings revealed that although the overall incidence and intensity of OOP health expenditure was concentrated among the richer consumption groups, in-depth study of the same in terms of inpatient and outpatient care showed that the incidence of outpatient care was highly concentrated towards the poorer consumption groups. Study also revealed that around 8% of the population fell below the poverty line due to OOP health expenditure in which outpatient care was the main contributing factor (5.8%). Among different socio-economic covariates, rural population, Muslims, Scheduled Castes and casual/agriculture labour were most affected and had higher impoverishment impact. Our findings suggest that there is a need to revisit the approach towards health-care financing in India. Abbreviations: OOP: Out-of-pocket; MPCE: Monthly per capita consumption expenditure; SCs: Scheduled Castes; STs: Scheduled Tribes; OBCs: Other Backward Castes; TCE: Total consumption expenditure; PFHI: Publicly financed health insurance; RSBY: Rashtriya Swasthya Bima Yojana; CMCHIS: Chief Minister’s Comprehensive Health Insurance Scheme; UHC: Universal health coverage

Does the unification of health financing affect the distribution pattern of out‐of‐pocket health expenses in Turkey?

Turkey has implemented health reforms for over a decade and has taken significant steps toward unifying health financing. This study investigated the financial burden associated with out‐of‐pocket (OOP) expenditures under universal health coverage, using national 2003–2015 household budget data from the Turkish Statistical Institute. Progress was evaluated using Kakwani–Suits indices and Lorenz concentration curves. The results indicate that overall, more than a decade after its unification, redistribution of wealth in the Turkish health financing system has benefitted the wealthy but not the poor. Both curve and index approaches (Kakwani index 2003 = −0.50; 2015 = −0.44) reveal an increasingly regressive pattern of OOP health expenditures. The effective use of fiscal space and good political leadership are essential for the successful continuation of reforms to combat poverty in Turkey.

DETERMINANTS OF OUT-OF-POCKET EXPENDITURE FOR HEALTH CARE: A SYSTEMATIC REVIEW

Background: Out-of-pocket (OOP) expenditure is a cost for health care that are paid by individuals at the time of treatment through user fees, co-payments and direct payments. It is the most common way of paying for health services in developing nations particularly in low and middle-income countries. OOP payments are typically perceived to be the most regressive instrument of health finance and high reliance to it create a significant financial barrier in accessing health care. Objectives: To assess the determinants of OOP expenditures for health care. Materials and Methods: Journal and articles related on determinants of OOP health expenditures were compiled using a major online database, PubMed and Science Direct. The search was limited to full-text papers published in English and studies conducted within the last 10 years (2007-2017). The selection of articles to be reviewed is done according to the PRISMA checklist. Result: The main determinants of OOP health expenditure identified were age, gender, place of living, education and income level, household size and presence of comorbidities. Other determinants were marital status, insurance status, payments for medical supplies and pharmaceuticals and distance to health facilities Conclusion: OOP payments is not an equitable nor efficient financing mechanism. A government need to formulate the best health financing mechanism to achieve a complete universal health coverage status. This review can help policy-makers in identifying the determinants of OOP, focussing on the mechanisms driving them, and formulate policy options for building stronger health financing mechanisms. Keywords: Determinants, Out-of-Pocket, Expenditure, Health Care

Longitudinal associations of multimorbidity, disability and out-of-pocket health expenditures in households with older adults in Mexico: The study on global AGEing and adult health (SAGE)

BackgroundEmpirical evidence suggests that multimorbidity and disability are each significantly associated with out-of-pocket (OOP) health expenditures; however few efforts have been made to explore their joint association with OOP health expenditures. ObjectivesTo estimate the association of multimorbidity and disability with OOP health expenditures in households with older adults in Mexico, as well as the potential interaction effects of multimorbidity and disability on OOP health expenditures. MethodsLongitudinal study based on data collected as part of the Study on global AGEing and adult health Wave 1 (2009) and Wave 2 (2014), a nationally representative study in Mexico with a sample of older adults aged 50 and older. The dependent variable was OOP health expenditures, and main exposure variables were multimorbidity and disability. Two-Part regression models were used to analyze the relation between multimorbidity, disability and OOP health expenditures. ResultsMultimorbidity was associated with the probability of incurring OOP health expenditures (OR = 1.28, CI95% 1.11–1.48), and also the tertiles of disability (2nd tertile: OR = 1.45, CI95% 1.23–1.70; 3rd tertile: OR = 2.19, CI95% 1.81–2.66). The presence of multimorbidity was associated with an increase of 13% in average OOP health costs (β = 0.13, CI95% 0.01–0.25), and 16% for the 3rd tertile of disability (β = 0.16, CI95% 0.01–0.31). We did not find significant interaction effects of multimorbidity and disability. ConclusionsMultimorbidity and disability appear to be important determinants of OOP health expenditures. The economic implications for the households and the health system should be highlighted, particularly in low- and middle-income countries because of the rapid growth of their aging populations.

Impact of an innovative financing and payment model on tuberculosis patients\u2019 financial burden: is tuberculosis care more affordable for the poor?

BackgroundIn response to the high financial burden of health services facing tuberculosis (TB) patients in China, the China-Gates TB project, Phase II, has implemented a new financing and payment model as an important component of the overall project in three cities in eastern, central and western China. The model focuses on increasing the reimbursement rate for TB patients and reforming provider payment methods by replacing fee-for-service with a case-based payment approach. This study investigated changes in out-of-pocket (OOP) health expenditure and the financial burden on TB patients before and after the interventions, with a focus on potential differential impacts on patients from different income groups.MethodsThree sample counties in each of the three prefectures: Zhenjiang, Yichang and Hanzhong were chosen as study sites. TB patients who started and completed treatment before, and during the intervention period, were randomly sampled and surveyed at the baseline in 2013 and final evaluation in 2015 respectively. OOP health expenditure and percentage of patients incurring catastrophic health expenditure (CHE) were calculated for different income groups. OLS regression and logit regression were conducted to explore the intervention’s impacts on patient OOP health expenditure and financial burden after adjusting for other covariates. Key-informant interviews and focus group discussions were conducted to understand the reasons for any observed changes.ResultsData from 738 (baseline) and 735 (evaluation) patients were available for analysis. Patient mean OOP health expenditure increased from RMB 3576 to RMB 5791, and the percentage of patients incurring CHE also increased after intervention. The percentage increase in OOP health expenditure and the likelihood of incurring CHE were significantly lower for patients from the highest income group as compared to the lowest. Qualitative findings indicated that increased use of health services not covered by the standard package of the model was likely to have caused the increase in financial burden.ConclusionsThe implementation of the new financing and payment model did not protect patients, especially those from the lowest income group, from financial difficulty, due partly to their increased use of health service. More financial resources should be mobilized to increase financial protection, particularly for poor patients, while cost containment strategies need to be developed and effectively implemented to improve the effective coverage of essential healthcare in China.

Coping with Out-of-Pocket Health Expenditure in India: Evidence from NSS 71st Round

The present paper seeks to examine the incidence and socio-economic inequality in the utilisation of different sources of finance to cope up with out-of-pocket (OOP) health expenditure in rural and urban India. By employing National Sample Survey Organisation (NSSO), 71st Round (2014) data, the authors found that among inpatient cases, about 60 and 50% households in rural and urban areas respectively rely upon distress sources such as borrowings, contributions from friends and relatives and sale of assets to finance OOP health expenditure. Socio-economically deprived sections in rural areas have a higher likelihood of using distress financing than in urban areas. Greater dependency on debt and sale of assets emphasises the need for a comprehensive health financing system in the country.

PHP51 - Burden and Source Of Out-Of-Pocket Health Expenditures in India

At 89.2% in out-of-pocket (OOP) expenditure on health, India ranks third in the list of countries with the highest OOP spending in Southeast Asia. Nearly 39 million Indian residents become impoverished yearly due to high OOP health expenditures. Understanding healthcare utilization and sources of financing for acute illnesses would enable the design of effective health insurance programs, and allocation of inadequate resources among competing needs. Social consumption and health data from the National Sample Survey Organization Round 71 (2014) obtained from the Ministry of Statistics and Implementation from the Government of India was used. Health care spending in India was described. A multiple regression model was used to study the association between various sources of financing and OOP health expenditures using STATA version 14.1. A sample of 31,240 individuals was studied. Average total expenditure for outpatient services was INR852.17. Average amount spent on medical expenses was INR774.14. Amount reimbursed by insurance/employer was INR54. Average OOP medical expenditure for acute illness was INR720. About 95.81% (n=29,814) used household income for acute illnesses, 2.61% (n=811) people borrowed money, and only 0.35% (n= 110) were covered by health insurance. Majority of the time, service provision followed payment (75.92%). People who used their household income for treatment incurred lower expenses than those who borrowed money for their health expenditure INR924.78 (CI: 768.58 – 1080.97) followed by people who sold their physical assets INR2148.98 (CI: 1172.22 – 3125.74). In India, economically disadvantaged individuals who borrowed money and sold assets faced higher OOP expenditures. Current national policy efforts centered on expanding health protection schemes for hospitalization, lack consideration of outpatient care costs and their significant contribution to individual OOP expenses. Focusing policy efforts on a sliding fee schedule that favors the disadvantaged is vital to reduce the burden of OOP health expenditures.

Out-of-pocket and catastrophic health expenditure in households of Cartagena, Colombia

To estimate out-of-pocket (OOP) health expenditure and the probability to incur in catastrophic health expenditure, as well as the socio-demographic determinants of households in Cartagena, Colombia. Population-based cross-sectional study on a randomized stratified sample of Cartagena households. Two regression models were developed using OOP health expenditure and the probability to incur in catastrophic health expenditure as dependent variables. The average annual OOP health expenditure was $1 566 036 COP (US$783) (95%CI: $1 117 597 - $2 014 475) in poor households, $2 492 928 COP (US$1 246) (95%CI: $1 695 845 - $3 290 011) in middle class households, and $4 577 172 COP (uS$2 288) (95%CI: $1 838 222 - $7 316 122) in upper class households. Regarding the household income ratio, the OOP health expenditure was 14.6% in poor households, 8.2% in middle class, and 7.0% in upper class households. The probability to incur in catastrophic health expenditure was 30.6% (95%CI: 25.6% - 35.5%), 10.2% (95%CI: 4.5%-15.9%) and 8.6% (95%CI: 1.8%-23%) in the low, middle- and high-class households, respectively. Educational attainment, socioeconomic strata and employment were the main determinants of OOP and the probability to incur in catastrophic health expenditure. The health system has persistent inequalities regarding the financial protection of households related to out-of-pocket expenditure and the probability of catastrophic expenditure. This study provides evidence to review the social protection policy for the most socio-economically vulnerable households.