Out Of Pocket Health Care Expenditure Research Articles

Program evaluation: improving the quality of life of older people in an urban slum in Bangladesh.

Aims:The study aimed to explore the quality and impact of care provided through an innovative palliative care project to improve the quality of life of older people in an urban informal settlement in Bangladesh.Methods:Center for Palliative Care (CPC) at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, in collaboration with the Worldwide Hospice Palliative Care Alliance (WHPCA) has been operating this community project since 2015. A cross-sectional observational design was used in this program evaluation study. A total of 594 people received services including 227 patients (Group-1) receiving regular and intensive palliative care and 367 patients with less intense needs (Group-2) receiving relatively less support based on need. In addition, current group-1 patients (total 114) and a matched cohort of 58 group-2 patients were interviewed with an experience of care survey questionnaire. Baseline and demographic data were presented in tables. The Z-test was used to measure mean statistical differences between two groups.Results:Multiple comorbidities were common. Pain was the most frequently noted physical symptom along with anxiety, sadness, and depression as common psychological concerns. Compassionate palliative care for the older people had significant (p < 0.05) impact on psycho-social and spiritual care, caregiver training, responding to emergencies, and reduction of out of pocket healthcare expenditure among the intensive intervention group.Conclusion:Using a community-based approach following this model may play a significant part in expansion of palliative care throughout Bangladesh to meet the huge need and scarcity of such services.

Current Scenario of Health Insurance in India: A Study Comprising Various Challenges and Measures For It

Ensuring healthy lives and promoting the wellbeing at all stages is necessary for making the process of&#x0D; sustainable development into reality. However, Poor accessibility to healthcare services especially in&#x0D; developing countries acts as a barrier towards this. Every year, Insufficient Government expenditure on&#x0D; healthcare services resulting heavy out of pocket healthcare expenses push people into vulnerable situation.&#x0D; In such a situation, the role of health insurance becomes very significant. Considering all these factors, in&#x0D; country like India, a well organised health insurance market has been gradually evolved over the years.&#x0D; But it is not sufficient because many people are still left untreated and even approximately 25% people&#x0D; are pushed below poverty line by catastrophic impact of out of pocket healthcare expenditure every year.&#x0D; Factors like lack of awareness, policy loopholes, poor infrastructure etc. are mainly responsible for the poor&#x0D; performance of the health insurance market in India. Through this paper, it is tried throw light on all these&#x0D; phenomena comprehensively along with some measures to correct the lacunas.

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

The costs of seeking healthcare: Illness, treatment seeking and out of pocket expenditures among the urban poor in Delhi, India.

The poor often experience illness and the treatment costs are high and even catastrophic for the poor. This paper reports the extent of illness, treatment-seeking behaviour and out of pocket healthcare expenditures and the determinants of treatment-seeking behaviour and healthcare expenditures among the urban poor living in Delhi. A total of 2,998 households participated in the study. Socio-demographic details, illness experiences (episodic illness in the past 3months, hospitalisation in the past 1year and any chronic illness), treatment seeking and healthcare expenditures were collected for all household members through a pretested, interviewer-administered questionnaire. Logistic regressions were carried out for factors associated with treatment-seeking choices. Multiple linear regressions were carried for factors associated with out of pocket expenditures (OOPE). Of the total 15,218 household members (of the 2,998 households), 4,052 (26.6%) experienced episodic illness (mainly fever, respiratory illnesses, food- and waterborne diseases and eye infections) in the past 3months, 230 (1.5%) were hospitalised and 976 (6.4%) have chronic illness (mainly hypertension, diabetes, arthritis and respiratory problems). Of the 2,998 households, 2,225 (74.2%) households reported at least one event of illness. Unqualified practitioners were the main source of care for episodic illnesses. Perceived seriousness of the illness, having Employees State Insurance Scheme (ESIS) benefit, higher educational status of the head of the household, higher monthly household incomes, belonging other backward castes and settled-migrant status led to seeking formal care. Dengue was the main reason for hospitalisation. Government including ESIS hospitals were mainly utilised for hospitalisation. Healthcare expenditures were higher for private healthcare. Possession of mandatory health insurance was protective against OOPEs. OOPEs were more for the men/boys and for the young. Improving access to government healthcare services is important. Extending the ESIS to the unorganised workers including urban poor migrants should be considered so as to bring them under mandatory social protection.

Out-of-pocket healthcare expenditure in Australia: trends, inequalities and the impact on household living standards in a high-income country with a universal health care system

BackgroundPoor health increases the likelihood of experiencing poverty by reducing a person’s ability to work and imparting costs associated with receiving medical treatment. Universal health care is a means of protecting against the impoverishing impact of high healthcare costs. This study aims to document the recent trends in the amount paid by Australian households out-of-pocket for healthcare, identify any inequalities in the distribution of this expenditure, and to describe the impact that healthcare costs have on household living standards in a high-income country with a long established universal health care system. We undertook this analysis using a longitudinal, nationally representative dataset – the Household Income and Labour Dynamics in Australia Survey, using data collected annually from 2006 to 2014. Out of pocket payments covered those paid to health practitioners, for medication and in private health insurance premiums; catastrophic expenditure was defined as spending 10% or more of household income on healthcare.ResultsAverage total household expenditure on healthcare items remained relatively stable between 2006 and 2014 after adjusting for inflation, changing from $3133 to $3199. However, after adjusting for age, self-reported health status, and year, those in the lowest income group (decile one) had 15 times the odds (95% CI, 11.7–20.8) of having catastrophic health expenditure compared to those in the highest income group (decile ten). The percentage of people in income decile 2 and 3 who had catastrophic health expenditure also increased from 13% to 19% and 7% to 13% respectively.ConclusionsOngoing monitoring of out of pocket healthcare expenditure is an essential part of assessing health system performance, even in countries with universal health care.

Triple burden of disease and out of pocket healthcare expenditure of women in India.

AimWomen, unlike men, are subjected to triple burden of disease, namely, non-communicable and communicable diseases and reproductive health related diseases. To assess prevalence of triple burden of disease of currently married women and to contrast out of pocket maternal care expenditure of these diseases in India.Subject and methodsThis study uses nationally representative unit level data from the 71st round (2014) of the National Sample Survey Organisation. Descriptive statistics and bivariate analysis are employed to assess triple burden of diseases by background of currently married women. Mean out of pocket (OOP) expenditure for healthcare care by demographic and household characteristics of women are also compared by type of diseases. Two parts model is adopted for assessment of determents of out of pocket healthcare expenditure of women.ResultsOverall medical and non-medical expenses of non–communicable disease are much higher than those of other disease and disability, reproductive health related and communicable diseases. OOP expenditure for treatment of non-communicable diseases, reproductive health and related diseases and other disease and disability are significantly higher than the inpatient treatment of communicable diseases and the differences are statistically significant.ConclusionOut of pocket expenditure for treatment of non-communicable diseases is the highest, followed by that of other diseases & disability, then reproductive health related diseases and the least is for communicable diseases. OOP expenditures for maternal healthcare in private health facilities are much higher than in public health facilities regardless of types of disease. Women from households having insurance of any member spent less than that of women from households not having health insurance. There is an urgent need to expand the outreach of the public health system in India to rural areas.

Pharmacy dispensing patterns and out of pocket expenditure to the patient for generic prescriptions of psychotropic medicines: a survey from 5 locations in Sri Lanka

Background: A crucial element that restricts access to medicines is price. Generic drugs provide the opportunity for major savings in out of pocket healthcare expenditure since they may be substantially lower in price. However when a generic drug is prescribed, pharmacist decides which brand of the drug to be dispensed. This results in patients paying for single drug at markedly different prices. Aims: To compare costs patient has to bear for psychotropic drugs fluoxetine and risperidone when a generic prescription is presented to a pharmacy. Methods: Pharmacies in 5 urban locations (Kurunegala, Kandy, Anuradhapura, Puttalam, Mahiyangana) in Sri Lanka were evaluated. A generic prescription for Fluoxetine 20 mg and Risperidone 2mg was presented to retail pharmacies and received medications were analyzed for the specific brands dispensed and costs incurred. Results: Price of a fluoxetine 20mg capsule ranged from Rs. 1.72 to Rs. 30.00 and price of risperidone 2mg tablet was from Rs 1.15 to Rs. 23.00. Combined monthly cost for the medications ranged from Rs 86.10 to Rs 1803.00. Approximately 80% prescriptions received brand preparations expensive than the cheapest brand among them. Lowest cost risperidone was dispensed only in 18% of instances. Lowest cost fluoxetine was dispensed only in 24% of instances. Conclusions: 80% of the time patients who get generic psychotropic prescriptions pay more than the cost of the lowest cost product. Knowledge about the price ranges of brands available in market could help in reducing the out of pocket expenditure for pharmaceuticals.

Effect of Health Insurance on Demand for Outpatient Medical Care in Rwanda: An Application of the Control Function Approach

In the 2000’s the Government of Rwanda initiated health sector reforms aiming at increasing health care access. Despite these reforms there has not been a corresponding increase in demand for health services, as only about 30 percent of the sick persons use modern care (NISR, 2011). The objective of this paper is to examine factors influencing outpatient care demand in Rwanda and suggest appropriate measures to improve utilization of health services. The source of data is the Integrated Household Living Conditions Survey (EICV2) conducted in 2005 by the National Institute of Statistics Rwanda (NISR). A structural model of demand for health care is estimated to measure demand effects of covariates. The findings indicate that health insurance is a significant determinant of outpatient medical care. In addition, price of health care and household income are among the main drivers of utilization of health care. Being female is found to increase the probability of seeking outpatient health care. Two main policy recommendations emerge from these findings. First, the government should reduce out-of-pocket health care expenditures (OOPE) through subsidies to public health facilities. Second, the government should reduce the premiums for Community Based Health Insurance Schemes (CBHIs) to increase the coverage rate.Keywords: Outpatient, Health insurance, User Fees and logit model.