Out Of Pocket Medical Expenses Research Articles

Stroke systems of care in the Philippines: Addressing gaps and developing strategies.

In the Philippines, the mortality from stroke during the last 10 years remains high. This paper aims to describe the gaps in stroke care and the development of stroke systems of care in the Philippines. Gaps in stroke systems of care include low number of neurologist, inadequate CT scan machines, lack of stroke training among health workers, lack of stroke protocols and pathways, poor community stroke awareness, low government insurance coverage with high out of pocket medical expenses, lack of infrastructure for EMS, inadequate acute stroke ready hospitals, stroke units and rehabilitation facilities. Although there are government programs for primary stroke prevention, the strategies are inadequate to address the stroke pandemic. The Stroke Society of the Philippines has worked with the government for nationwide and regional stroke training of health care workers, community stroke awareness, setting up acute stroke ready hospitals and acute stroke units in different areas of the country and adapting stroke protocols and pathways. Stroke registries are now utilized for quality improvement. Thrombolysis rate has improved from 1.4% in 2014-2016 to 11% in 2021 based on RES-Q database. Because of government subsidy, thrombolysis in the government hospitals is higher at 7.4% (range 4.4-16.9) compared to 4.8% (range 0-10.1) rate in private hospitals. Mechanical thrombectomy rate remained low at 0.4% of all acute ischemic stroke patients because of the cost. With limited resources, infrastructures for emergency medical service is lacking. The innovations done by other LMIC can be done in the Philippines including the use of technology to reach out to geographically isolated areas and use of mobile stroke units. Non neurologist can be trained to help treat stroke patients. Upgrading of the Philhealth insurance to cover for reperfusion therapies, adequate stroke infrastructures and network, and increase in community stroke awareness are areas for improvement in the Philippine stroke systems of care.

Impact of Out of Pocket Health Expenditure on Consumption Pattern of Below Poverty Line Households in India

Financial burden from health expenditure is a serious cause of concern for low-income and developing countries. Studies have shown that low public investment in health, lack of adequate safety net mechanisms and poor quality of public health system in these countries are few basic grounds for placing high financial burden on people. In order to make both ends meet during illness, poor people resort to various alternative means. One of the popular strategies adopted is to reduce or reallocate the consumption bundle, so as to meet the medical expenditure. The impact of out of pocket (OOP) health expenditure on the consumer expenditure has immediate and direct impact especially among the poor sections of the society. This article aims to study the impact of out of pocket health expenditure on the constituents of consumer expenditure and how the composition of consumer expenditure differs with the levels of out of pocket expenditure among different consumption quintiles. The study uses IHDS household level survey data for the year 2011–2012. A mean comparison test is carried out to check whether significant difference exists in the consumption bundles of households with and without medical expenditure. A system of Engel curves is estimated with seemingly unrelated regression equation (SURE) to study the impact of out of pocket medical expenses on the consumption bundle. The results show that there exists significant difference in the share of different consumption items in the consumption bundles of households with and without out of pocket expenditure. Despite having larger share for food expenditure, poor households tend to protect the consumption of food share in the bundle. Compensation for rise in medical expenses is reflected in the reduced share of non-food expenditure items like fuel, education, entertainment, clothing and footwear. With high share of out of pocket expenditure, poor households in the states with high public health expenditure mainly reduced their education expenditure whereas consumption of most of the non-food items were reduced by poor households in low public health expenditure states.

Health Trajectories of Older Americans and Medical Expenses: Evidence from the Health and Retirement Study Data Over the 18 Year Period

This study investigates the long-term relationship between individuals’ health state changes over time and burdens due to out-of-pocket medical expenses (OOP) in later years. We kept track of 5540 individuals’ health trajectories and their accumulated OOP using the HRS data from 1992 to 2010. American adults between 50 and 70 years old spend on average $27,000 on OOP, and have five common health trajectory patterns (Multi-Morbidity, Co-Morbidity, Mild Disease, Late Event, and No Disease). However, their OOPs differed substantially depending on the pattern of health trajectory. The most costly pattern of Multi-Morbidity needed $18,823 more than the least costly No Disease pattern. Older adults with the most costly pattern spent most of OOP on either prescription drugs or doctor/dental visits. Additionally, we found that the OOP burden of prescription medications was substantially relieved by the Medicare Part D implementation. These findings have several important implications for individuals, financial educators, and policy makers.

The asset cost of poor health

Abstract This paper examines the correlation between poor health and the evolution of wealth for households in the first nine waves of the Health and Retirement Survey (HRS). It complements previous studies that have enumerated specific financial costs of poor health, such as out of pocket medical expenses or lost earnings. Because poor health can affect wealth accumulation through several channels, the “asset cost” measure can provide additional insight on the health-wealth nexus. We develop a simple measure of health status based on the first principal component of HRS survey responses on self-reported health status, diagnoses, ADLs, IADLs, and other indicators of underlying health. We find a large and substantively important correlation between this health measure and wealth accumulation. Within each 1994 asset quintile, individuals in the top third of the 1994 health status distribution averaged 50 percent more wealth in 2010 than those in the bottom third of that distribution.

Public Retreat, Private Expenses, and Penury

Health care can be expensive for the un-insured, often constituting a potential poverty trap. Urban India is particularly vulnerable to this possibility given the greater demand for health, absence of a structured health care system, overburdened public institutions, ubiquitous, and unregulated private health care market and the generic paucity of public funds. Using nationally representative household level data for two points of time and a suitable alteration of an existing methodology, this article computes the degree and depth of impoverishment from out of pocket medical expenses, and its variation across states and select socioeconomic characteristics. Roughly 6 percent of the urban population or about 18 million people face impoverishment entirely due to out of pocket medical expenses in India. There are substantial inter-state and inter-group variations in the incidence of this burden. The findings are potentially crucial as India prepares to embark on its journey toward universal health coverage.

Health Shocks, Out‐of‐Pocket Medical Expenses and Consumer Debt Among Middle‐Aged and Older Americans

We examine two important issues related to health and financial burden in middle‐aged and older Americans: (1) whether or not new health events affect a consumer's unsecured debt, and (2) to what extent the associated out‐of‐pocket medical expenses (OOP) contribute to unsecured debt. We use six biennial waves (1998, 2000, 2002, 2004, 2006 and 2008) from the Health and Retirement Study (HRS). We estimated fixed effects models and conducted mediation analyses. We find that new health events affect the accumulation of unsecured debt. Our estimates suggest that new health events increase unsecured debt by 6.3% ($230) to 9.3 % ($339); approximately 20% of the increase in unsecured consumer debt comes from OOP when experiencing new health events. New severe health events increase debt for the 50–64 age group, but do not increase it for the 65+ group.

Population based estimates of non-fatal injuries in the capital of Iran

BackgroundFatal injuries are at the top of the injury pyramid; however, non-fatal injuries are quite common and impose huge medical expenses on the population. Relying on hospital data will underestimate the incidence of non-fatal injuries. The aim of this study was to estimate the annual incidence and out of pocket medical expenses of all injuries in urban population of Tehran (the capital city of Iran).MethodsUsing the cluster random sampling approach, a household survey of residents of greater Tehran was performed on April 2008. At randomly selected residential locations, interviewers asked one adult person to report all injuries which have occurred during the past year for all household members, as well as the type of injury, place of occurrence, the activity, cause of accidents resulting in injuries, the amount of out of pocket medical expenses for injury, and whether they referred to hospital.ResultsThis study included 2,450 households residing in Tehran during 2007-8. The annual incidence of all injuries was 188.7 (180.7-196.9), significant injuries needing any medical care was 68.8 (63.7-74.2), fractures was 19.3 (16.6 - 22.4), and injuries resulted in hospitalization was 16.7 (14.2 - 19.6) per 1000 population. The annual incidence of fatal injuries was 33 (7-96) per 100,000 Population. In children aged 15 or less, the annual incidence of all injuries was 137.2 (120.0 - 155.9), significant injuries needing any medical care was 64.2 (52.2 - 78.0), fractures was 21.8 (15.0 - 30.7), and injuries resulted in hospitalization was 6.8 (3.3 - 12.5) per 1000 population. The mean out of pocket medical expense for injuries was 19.9 USD.ConclusionThis population based study showed that the real incidence of non-fatal injuries in the capital of Iran is more than the formal hospital-based estimates. These injuries impose non trivial medical and indirect cost on the community. The out of pocket medical expense of non-fatal injuries to Tehran population is estimated as 27 million USD per year. Effective strategies should be considered to minimize these injuries and decrease the great financial burden to public and the health system.

The Asset Cost of Poor Health

This paper examines the correlation between poor health and asset accumulation for households in the first nine waves of the Health and Retirement Survey. Rather than enumerating the specific costs of poor health, such as out of pocket medical expenses or lost earnings, we estimate how the evolution of household assets is related to poor health. We construct a simple measure of health status based on the first principal component of HRS survey responses on self-reported health status, diagnoses, ADLs, IADL, and other indicators of underlying health. Our estimates suggest large and substantively important correlations between poor health and asset accumulation. We compare persons in each 1992 asset quintile who were in the top third of the 1992 distribution of latent health with those in the same 1992 asset quintile who were in the bottom third of the latent health distribution. By 2008, those in the top third of the health distribution had accumulated, on average, more than 50 percent more assets than those in the bottom third of the health distribution. This “asset cost of poor health” appears to be larger for persons with substantial 1992 asset balances than for those with lower balances.

Estimated out of pocket medical and work loss expenses due to road traffic injuries in Karachi, Pakistan

IntroductionOver 35 000 road traffic injuries (RTIs) were reported in Karachi in 2007. The aim of this study was to assess out of pocket medical and work loss expenses due...

Population based estimates of non-fatal injuries in the capital of Iran

IntroductionHospital data underestimate the incidence of non-fatal injuries.This study is a household survey to estimate the annual incidence and out of pocket medical expenses of non-fatal injuries in capital of...

The unexpected impact of health on the labor supply of the oldest Americans

Since many workers who retire early do so because of health considerations, one would think that those who continue to work after the traditional retirement age of 65 enjoy good health. By extension, it seems obvious that the elderly who spend the most time working for pay would be in the best health. However, at a time when many in this age group rely on expensive Pharmaceuticals not covered by Medicare, one important consideration is whether these individuals have some form of supplementary insurance to assist with these and other outofpocket medical expenses. The AHEAD (Asset and Health Dynamics Among the Oldest Old) data set is used to test the hypothesis that elderly working Americans in belowaverage health spend more hours engaged in market work. This result is consistent with the possibility that they do so in order to gain access to employer-provided health insurance or to pay high outofpocket medical expenses. A labor supply analysis, performed using a multistage Heckit procedure, reveals that women are particularly vulnerable: Those in poor or only fair health, those need-ing assistance with one or more Activities of Daily Living, and those with higher medical expenses tend to work significantly more hours than do those in better physical condition, as do men without pensions who presumably lack retiree health benefits.