Out Of Pocket Spending Research Articles

A Study For: Socio-cultural Environment and the Microinsurance

The poor are much more exposed to the dangers from their surroundings. They live in unhealthy environment where even proper sanitation is not available. Natural calamities like floods, drought, earth quake etc. hit them the hardest. An unfortunate event like Illness or death in the family can change the living standard of the poor for the worse. Cost of medical care being prohibitive, s/he consumes lots of (already diminished) resources from the family. Since they do not have adequate savings, such an episode drives them to either sell their assets or borrow money from local money lenders at high interest rates. According to World Health Organization report (2006), out of total health expenditure in India, 73% happens through out-of pocket spending. This is a very precarious situation as it exposes the poor household to sudden spurt in unplanned and unexpected medical expenses. So, how do we ensure that the poor, or the ‘excluded’ face this ever-threatening risk to their lives and livelihood? Insurance as a concept was introduced in 19th century to do exactly that - protect the poor! But over a period of time, it became a financial tool for the rich. Affordability being one of the prime reasons but exposure and access being other important reason for low penetration in this segment.

The impact of health reform on poverty estimates in Iran: Implications for monitoring the first goal of Sustainable Development Goals.

Iran launched a series of health reforms called Health Transformation Plan (HTP) in order to improve financial protection and access to health care in 2014. This study aimed to investigate the extent of impoverishment due to out of pocket (OOP) payments during 2011-2016 and to assess the implications of health expenditures to overall national poverty rate before and after the HTP implementation, with a focus on monitoring the first Sustainable Development Goals (SDGs). The study relied on data from a nationally representative household income and expenditure survey. Two measures of poverty were estimated in this study: the prevalence (poverty headcount) and the intensity of poverty before and after OOP health payments (poverty gap). Proportion of the population fell into poverty due to OOP spending for health care from total poor population calculated for 2years before and after the HTP implementation using three poverty lines suggested by the World Bank for global poverty comparison ($1.90, $3.2 and $5.5 per day in 2011 purchasing power parity (PPP) $). Our results indicate that the incidence of impoverishing health expenditures has remainedrelatively low during 2011-2016. At the 2011 PPP $5.5 daily poverty line, the average incidence rate at the national level was 1.36% during the period. The percentage of population impoverished due to OOP health expenditures increased after HTP implementation, irrespective of the poverty line used. However, the proportion of individuals that pushed further into poverty decreased after HTP implementation. It was estimated that around 12.5% of total poor population fell below poverty line due to paying OOP payments in 2016. Although health care costs are not major causes of impoverishment in Iran, the relative impact of OOP spending for health is not negligible. To attain SDG 1, pro-poor interventions that aim to reduce the burden of OOP payments should be advocated and implemented with an inter-sectoral approach.

Barriers and enablers for technology diffusion in ophthalmology at not-for-profit advanced eye care institute

Managed care and insurance have penetrated ophthalmic services for patient care and continue to affect outof-pocket spending related to eye care. In such a scenario, understanding technology diffusion is crucial from the perspective of both technology developers as well care providers. Should healthcare organizations choose cheaper technologies or the ones that can be quickly diffused? In this paper, we try to answer this question by reviewing technologies used in the past 10 years across different services in ophthalmology. We generate a framework that bifurcates technologies and provides nomenclature to them based on cost and speed of diffusion. Our work, within its limitations, can provide insights into contemporary technology producers and healthcare organizations.

Out Of Pocket (OOP) Health Expenditure and Utilization of Financial Risk Protection Measures Among COVID-19 Affected Individuals in Chennai- A Cross-Sectional Study

Background: Pandemic has affected people physically, mentally and economically. India being a growing economic power house, spends only around 1.2% of GDP on health which thereby leads to high OOP spending. This study aims to estimate out of pocket health expenditure and proportion of financial risk protection.
 Methods: Cross sectional study conducted among Covid-19 affected individuals in Chennai. It was a questionnaire based study with questions about covid-19 management status, cost and insurance utilization. Descriptive statistics and regression analysis was used for analysis.
 Results: Total of 47 were treated at hospital and 85% of them were treated at private hospital.. The mean cost investigations for patients treated at hospital was of Rs. 50000+11547 and for medicines was Rs. 110000+57735. 53% of study participants had health insurance. 29 (54.72%) of them had Covid-19 treatment cost covered under insurance. The multiple regression analysis showed a statistically significant association between total OOPE incurred and age, religion and socio-economic status.
 Conclusion: Majority of participants spent for their treatment through savings and borrowing money. OOPE was compensated by reimbursement through health insurance. Provision of quality health care in government hospitals, increase public health spending and creating awareness about health insurance are ways to reduce OOP costs.

Out-of-pocket spending on hypertension and diabetes among patients reporting in a health -care teaching institute of the Western Rajasthan.

Background:Across the globe, morbidity and mortality due to non-communicable diseases (NCDs) are major public health issues. The resulting concern is not just epidemiological but also about the economic consequences at the household level.Objective:To assess the various facets of out-of-pocket spending (OOPs) incurring on NCDs, namely hypertension and diabetes on patients attending a healthcare teaching institute in Rajasthan.Methodology:This cross-sectional study involves patients older than 18 years attending either out-patient clinics or who were admitted in the wards in a healthcare teaching institute for seeking care for diabetes or hypertension. Four hundred patients were chosen purposively and a pretested questionnaire was used to elicit information on incurring OOPs for NCDs. Descriptive statistics (like percentage, mean, median, and standard deviation) were calculated.Results:The study shows a significant expenditure other than out-patient, in-patient admissions, in the form of personal expenditure and loss of employment, amounting to 31.86 and 34.07%, respectively, of the mean total expenditure. In a quarter (3 months), the mean total expenditure is ₹ 9014.37 ± 6452.37. On average, the OOP expenditure per visit for an out-patient visit was ₹370.54 ± 237, while for the patients admitted to the hospital, the average OOPs was ₹1564.72 ± 1310.5.Conclusions:Health expenditures can contribute toward the impoverishment of many segments of the community. Undoubtedly, numerous people may tend to neglect the needed care for NCDs due to financial hurdles. Thus, there is a need to develop NCD care management centers with health insurance packages and make them accessible for all.

OUT OF POCKETS SPENDING AMONG BREAST CANCER WOMEN RECEIVING OUT-PATIENT TREATMENT IN A TERTIARY TEACHING HOSPITAL IN KUALA LUMPUR MALAYSIA

There is lack of information about the estimates of out-of-pocket (OOP) spending among women diagnosed with breast cancer and effects on their family’s financial situation in Malaysia. This study is to determine estimates of out-of-pocket spending among women with breast cancer in HCTM and identify factors that significantly associated with high OOP spending. This cross-sectional study assessed out of pockets spending among breast cancer women in HCTM for breast cancer as out-patient. Sampling unit is a woman who has been diagnosed breast cancer and receiving treatment and follows up in HCTM. A 189 breast cancer women were identified for a 6 months period between July to December 2017. Only those patients who received at least 6 months treatment in HCTM were recruited. Out of pocket spending for treatments for adjuvant therapy and follow up, consultations with other practitioners, care taker fee, equipment and traditional/complementary treatment were collected by face-to-face interview using structured questionnaires. The dependent variable was OOP, analyzed using SSPS v23 for descriptive analysis and both univariate and multivariate analysis.173 out of 186 women were recruited and only 172 were considered for cost calculation (participation rate, 93.0 %) in this study. Total out of pocket spending for breast cancer treatment in 2017 was RM 1,037,446.23 with women’s total means out of pocket spending was RM6031.66 (SD =/- 495.58). The highest percentage of cost component contributed by cost of adjuvant therapy, RM334,056.00 (30.2%) followed by traditional/complementary medicine, RM268,278.00 (24.3%), other expenses/private hospital, RM224,887.00 (20.4%), transportation RM 79,772.52 (7.2%), chemotherapy RM67,300.00 (6.1%), dressing RM54,850.00 (5.0%), equipment/prosthesis RM50,550.00 (4.6%) and care taker cost RM24,661.43 (2.2%). Out of pockets costs from breast cancer in HCTM for 2017 are a burden for women and their family. Financial support provides assistance to the out-of-pocket spending in breast cancer treatment and is able to reduce the financial burden among patients and families.

Non-medical switching of prescription medications, brand-name drugs and out-of-pocket spending on medicines among Peruvian adults

Abstract Objectives This study evaluated the association between non-medical switching of prescription medications (NMSPM) with brand-name drugs and out-of-pocket spending (OPS) on drugs among Peruvian adults. Methods We conducted a secondary analysis of the National Survey of User Satisfaction Health using an analytical cross-sectional design. We included 3155 adults who went to drugstores and pharmacies with prescriptions. The independent variable was the self-reported NMSPM. The outcomes were brand-name drug purchase and OPS on drugs. We calculated crude and adjusted prevalence ratios (PR) with their respective 95% confidence intervals (CIs), and the OPS on drugs was analysed using linear regression with crude and adjusted β and their 95% CIs. Key findings The rate of NMSPM was 6.7%, the proportion of brand-name drug purchases was 55.7% and the average spending on drugs was US$1.73. In the adjusted analysis, the proportion of brand-name drug purchases with NMSPM was higher than without (73.3% versus 54.5%; P < 0.001), with a statistically significant association (adjusted PR = 1.38; 95% CI = 1.29 to 1.47; P < 0.001), and the association between NMSPM and OPS on drugs was statistically significant (adjusted β = 0.23; 95% CI = 0.16 to 0.30; P < 0.001). Conclusions There is a greater probability of brand-name drug purchases and OPS on drugs when NMSPM exists among adults who go to drugstores and pharmacies in Peru.

Actuarial Technique of Modelling the Out of Pocket with Deductible and Stop Loss in Health Care Insurance

The paper is intended to numerically estimate health insurance out of pocket spending from the perspective of the enrollees in order to inform whether health insurance scheme pricing policy delivers value to the enrollees. We study the implications of financing health care insurance using a classification model for health care insurance under the framework of deductibles and stop loss. The paper is designed for health underwriting professionals, particularly those who consult for health insurance schemes. This is essential given the form and emergence of treating enrollees fairly, based on regulations that impact on actuarial consultants advising on health insurance scheme product lines. The objectives of this paper are to demonstrate actuarial methods for estimating (i) total health expenses (ii) out of pocket costs (iii) reimbursements by third party insurance. (iv) examine the actuarial implications of the chosen model. In computing the out of pocket and reimbursement, the Pitacco’s model was adopted because of its relatively computational superiority and the fact that both deductible and stop loss form its core parameters. Our results show that there is a positive relationship between total health expense and the share funded by out of pocket spending. As the health expenditure increases, the share funded by out of pocket progressively increases.

The societal cost and economic impact of surgical care on patients\u2019 households in rural Uganda; a mixed method study

BackgroundThe epidemiology and cost of surgical care delivery in low-and middle-income countries (LMICs) is poorly understood. This study characterizes the cost of surgical care, rate of catastrophic medical expenditure and medical impoverishment, and impact of surgical hospitalization on patients’ households at Soroti Regional Referral Hospital (SRRH), Uganda.MethodsWe prospectively collected demographic, clinical, and cost data from all surgical inpatients and caregivers at SRRH between February 2018 and January 2019. We conducted and thematically analyzed qualitative interviews to discern the impact of hospitalization on patients’ households. We employed the chi-square, t-test, ANOVA, and Bonferroni tests and built regression models to identify predictors of societal cost of surgical care. Out of pocket spending (OOPS) and catastrophic expenses were determined.ResultsWe encountered 546 patients, mostly male (62%) peasant farmers (42%), at a median age of 22 years; and 615 caregivers, typically married (87%), female (69%), at a median age of 35 years. Femur fractures (20.4%), soft tissue infections (12.3%), and non-femur fractures (11.9%) were commonest. The total societal cost of surgical care was USD 147,378 with femur fractures (USD 47,879), intestinal obstruction (USD 18,737) and non-femur fractures (USD 10,212) as the leading contributors. Procedures (40%) and supplies (12%) were the largest components of societal cost. About 29% of patients suffered catastrophic expenses and 31% were medically impoverished.ConclusionDespite free care, surgical conditions cause catastrophic expenses and impoverishment in Uganda. Femur fracture is the most expensive surgical condition due to prolonged hospitalization associated with traction immobilization and lack of treatment modalities with shorter hospitalization.

1157-P: Out-of-Pocket and Health Plan Spending on Diabetes Drugs, 2006-2018

The rising cost of managing diabetes is of major concern. To examine trends in expenditures on diabetes drugs, we used OptumLabs Data Warehouse to identify commercially insured and Medicare Advantage enrollees with type 2 diabetes who filled ≥1 diabetes drug between 2006 and 2018. In each year, we examined mean health plan and patient out of pocket (OOP) spending, stratified by health plan (commercial vs. Medicare Advantage), for generic vs. brand, and for insulin vs. non-insulin drugs. We assessed trends using logistic regression. All costs were adjusted to 2018 U.S. dollars. 1,592,663 unique type 2 diabetes patients were included (commercially-insured: 698,725, Medicare Advantage: 893,938). Total mean diabetes drug expenditures increased among all patients (Figure). Among commercially insured patients, OOP spending increased for brand drugs and insulin but decreased for generics (p for trends <0.001). Health plan spending also increased for brand drugs and insulin (p<0.001) but did not change for generics (p=0.32). Among Medicare Advantage enrollees, OOP spending for brand drugs and insulin did not change (p=0.69 and 0.41, respectively), but decreased for generics (p<0.001). Health plan spending increased for brand drugs and insulin (p<0.001) but decreased for generics (p=0.02). Health plan and OOP spending on diabetes drugs increased 2006-2018, particularly among commercially insured patients, those using brand drugs and insulin. Disclosure K.J. Lipska: None. R.G. McCoy: None. H. Van Houten: None. X. Yao: None. J. Ross: Research Support; Self; Centers for Medicare and Medicaid Services, Janssen Pharmaceuticals, Inc., U.S. Food and Drug Administration. A.E. Altan: None. N. Shah: None.

Out-of-pocket spending (OOPS) and financial toxicity survey for neuroendocrine tumor (NET) patients.

632 Background: Incidence and prevalence of neuroendocrine tumors (NETs) are on the rise. However, with the increasing burden of the disease, there is a need to understand financial toxicity associated with NET management. Especially the out of pocket spending or expenses made by patients and family members, which affects the management and treatment adherence. We report results of our prospective online survey based study looking into determinants and the burden of financial toxicity in NET patients. Methods: We collaborated with NCAN (Neuroendocrine Cancer Awareness Network) a national NET patient support group for our prospective online questionnaire-based survey. After IRB approval, NCAN disseminated online link to the survey on their webpage. The survey had twenty-one questions with the goal of at least 200 complete responses. Results: We received 215 responses before we decided to stop the survey for analysis. The average age of the respondents was 58.4 years. 75% of respondents were females with most repsondents of the survey (37%) being graduates. About 41% of respondents had small bowel NET while 27% had pancreas NET as their NET diagnosis. The median income of the respondents was $65000/year. Median oncology visits were reported to be 4 per year. Median co-pay for the NET specialist visit was found to be $30. The median spending on travel for the physician`s appointment was $250 per visit to see NET specialists. Median monthly insurance premium was $300. Study participants reported spending $75 out of pocket on NET related care every month on top of insurance premiums. More than half of the respondents were on Somatostatin analogues only as their main treatment. About 21% mentioned that they were not able to get required treatment due to cost related issues. Conclusions: The preliminary analysis of the survey gave us an insight into financial toxicity related to NET management. Although most NETs are indolent, the chronic nature of disease and associated, symptom management is often time and resource-intensive. Many patients mentioned having issues with the coverage of insurance and having to travel a long distance to see a NET specialist, which demonstrate a lack of access to NET specialists.

Critical Determinants of Demand for Services in the Nigeria Formal Sector Social Health Insurance Programme

Introduction: Social health insurance programme was initiated in Nigeria with one of the aims being to improve the demand for quality healthcare services with a resultant reduction in catastrophic spending among the citizenry. Unfortunately, in this programme, healthcare providers who offer quality healthcare services still witness poor enrollee demand for services which has led to inability of the programme to achieve its set out objectives. Hence, the need to study the effects of selected critical determinants on demand for health insurance services and how much these determinants can collectively account for the demand for services in the programme. Design/Methodology: The study adopted a cross sectional design with a quantitative approach. The sample size was calculated using G - Power 3.1 software and the determined sample for the study was one thousand four hundred and thirty five (1435). Multistage sampling method was adopted. Data was analyzed using descriptive statistics and linear regression method with the aid of SPSS version 11. Result: The critical determinants of provider ownership, distance to healthcare provider, enrollee educational level have significant positive effect on the demand for health insurance services (<0.05) but the effect of enrollee income was positively insignificant (>0.05). Similarly, 75% of the changes in demand for health insurance services can be accounted for by the predictor variables in this study. Conclusion: The inability of the programme to address these selected critical determinants significantly will lead to out of pocket spending for healthcare services with a resultant catastrophic effect on families’ finances. Therefore, there is a need to take into account the effects of these determinants duringpolicy formulation, reviews and process implementation in the programme.

Disasters and Exemplified Vulnerabilities in a Cramped Public Health Infrastructure in India

The varied connotations to the term ‘Development’ are been channeled through perception. The perception of a political stakeholder differs from that of a rich-businessman, and again, from those who are lesser endowed. There is a pressing need for the government, to identify and maintain checks and balances between exploitative and responsive governance. The extension of the healthcare sector is an integral part of this holistic growth, while the customer base has largely financed the industry; the obligation on the hand of government needs to increase. The out of pocket spending by patients covers the finances of the sector by 64.2%. (NSSO, 2014 report). The lesser amount of government spending in the healthcare system is a drawback and has effects on the Industry in a negative frame in a large manner, only 28.6% of Total Health Expenditure is financed by Govt. of India and therefore, calls for the need for better financing mechanisms in the country in the form of insurance schemes and a smoother flow of the already existing policies and frameworks. In the debate of private v/s public hospitals, the paper presents reasons that create a barrier on effective utilization of benefits provided, and further constructs the viewpoint that though expensive, private healthcare services provide more assurance to the population in general. The over-crowding of these public institutions in times of epidemics or otherwise, is a self-indication of the dearth of infrastructure and the kind of impacts the interventions has had in terms of alleviating such grievances. The several debates that I have tried to analyze and interpret include those of the intersections the individuals of the country and the lawmakers have crossed in terms of developmental projects and whether these promises hold true in terms of concrete reality. The depth of understanding and entering these discussions is only a gateway to more pertinent questions of whether the present infrastructure has dwindled due to disasters in the past? Are we actually moving to building resiliency or is it just a mock-up present on paper only? The paper reflects qualitatively on several government reports on health and the state of the hospitals presented within various contexts of Disasters in the past. The analysis of the National Rural Health Mission, National Urban Health Mission and various others programs initiated by the Government of India and the scope that it has to remove the present day struggled faced by an over-crowded and pressurized public sector healthcare structure.

CALIDAD DE VIDA Y PRESTACIONES EN SALUD EN PACIENTES CON DIABETES MELLITUS TIPO 2 SEGÚN REGIÓN GEOGRÁFICA EN ARGENTINA

Introducción: la adherencia al tratamiento de la diabetes mellitus tipo 2 (DM2) en el adulto es un tema complejo y multifactorial que aúna aspectos propios de la enfermedad como no propios, los cuales impactan en la calidad de vida. En Argentina se presentan grandes dificultades al costear la totalidad del tratamiento de la enfermedad. El impacto del ingreso sobre el gasto en salud en DM2 es mayor para los niveles más bajos de ingresos.Objetivos: analizar en adultos con DM2 en Argentina diferencias en variables de calidad de vida y objetivos metabólicos según regiones geográficas y prestación en salud; conocer el gasto de bolsillo en salud y los costos en salud vinculados a DM2; establecer la asociación entre el gasto de bolsillo con variables socioeconómicas y el cumplimiento de los objetivos metabólicos.

Impact of U.S. federal and state generic drug policies on drug use, spending, and patient outcomes: A systematic review.

Prescription drugs contribute to increased healthcare expenditures in the United States (U.S.). Use of generic drugs has been recognized as an effective tool to control rising prescription drug costs. This study aimed to evaluate the impact of U.S. federal and state generic drug policies on drug use, spending, and patient outcomes. A systematic search was performed in June 2017, using PubMed, Web of Science, PsycINFO, and Business Source Premier. Search was limited to published articles in English language, including human subjects in the U.S., and with at least one outcome measure related to health service utilization, spending, or patient outcomes. Thirty-four studies constituting seven key policy domains were included. Medicaid/Medicare Prior Authorization (PA) policies (n = 4) led to increased generic use, reduced patient and payer's spending on prescriptions without causing deterioration in patient's health-related quality of life. Medicare prescription plan's generic drug benefits (n = 4) had impact on increased generic use and generated savings, but the limited access to branded drugs may increase medication use gaps and risks of hospitalizations. State generic substitution laws (n = 3) caused increased generic use and cost savings for both consumers and states. Medicare/Medicaid coverage cap policies (n = 3) were associated with increased patient's out-of-pocket spending (OOP) and reduced prescription spending for payers. Policies lowering cost-sharing (n = 7) were associated with increased patient's medication use and adherence, but the impact varied by therapeutic classes. Existing evidence evaluating Medicare Part D (n = 12) suggested decreased prescription spending for beneficiaries and Medicare. Generic gap coverage reduced patient's OOP and Medicare spending. Finally, early evidence showed reduced consumers' OOP prescription spending after the ACA (n = 2). Federal and state policies regarding generic drugs have resulted in reduced spending for consumers and payers. However, the overall impact on patient outcomes remains unclear.

PRIME MINISTER'S NATIONAL HEALTH PROGRAMME (PMNHP): A COST COMPARISON ANALYSIS

Background: Prime Minister's National Health Programme (PMNHP) is a publically funded cashless scheme at point of service, which was initiated in December 2015 to provide access to universal healthcare to people living below poverty line for indoor secondary and tertiary healthcare services for priority diseases in Pakistan. Objective: Our study aimed to compare prices of PMNHP districts packages, compare PMNHP with average payments made to healthcare providers by various health insurance companies, and compare prices among PMNHP itself, public sector not supported by the programme, and private healthcare not supported by the programme in Islamabad Methods: We conducted this comparative descriptive cross sectional study. For first two objectives, we collected secondary data, and for the third objective, we did convenient sampling of the treated patient (n-158) from PMNHP, public and private hospitals for selected diseases. Results: PMNHP district comparisons showed no significant difference among districts except Normal Delivery (NVD) at Rahim Yar Khan had lowest cost (mean=10111.11). For Diabetes Mellitus, Muzaffarabad had lowest (mean=1733.33), and Quetta had highest (mean=5300). Average price paid to healthcare providers by various insurance companies are on higher side as compared to PMMHP. Price differences were significant among PMNHP, Public Out of Pocket Spending (OOPS) and Private For NVD, [F(2, 27)=3364, p=0.000] with PMNHP (mean=15.000, SD=0.000) Public (OOPS) (mean=2.127, SD=0.221) and Private (mean=14.702, SD=0.658) For caesarian section [F(2,27)=2850, p=0.000], and Cholecystectomy, [F(2, 28)=221, p=0.000]. While in comparison with Private, PMNHP were cost beneficial for caesarian section (mean=32.016, SD=1.31) and Cholecystectomy (m=43.133, SD=6.648). Conclusion: PMNHP district wise packages are almost same among and for all the districts. Program is fairly and competitively priced against public and private healthcare providers, and private health insurance healthcare provider payments. PMNHP design features may be used to extend program in other districts.

Economic burden of cancer in India: Evidence from cross-sectional nationally representative household survey, 2014.

With the ongoing demographic and epidemiological transition, cancer is emerging as a major public health concern in India. This paper uses nationally representative household survey to examine the overall prevalence and economic burden of cancer in India. The age-standardized prevalence of cancer is estimated to be 97 per 100,000 persons with greater prevalence in urban areas. The evidence suggests that cancer prevalence is highest among the elderly and also among females in the reproductive age groups. Cancer displays a significant socioeconomic gradient even after adjusting for age-sex specifics and clustering in a multilevel regression framework. We find that out of pocket expenditure on cancer treatment is among the highest for any ailment. The average out of pocket spending on inpatient care in private facilities is about three-times that of public facilities. Furthermore, treatment for about 40 percent of cancer hospitalization cases is financed mainly through borrowings, sale of assets and contributions from friends and relatives. Also, over 60 percent of the households who seek care from the private sector incur out of pocket expenditure in excess of 20 percent of their annual per capita household expenditure. Given the catastrophic implications, this study calls for a disease-based approach towards financing such high-cost ailment. It is suggested that universal cancer care insurance should be envisaged and combined with existing accident and life insurance policies for the poorer sections in India. In concluding, we call for policies to improve cancer survivorship through effective prevention and early detection. In particular, greater public health investments in infrastructure, human resources and quality of care deserve priority attention.

THE MARKETING MIX FOR LOW COST HEALTHCARE

The Indian health care industry has a history of dealing with poor doctor-patient ratio, shortage of medical professionals, poor health infrastructure, and low expenditure on healthcare information technology; steep out of pocket spending (OOP), low health insurance coverage, inadequate government spending, poor access to health care facilities and social stigma related to diseases. The unique mindset and ability for frugality has successfully been applied in offering low cost healthcare of uncompromised quality. While this has been achieved by few innovative entrepreneurs, it is imperative to help the new entrants with the collective experience in dealing with the rural market.&#x0D; A qualitative study was undertaken. Five Indian organizations, that have earned accolades and awards for successfully innovating for the poor were studied in-depth. The research looked into the challenges faced by the entrepreneurs. The methods and measures that evolved from their operation were analyzed. In order to help marketers learn from the pioneers, the paper has simplified the measures and steps in marketing to the familiar P’s of the marketing mix. In healthcare, the product is tied with service and the need is to work on all the 7P’s is useful. Keywords: frugal, innovation, entrepreneurship, marketing mix, healthcare.

Burden of out-of-pocket spending among high-deductible health plan members with metastatic breast cancer.

1029 Background: 50% of workers have high-deductible health plans (HDHP) that require major outofpocket (OOP) spending for cancerrelated care. The OOP burden among patients with advanced cancer in HDHPs is unknown. Our objective was to estimate OOP spending for women with metastatic breast cancer (mbc) stratified by health plan type. Methods: Our data source was administrative health insurance claims and enrollment data of members insured though a large national health plan. We included 7142 women age 25-64 with mbc who had at least 6 months enrollment before the diagnosis and at least 12 months followup. We used a time series design and plotted OOP spending stratified by HDHP vs low-deductible plan. Primary outcome measures included: (1) 20042012 calendar trends in total annual OOP spending, (2) monthly total OOP spending in the 6 months before and 24 months after women were diagnosed with mbc, and (3) monthly total OOP spending in the last 6 months of life. Plots were adjusted for age, socioeconomic status, race/ethnicity, and US region of residence, and we then conducted linear regression to assess for statistical significance of trends. Results: In 2004, average annual OOP spending for women with mbc cancer in low-deductible health plans was $1196.2 and increased to $2570 in 2012, a yearly increase of $159.2 (113.2205.2). For women in HDHP average OOP spending in 2004 amounted to $2648 and increased to $3736.4 in 2012, representing an annual increase of $160.4 per year (105.4215.4) Average OOP spending per person month peaked in the month of diagnosis to $1633.8 for women in HDHPs and to $643 among low-deductible plan members. Average OOP spending in the last 6 months of life were $285.7 per person month among low-plan ($1714.2 per 6 months) and $607.3 among HDHP ($3644 per 6 months). Conclusions: To our knowledge, this is the first analysis to estimate OOP spending for women with mbc accounting for enrollment in HDHPs versus low-deductible plans. We found that OOP spending is increasing over time and is high in the last 6 months of life. HDHP members with mbc faced much higher OOP spending than women in traditional plans across all analyses. Findings raise concerns that HDHPs could worsen access to mbc treatments.

Extending health insurance to the poor in India: An impact evaluation of Rashtriya Swasthya Bima Yojana on out of pocket spending for healthcare

India launched the ‘Rashtriya Swasthya Bima Yojana’ (RSBY) health insurance scheme for the poor in 2008. Utilising 3 waves (1999–2000, 2004–05 and 2011–12) of household level data from nationally representative surveys of the National Sample Survey Organisation (NSSO) (N = 346,615) and district level RSBY administrative data on enrolment, we estimated causal effects of RSBY on out-of-pocket expenditure. Using ‘difference-in-differences’ methods on households in matched districts we find that RSBY did not affect the likelihood of inpatient out-of-pocket spending, the level of inpatient out of pocket spending or catastrophic inpatient spending. We also do not find any statistically significant effect of RSBY on the level of outpatient out-of-pocket expenditure and the probability of incurring outpatient expenditure. In contrast, the likelihood of incurring any out of pocket spending (inpatient and outpatient) rose by 30% due to RSBY and was statistically significant. Although out of pocket spending levels did not change, RSBY raised household non-medical spending by 5%. Overall, the results suggest that RSBY has been ineffective in reducing the burden of out-of-pocket spending on poor households.