Out Of Pocket Research Articles

A23 ESTIMATING INDIRECT AND OUT-OF-POCKET COSTS IN PEDIATRIC INFLAMMATORY BOWEL DISEASE: A NATION-WIDE CROSS-SECTIONAL ANALYSIS

BackgroundIdentifying disease-related costs is a crucial step to plan for proper allocation of resources and future healthcare services for persons with inflammatory bowel disease (IBD). Data on pediatric inflammatory bowel disease-associated costs are limited.AimsWe aimed to estimate indirect and out of pocket (OOP) pediatric IBD-associated costs in Canada.MethodsIn a nation-wide cross-sectional analysis, caregivers of children and young adults (<17 years) with IBD were invited to complete a questionnaire on lost work hours and OOP costs related to IBD in the 4 weeks prior to the survey. Participants were re-invited to periodically answer the same questionnaire every 3–9 months for 2 years. Lost productivity was calculated using the Human Capital method. Costs were reported in 2018 inflation-adjusted Canadian dollars. Predictors of high cost users (top 25%) were examined using negative binomial regression.ResultsConsecutive 243 (82 incident cases) of 262 (92.7%) approached participants completed the first survey with a total of 450 surveys longitudinally completed over 2 years. The annual median indirect costs per patient were $5,951 (IQR $1,812- $12,278), with $5,776 (IQR $1,465-$11,733) for Crohn’s disease (CD) and $6,084 (IQR $2,470-$13,371) for ulcerative colitis (UC) (p=0.77). The annual median per patient OOP costs were $2,925 (IQR $978- $8,125) with $3,021 (IQR $978- $8,125) for CD and $2,600 (IQR $975- $8,125) for UC (p=0.55). Older age (10-17y) at diagnosis (p=0.04) and parents in part-time employment (p=0.01) were predictors of higher indirect costs, while female sex (p<0.001), parents with a lower education level (p<0.001) and lower annual family income (p<0.01) were associated with higher OOP costs.ConclusionsIndirect and OOP IBD-associated costs are substantial and more likely to affect families with unstable employment and lower annual income. Examining different strategies and interventions to reduce these costs such as virtual platforms, telephone and outreach clinics especially in poor communities and families with low annual income is warranted.Funding AgenciesCIHRThe Children’s Hospital Research Institute of Manitoba

TREATMENT COST OF ROAD TRAFFIC ACCIDENT IN VICTIMS WITH SURGICAL INTERVENTION AT DANANG HOSPITAL

Objective: To analyze treatment cost of road traffic accident in victims with surgical interventions at Danang hospital on perspective of payers and to identify some factors affecting out of pocket cost of victims and their households. Materials and Method: This is a cross sectional and descriptive study. 193 victims or their relatives were interviewed directly and medical records and invoices were reviewed to collect data of their treatment costs at hospital. Multivariate linear regression model was used to identify factors affecting out of pocket cost of participants. Results: Economic total cost of road traffic accident victims who suffered surgical intervention at Danang Hospital was 28,475 thousand VND, in which medical direct cost, non-medical direct cost and indirect cost were accounting for 69.8%, 13.6% and 16.6%, respectively. Cost for surgery, medication and hospital bed accounted for the highest proportions of medical direct cost with 33.3%; 25.5% and 18%, respectively. Out-of pocket average total cost was 9,154 thousand VND. Factors influenced their out of pocket cost including participating in health insurance (B= -9,865,109; 95% CI: -12,960,181 - -6,770,038), number of inpatient days (B= 882,125; 95% CI: 780,081- 984,169) and being students (B= 4,081,835; 95% CI: 883,645- 7,280,025). Conclusion: Treatment cost for road traffic accident victims with surgery is economic burden to them and their household. Key words: road traffic accident, economic cost, economic burden, ability to pay, victim.

P632 Estimating indirect and out-of-pocket disease-associated costs in paediatric Inflammatory Bowel Disease: a nation-wide cross-sectional analysis

Abstract Background Identifying disease-related costs is a crucial step to plan for proper allocation of resources and future healthcare services for persons with inflammatory bowel disease (IBD). Data on paediatric inflammatory bowel disease-associated costs are limited. We aimed to estimate indirect and out of pocket (OOP) paediatric IBD-associated costs in Canada. Methods In a nation-wide cross-sectional analysis, caregivers of children and young adults (&amp;lt;17 years) with IBD were invited to complete a questionnaire on lost work hours and OOP costs related to IBD in the 4 weeks prior to the survey. Participants were re-invited to periodically answer the same questionnaire every 3–9 months for 2 years. Lost productivity was calculated using the Human Capital method. Costs were reported in 2018 inflation-adjusted Canadian dollars. Predictors of high cost users (top 25%) were examined using negative binomial regression. Results Consecutive 243 (82 incident cases) of 262 (92.7%) approached participants completed the first survey with a total of 450 surveys longitudinally completed over 2 years. The annual median indirect costs per patient were $5,951 (IQR $1,812- $12,278), with $5,776 (IQR $1,465-$11,733) for Crohn Disease (CD) and $6,084 (IQR $2,470-$13,371) for Ulcerative Colitis (UC) (p=0.77). The annual median per patient OOP costs were $2,925 (IQR $978- $8,125) with $3,021 (IQR $978- $8,125) for CD and $2,600 (IQR $975- $8,125) for UC (p=0.55). Older age (10-17y) at diagnosis (p=0.04) and parents in part-time employment (p=0.01) were predictors of higher indirect costs, while female sex (p&amp;lt;0.001), parents with a lower education level (p&amp;lt;0.001) and lower annual family income (p&amp;lt;0.01) were associated with higher OOP costs. Conclusion Indirect and OOP IBD-associated costs are substantial and more likely to affect families with unstable employment and lower annual income. Examining different strategies and interventions to reduce these costs such as virtual platforms, telephone and outreach clinics especially in poor communities and families with low annual income is warranted.

Out-of-pocket costs near end of life in low- and middle-income countries: A systematic review.

Globally, there is a rise in chronic disease, including cancer, major organ failure and dementias. Patients and their families in low- and middle-income countries (LMICs) pay a high proportion of medical costs out of pocket (OOP), and a diagnosis of serious illness often has catastrophic financial consequences. We therefore conducted a review of the literature to establish what is known about OOP costs near end of life in LMICs. To identify, organise and report the evidence on out-of-pocket costs in adult end-of-life populations in LMIC. A systematic search of 8 databases and a hand search of relevant systematic reviews and grey literature was performed. Two independent reviewers screened titles and abstracts, assessed papers for eligibility and extracted data. The review was registered with PROSPERO and adhered to the Preferred Reporting items for Systematic Reviews and Meta Analyses. The Mixed Methods Appraisal Tool was used to assess quality. The Wagstaff taxonomy was used to describe OOP. After deduplication, 9,343 studies were screened, of which 51 were read and rejected as full texts, and 12 were included in the final review. OOP costs increased with advanced illness and disease severity. The main drivers of OOP were medications and hospitalizations, with high but variable percentages of the affected populations reporting financial catastrophe, lost income, foregone education and other pressures. Despite a small number of included studies and heterogeneity in methodology and reporting, it is clear that OOP costs for care near end of life in LMIC represent an important source of catastrophic health expenditures and impoverishment. This suggests a role for widespread, targeted efforts to avoid poverty traps. Financial protection policies for those suffering from incurable disease and future research on the macro- and micro- economics of palliative care delivery in LMIC are greatly needed.

Patient Preferences for Early Diagnosis of Endometriosis and Associated Determinants in the United States: A Discrete Choice Experiment

Background: Endometriosis is a chronic and incurable gynecological disease that mainly affects women of reproductive age worldwide. It imposes clinical and economic burdens on patients, families, and society. A better understanding of the determinants of preferences towards early diagnosis of endometriosis may help develop programs and interventions to reduce the risk of more severe illness. We quantified patient preferences for early endometriosis diagnosis and explored whether preferences vary on the patient characteristics and pre-established social determinants of health. Methods: A discrete choice experiment (DCE) was designed to elicit women's preferences and willingness to pay for early diagnosis of endometriosis. Women ages 18 and older were eligible to participate in the study. The attributes (and levels) considered to describe hypothetical scenarios included diagnosis (immediate/postponed), the chance of advanced endometriosis and more severe illness (low/ high), time away from living, and professional activities (8 days, 15 days, 22 days and 30 days), and possible out-of pocket costs ($0, $15, $60 and $210). The effects of participants' characteristics and social determinants of health on the preference for early diagnosis were modeled using a Tobit model. Results: A total of 66 women with (2) or at-risk (64) of endometriosis completed the experiment. The respondents' age and insurance statuses significantly influenced their preference or choice for early diagnosis. On average, respondents were willing to give up $61.55 out-of-pocket cost to have a low risk of advanced endometriosis and more severe disease. The Tobit model indicates only age and insurance variables significantly affected early diagnosis preference. The results suggest that older ages and not having insurance increase the likelihood of respondents choosing early diagnosis than the younger age group and having insurance. Conclusions: This study indicates the importance of considering the patient characteristics and social determinants of health when designing and implementing health programs and interventions for endometriosis.

Vision Payment Claims Analyses with Health Insurance

The purpose of this study was to identify associations between insurance type and costs and to investigate specified variables’ influence on individuals’ access to adequate coverage. This was a cross sectional study, using secondary data analyses. The study was completed at The Eye Institute (TEI) East Oak Lane Campus in Philadelphia, PA. The study population was all patients seen at TEI East Oak Lane Campus, specifically patients seen at TEI clinic from January 1st, 2019, - to December 31st, 2019, whose encounter generated an insurance claim (n=68,484). The exposure was insurance type and outcomes were patient total amount, billed amount, and pay amount by patient. Data analyses were performed using SAS, version 9.4. In all statistical analyses, p-values were one-sided and considered statistically significant if 0.05 or lower. The study protocol was approved by the Institutional Review Boards of Salus University. The sample represented an older population with an average age of about 55. There was a significant association found between financial class with patient total amount (p&lt;0.0001), billed amount(p&lt;0.0001), and pay amount (p&lt;0.0001). People with managed PPO pay the least, while those on Medicaid and workers compensation pay the most out of pocket. The two Philadelphia zip codes which pay the most out of pocket have two of the lowest average household incomes in the Greater Philadelphia area. Insurance type and out of pocket expenses potentially have a negative effect on patient vision health and affordability of care as well as access to care. These findings contribute to the identification of variables that influence individual’s healthcare accessibility and evidence for opportunities to improve insurance coverage.&#x0D;

Evolution of Public Health Expenditure Financed by the Romanian Social Health Insurance Scheme From 1999 to 2019.

The Romanian health system is mainly public financed (80.45%) through the following sources: Social Health Insurance (65%), State and Local Authorities Budget (15.45%), while the private sources (voluntary health insurance and out of pocket) adds an additional 19.55% to the public funds. The shares of the types of expenditure reflect the importance of each sector in the overall health system, and trends in expenditure show the impact of financing on the health sector's structural changes. We analyzed the 20-year trend of the Social Health Insurance budget, from 1999 to 2019. The influences of the different allocations, subcategories, and new budget categories appearing over time were adjusted to reveal relevant trends. Of the 14 medical service categories and the stand-alone Administrative expenditure category, six expenditure categories including Hospital services, Total drugs, and Primary care showed stationary 20-year trends; five including Medical devices, Dialysis, and Homecare services showed ascendant trends; and four including Dentistry and Emergency services showed descendant trends. Stationary trends imply no structural changes in the health sector of relevant magnitude to impact the financing shares of major categories: hospitals, drugs, or primary care. Emerging trends related to the impact of different reforms were revealed only in the low share of expenditures categories. The allocation methodology and statistical analysis of the trends reveal a new perspective on the evolution of health sector in Romania.

Awareness and Willingness to Pay for Health Insurance: A Study on Selected Government and Non-Government Employees of Bangladesh

Introduction: The high cost of health services along with the unpredictability of health needs and the inadequacy of personal savings is the primary reason for the growing importance of insurance as a means of financing health services. Health insurance ensures easy access, high quality, sustainability and affordability of care. This study was undertaken in an attempt to generate some scientific data on awareness and willingness to pay (WTP) for health insurance in our country perspective. Objective: To determine awareness and demand or willingness to pay for health insurance in order to ascertain the feasibility of such schemes and establishing prices. Materials and Methods: This descriptive cross-sectional study was carried out from 1st July 2015 to 30th June 2016 in two governments and two non-government organizations. Randomly 200 government and 200 non-government employees were taken in the sample. A semi structured questionnaire designed to elicit WTP by Contingent Valuation Method (CVM) was used to collect data. Results: Among 400 respondents, 82.8% were male and 17.2% were female. Most of them (85.5%) heard about health insurance earlier and 2.5% subscribed for health insurance. Majority (58.7%) expressed WTP Tk 100-200 (Mean Tk 261.3 ± 196.3) and by percentage of monthly income, average WTP of a formal sector employee was 1.2%. Coverage of health expenditure from employer (10.6%) or insurance (1.1%) side was less and 88.8% of employees had to spend 100% from out of pocket (OOP). Conclusion: Introduction of health insurance, appropriately designed for each population group is imperative for achieving Universal Health Coverage. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 9-13

ANALYSIS OF WILLINGNESS TO PAY CONTRIBUTIONS IN THE MEMBERSHIP OF THE NATIONAL HEALTH INSURANCE IN REGENCY OF BANYUASIN

BPJS Kesehatan as the manager of the National Security Program (JKN), can be an appropriate health insurance to reduce the risk of people bearing health costs from their own pocket (out of pocket) in a very large and can lead to poverty. This study aims to analyze the willingness to pay JKN contributions to farmers in Banyuasin Regency in order to identify community groups that need subsidies from the government. This research is an analytical study with cross sectional design. The population of this research is all residents who work as farmers and have not registered as JKN participants with a total sample of 176 people. data analysis used chi square test and logistic regression test. This study found that the willingness to pay JKN contributions of Rp22.028 per person per month. The determinants of willingness to pay contributions in JKN membership are family income, food expenditure, non-essential food expenditure, non-food expenditure, number of family members, history of catastrophic disease, knowledge of contributions, and the ability to pay JKN contributions. The most dominant factor affecting the willingness to pay is non-essential food expenditure. The willingness to pay the JKN dues is still low. The ability to pay contributions is influenced by income, food expenditure, non-essential food expenditure, total non-food expenditure, number of family members, history of catastrophic disease, knowledge of contributions, and the ability to pay JKN contributions.

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.

Perception of rural and urban population on generic and branded drugs

Generic medicines are identical/ clone to an innovator or product brand name. After expiration of patent terms of the innovator product, other pharmaceutical companies usually apply to the drug regulatory bodies for approval to market the generic versions of the innovator's drugs. Generic drugs in the market were sold under the non-proprietary name or brand name. Drugs and medicines form a significant portion of out of pocket (OOP) expenses in Indian households. In order to resolve this issue, Government of India launched Jan Aushadhi Scheme (JAS) to provide inexpensive generic drugs to the patients. A separate interview was conducted for the illiterate people and Google forms were forwarded through whatsapp for literates, both contain the same questions to exclude the bias. The collected data was analysed and converted to graphs/ pie charts and the collected data was documented. Our study concludes that by using the questionnaire, the total patients (n= 500) were interviewed, different ages of people were included(15 to above 50).15-30 age group 29.2%, 31-49 age group 39.8%, above 50 age group 31% were involved. Male 60.4%, Female 39.4%, literate 47.4%, illiterate 52.6%, rural 49%, urban 51% were involved. A standard survey form/data collection sheet for both rural and urban population was used. Both literates and illiterates in rural and urban population almost 49% preferred branded drugs due to brand trust, quality, efficacy, and nearly 38% purchase medications based on the availability and remaining 13% preferred generic due to various reasons like cost effectiveness, same as branded quality and effectiveness.

Households’ responses on medical pluralism: Dynamics and determinants of access to traditional medicines in India

The Indian healthcare practice is pluralistic and unique since it is poised with many challenges. High out of pocket (OOPE) expenditure, scanty institutional facilities, and expensive private healthcare, etc. have strong bearing on adoption of traditional health care practices besides socio-cultural and other gradients. The paper addresses the dynamics and determinants of the access to traditional medicines in India using the representative dataset of the national sample survey (71st and 75th round) conducted in 2014 and 2017–2018. The analysis includes descriptive statistics, conditional Logit regression with marginal effects and Tobit regressions models. Results confirm increased access to traditional medicines even in case of major ailments which has reduced the OOPE on healthcare. The Covid19 pandemic has synergised the use of AYUSH owing to its immunity-boosting measures. The paper also incorporates some of the recent policy initiatives taken over recently in India to facilitate the Ayurveda, Yoga and Naturopathy, Unani, Sowa Rigpa, Siddha and Homoeopathy (AYUSH).

Associations between costs of oral hormonal therapies for prostate cancer, financial assistance mechanisms, and time on treatment.

61 Background: Numerous oral anticancer drugs approved for metastatic prostate cancer are expensive and put patients at risk for financial toxicity. Mechanisms to mitigate these costs are complex to navigate and are variable for different patient populations. We examined the impact of high costs and insurance type on time on therapy and reason for discontinuation of oral medication in patients with prostate cancer. Methods: We identified patients with prostate cancer who filled prescriptions for abiraterone or enzalutamide at our comprehensive cancer center 1/1/17-3/31/19, or who were prescribed one of these therapies but could not fill due to cost. Those with commercial insurance or Medicare part D were included. Clinical and demographic data was extracted for evaluation. Primary outcome variables included initial out-of-pocket cost, time on treatment, and failure to fill medication due to cost. Analysis using chi squared, T-tests and ANOVA was performed to assess associations. Results: We identified 193 patients. Of these, 34% had commercial insurance and 66% had Medicare part D. Mean out-of-pocket expense for the first fill was $62 for patients with commercial insurance and $582 for patients with Medicare Part D. Among those who did not fill due to cost, 9 had Medicare Part D and 1 had commercial insurance. The mean time on therapy for those with commercial insurance was 452 days vs 442 days for those with Medicare Part D. At time of data analysis, 50% of those with commercial insurance vs 45% of those with Medicare Part D remained on treatment. Of those who discontinued, 50% of those with commercial insurance did so due to progression or death vs 44% with Medicare part D. 14% with commercial insurance and 15% with Medicare part D discontinued to due patient preference or toxicities. 1 patient with Medicare part D and no patients with commercial insurance discontinued due to cost. There was no difference in time on therapy by out-of-pocket expense (average 444 days for out-of-pocket &lt; $100 vs 477 days for out-of pocket &gt; $100; p = 0.6) although those with an initial out of pocket expense &gt; $100 were more likely not to fill their medication (24% vs 1%, p &lt; 0.01). Conclusions: Costs remain high for oral prostate cancer treatments. Our findings suggest disproportionate financial burden among patients with Medicare Part D causing a significant number of patients to forego recommended therapy. While high costs did lead to failure to fill, we did not observe significant differences in time on treatment for patients with Medicare part D or with high out-of-pocket expense. Additionally, there was not a significant difference in stated reason for stopping therapy. Further research on patient perceptions of financial assistance programs and medication costs are planned.

The impact of out-of pocket payments of households for dental healthcare services on catastrophic healthcare expenditure in Iran

BackgroundDental healthcare is the costliest and single most source of the financial barrier to seeking and use of needed healthcare. Hence, this study aims to analyses impact of out-of-pocket (OOP) payments for dental services on prevalence catastrophic healthcare expenditure (CHE) among Iranian households during 2018.MethodsWe performed a cross-sectional analysis to determine the prevalence rate of CHE due to use of dental healthcare services among 38,858 Iranian households using the 2018 Household Income and Expenditure Survey (HIES) survey data of Iran. The WHO approach was used to determine the CHE due to use of dental care services at the 40% of household capacity to pay (CTP). Multiple logistic regression models were used to obtain the odds of facing with CHE among households that paid for any dental healthcare services over the last month while adjusting for covariates included in the model. These findings were reported for urban, rural areas and also for low, middle and high human development index HDI across provinces.ResultsThe study indicated that the prevalence of CHE among households that used and did not used dental services over the last month was 16.5% (95% CI: 14.9 to 18.3) and 4.3% (95% CI: 4.1 to 4.6), respectively. The adjusted odds ratio (AOR) for the covariates revealed that the prevalence of CHE for the overall households that used dental healthcare service was 6.2 times (95% CI: 5.4 to 7.1) than those that did not use dental healthcare services. The urban households that used dental healthcare had 7.8 times (95%CI: 6.4–9.4) while the rural ones had 4.7 times (95% CI: 3.7–5.7) higher odds of facing CHE than the corresponding households that did not use dental healthcare services.ConclusionsThe study indicates that out-of-pocket costs for dental care services impose a substantial financial burden on household’s budgets at the national and subnational levels. Alternative health care financing strategies and policies targeted to the reduction in CHE in general and CHE due to dental services in particular are urgently required in low and middle income countries such as Iran.

An Analysis of Out-of-Pocket Expenditure Due to Non-Availability of Computed Tomography Scan in Public Sector: A Case Study of Hira Medical Center Sukkur Pakistan

Background: Out of pocket (OOP) spending on health contributes significantly to levels of poverty in developing countries such as Pakistan. In poor countries there is reduced or limited access to health services, the issue of affordability and availability which all lead to impaired health status and increased morbidity and mortality rates in developing countries. Catastrophic health expenditure is not always synonymous with high health care costs; even small Out of pocket expenses may cause catastrophic condition for poor people. Methods: This is a cross sectional study that determined the out of pocket cost of computed tomography scan test (CT scan). The study was conducted from April to June 2015. The study population was those patients who came for CT scan at Hira medical center in district Sukkur Sindh Pakistan. The study sample was one hundred and seventy patients. (n=150). From the perspective of consumer the methodology was adopted, various recurrent costs were determined under different levels of input and cost canters. The data was entered and analyses using SPSS 20 to provide the results as percentages and averages for the different variables in this study. Results: Through this research we found that out of pocket payments are way too high while putting alot of burden on lower socioeconomic groups. Health expenditure Average cost per patient calculated were Rs. 11000 which means people spend more than 40% of their monthly income on health. There should be a government health facility in the city to compensate the huge cost which people pay for health especially low monthly income people. Conclusion: Government should introduce a health coverage insurance system in Pakistan in order to cover all health care needs of the people irrespective of their socioeconomic status. Keeping in view high out of pocket spending on health, the Government should subsidize the prices of diagnostic test to give relief to its Population. Community participation is also essential for sustainable solutions.

The influential factors for achieving universal health coverage in Iran: a multimethod study

BackgroundThe initial purpose of healthcare systems around the world is to promote and maintain the health of the population. Universal Health Coverage (UHC) is a new approach by which a healthcare system can reach its goals. World Health Organization (WHO) emphasized maximum population coverage, health service coverage, and financial protection, as three dimensions of UHC. In progress for achieving UHC, recognizing the influential factors allows us to accelerate such progress. Therefore, this study aimed to identify the influential factors to achieve UHC in Iran.MethodsThis is a multi-method study was conducted in four phases: First, a systematic review of the literature was conducted to identify the factors in PubMed, Web of Science, Embase, Scopus, ProQuest, Cochrane library, and Science Direct databases, and hand searching google scholar search engine. For recognizing the unmentioned factors, a qualitative study consisting of one session of Focus Group Discussion (FGD) and five semi-structured interviews with experts was designed. The extracted factors were merged and categorized by round table discussion. Finally, the pre-categorized factors were refined and re-categorized under the health system’s control knobs framework during three expert panel sessions.ResultsFinally, 33 studies were included. Eight hundred two factors were extracted through systematic review and 96 factors through FGD and interviews (totally, 898). After refining them by the experts’ panel, 105 factors were categorized within the control knob framework (financing 19, payment system7, Organization 23, regulation and supervision 33, Behavior 11, and Others 12). The majority of the identified factors were related to the “regulation and supervision” dimension, whilst the “payment system” entailed the fewest. The political commitment during political turmoil, excessive attention to the treatment, referral system, paying out of pocket(OOP) and protection against high costs, economic growth, sanctions, conflict of interests, weakness of the information system, prioritization of services, health system fragmented, lack of managerial support and lack of standard benefits packages were identified as the leading factors on the way to UHC.ConclusionConsidering the distinctive role of the context in policymaking, the identification of the factors affecting UHC accompanying by the countries’ experiences about UHC, can boost our speed toward it. Moreover, adopting a long-term plan toward UHC based on these factors and the robust implementation of it pave the way for Iran to achieve better outcomes comparing to their efforts.

Abstract 38: Setting up a Cancer Clinic in a Low-and-Middle-Income Country (LMIC) in Sub-Saharan Africa: A Case of Taita Taveta County in Kenya.

Abstract Purpose: Quality Cancer treatment is expensive and not accessible to all in LMIC settings in sub-Saharan Africa including Kenya. Despite having a cancer diagnosis, patients and their families not living in major towns and cities, have to travel far to seek treatment incurring cost in transport, upkeep during treatment and out of pocket expenditure to access care. Methods: International Cancer Institute in Eldoret-Kenya, partnered with Taita Taveta County to implement a cancer and other non-communicable disease (NCD) project in August 2020. Taita Taveta County established a technical working group (TWG) in September 2020 to oversee the project activities and identified space and staff to set up a new cancer clinic. ICI provided technical support in project planning, budgeting, capacity/needs assessment, training and mentorship of healthcare providers; and running joint cancer clinics. Results: Periodic review meetings between ICI and Taita Taveta County TWG identified lack of: qualified staff to provide cancer care; cancer screening supplies; and drug stock-outs. In September 2020, ICI and its strategic partners supported Taita Taveta County to launch a Cancer Clinic to provide basic Cancer care. ICI offered trainings and continuous medical education on cancer for 91 healthcare providers both online (26) and on-site (65); ICI provided cervical, breast and prostate cancer screening supplies; established a revolving fund pharmacy as a stop gap measure to drug stock-outs; and held joint cancer clinics twice a month where mentorship and skills training for county staff paired with ICI staff across various disciplines was achieved resulting in the first patient receiving chemotherapy in November 2020; histopathology support was provided for 151 samples. Conclusion: The process of setting up a cancer clinic in a low resource setting requires a systematic needs assessment approach; identifying a core team early that outlines output measures of interest; and having strategic partnership guiding step-by-step developments. Citation Format: Gloria Kitur, Emmah Achieng, Rebecca Mwakichako, Felix Kimotho, Chite Asirwa. Setting up a Cancer Clinic in a Low-and-Middle-Income Country (LMIC) in Sub-Saharan Africa: A Case of Taita Taveta County in Kenya. [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 38.

Tobacco Farming and Illness Induced Poverty in Pakistan

Tobacco has been projected for its economic prosperity in Pakistan and many other developing countries while the opportunity cost of domestic labor, health issues and associated health cost related with tobacco farming are often overlooked. Various health conditions associated with tobacco farming result in catastrophic health expenditures which not only increase the chances of poverty head counts but also deepens it further. Taking into account the opportunity cost of domestic labor and health cost associated with tobacco induced illnesses obscure the tobacco prosperity rhetoric. This study examined effect of incremental health cost associated with tobacco farming on poverty head counts and severity. Using survey data from the tobacco producing districts in Khyber Pakhtunkhwa, Pakistan, this study found that tobacco farmers experienced higher proportion of sever health hazards and illnesses like CVD and respiratory issues. The severe nature of ailments caused them higher share of out of pocket expenditures as compared to non-tobacco farmers and general population. Increase in health expenditures not only increased their poverty head counts by four and half percent but also severity of poverty worsened further by 8 percentage points using the Cost of Basic Needs (CBN) approach for measuring poverty. This study concludes that it is not only tobacco consumption associated with various health conditions but also tobacco farming. It is recommended that health cost associated with tobacco farming be considered both in setting up of minimum indicative prices for tobacco and consideration of health cost can be used as a tool against prosperity rhetoric which is used to block tobacco control policy.

315-OR: Trends in Racial and Ethnic Difference in Glucose-Lowering Medication (GLM) Use, Out of Pocket (OOP) Payment, and HbA1c Control in U.S. Adults with Diabetes, 2005-2018

Fast escalating price of insulin and introductions of high-cost new GLMs in the last decade could affect racial/ethnic groups differently. This study examined trends in GLM uses, OOP payments for GLMs, and HbA1c control by racial/ethnic group among US adults with diabetes from 2005 to 2018. Data were from the Medical Expenditure Panel Survey and the National Health and Nutrition Examination Survey. Persons with diabetes were identified by self-report or lab test. GLM uses were identified by national drug code. We compared trends in the three study outcomes among non-Hispanic White perons, non-Hispanic Black perons, and Hispanic perons. Between 2005 and 2018, the use of newer GLM (dipeptidyl peptidase-4 inhibitors, glucagon-like peptide 1 receptor agonists, and sodium-glucose transport protein 2 inhibitors) was higher in non-Hispanic White persons (0% to 24.9%) than non-Hispanic Black persons (0% to 19.9%,) or Hispanic persons (0% to 19.5%, all p&amp;lt;0.05). Use of insulin analogue increased from 43.4% to 87.3% in Non-Hispanic White persons, 22.3% to 78.4% in non-Hispanic Black persons and 32.8% to 77.9% in Hispanic persons. Significant falls in annual OOP payments for GLMs were seen among Hispanic perons ($350 in 2005 to $205 in 2018) and non-Hispanic Black persons ($350 to $210), but not among non-Hispanic White persons ($355 to $345). In 2005, a higher proportion of non-Hispanic White persons achieved the HbA1c goal of &amp;lt;7.0%, compared with Hispanic persons and non-Hispanic Black persons (68.4% vs. 47.2% vs. 52.3%, p&amp;lt;0.05). Non-Hispanic White persons also had a lower average HbA1c level than Hispanic persons or non-Hispanic Black persons (6.7% vs. 7.8% vs. 7.4%, p&amp;lt;0.05). These differences remained throughout the study period. Our findings providevidence on racial/ethnic differences in GLM and insulin usage over time and could assist decision-makers in identifying the means to reduce racial/ethnic disparities in HbA1c control. Disclosure P. Li: None. D. Guan: None. J. Guo: None. A. G. Winterstein: Research Support; Self; Merck Sharp &amp; Dohme Corp. P. Zhang: None. H. Shao: Research Support; Self; Sanofi.

Catastrophic Household Health Expenditures and its Poverty Impact (A Case Study of Rural and Urban Area of Eastern Chitwan)

The principle of "health as a fundamental right of the people" is enshrined in the constitution of Nepal 2072 which has guided the state’s obligation towards good health for all Nepali people. In order to ensure this constitutional obligation there is a need to provide equitable health services that factor in differences in geographical area, gender, caste and economic conditions. The study describes the field study on the catastrophic health expenditure and its impact on poverty in Ratnanagar municipality and shaktikhor village of eastern chitwan. The people in the study area are highly affected by catastrophic health expenditure. Catastrophic health expenditure is experienced by all socio- economic groups but severe impoverishment impact is experienced by poor. The impact of out-of pocket payments for health care can become catastrophic over time and can significantly affect the living standards, welfare and poverty of individuals or household.&#x0D; The study is based on primary as well as secondary data. Primary data were collected from primary sources. The sources of primary data are obviously based on the information obtained from the head of the households. A household survey and group discussion techniques were used to obtain statistical data and required information.&#x0D; The findings reveal that 28 percent of the total studied households are experiencing catastrophic health expenditure. 7 percent of the household are poor and 6 percent of the households fall below the poverty line because of the health expenditure. It was also found that the normalized poverty gap as 1.97 percent whiles the poverty gap after deduction of OOP is 2.65 percent (an increase by 0.68 percent). This indicates a percentage point change by 34.5 percent of the conventional poverty gap.