Out Of Pocket Health Research Articles

Out-of-pocket health expenditure and associated factors among patients with hypertension in Debre-Tabor Comphrensive Specialized Hospital, South Gondar zone, Northwest Ethiopia, 2020.

Hypertension is a non-communicable chronic disease that has a wide financial effect at the individual and household levels especially in developing countries due to its complexity and chronicity. Nevertheless, there are limited studies in Ethiopia. Therefore the aim of this study was to assess out-of pocket health expenditure and associated factors among adult patients with hypertension in Debre-Tabor Comphrensive Specialized Hospital. A facility-based cross-sectional study was conducted in total of 357 adult hypertensive patients from March to April 2020 using a systematic random sampling technique. Descriptive stastics were used to estimate the magnitude of out-of-pocket health expenditure, while after checking the assumptions linear regression model was fitted for identifying the factors associated with the outcome variable at a significance level of value of p < 0.05 and 95% confidence interval. A total of 346 study participants interviewed with a response rate of 96.92%. Annual mean out of pocket health expenditure of the participant was $113.40 ± $10.18 with 95% CI = (102.63, 124.16) per patient. The direct medical mean out of pocket health expenditure of the participant was $68.86 per patient per year and the median of non-medical components of the out of pocket health expenditure of the participant was $3.53. Sex, wealth status, distance from hospital, comorbidity, health insurance and number of visit are factors significantly associated to out-of-pocket expenditure. This study revealed that out of pocket health expenditure among adult patients with hypertension was found high compared to the national per capita health expenditure. Sex, wealth index, distance away from hospital, frequency of visit, comorbidities, and health insurance coverage were factors significantly associated with high out-of-pocket health expenditure. Ministry of health together with regional health bureaus and other concerned stakeholders work on strengthening early detection and prevention strategies of chronic comorbidities of hypertensive patients,promote health insurance coverage and better to subsidize medication costs for the poors.

Assessment of out-of–pocket health expenditure and prevalence of protective mechanisms against it among the households in an urban area, Bangalore: a longitudinal study

Background: Achieving Universal Health Coverage according to The World Health Assembly’s way to reinforce the principle of human right to health in 2005 has been a huge task for India. India has one of the highest proportions of household out-of-pocket expenditures on health in the world, estimated at 71.1% in 2008–09. The unpredictable payments are impoverishing an estimated 3.3% of India's population every year. In this regard various strategies have been adopted such as—reforming tax based health financing or introducing health insurance. This highlights the need for alternative finances which includes the provision of medical insurance. The study was conducted to assess the out-of-pocket health expenditure and estimate the prevalence of protective mechanisms against it in an urban area- Bangalore.Methods: A longitudinal study was conducted in the urban area of Bangalore. Sample size was calculated to be 350 households. Data regarding socio-demographic profile, protective mechanisms and other details were obtained by interview method using a pre-tested and semi-structured questionnaire.Results: Majority were in the productive age group i.e. 991 (62.68%) individuals. Female population was slightly higher in our study. Most of the households belonged to upper lower class (54.29%). A major burden of health care cost was experienced both in acute as well as chronic illness by the households. Only 8.9% (31 households) had one or the other type of health insurance.Conclusions: Population has profound chances of experiencing catastrophic health expenditure in times of severe illness.

Cepten Sağlık Harcamalarının Finansmanında Eşitsizlik ve Hakkaniyet: Uygulamalı Bir Ekonometrik Yaklaşım - Inequality and Inequity in Financing Out-of-Pocket Health Expenditures: An Applied Econometric Approach

In this study, it is aimed to examine the effect of regulations about unification of health financing system to control out-of-pocket health expenditures, in terms of inequality and inequity of distribution of out-of-pocket health expenditures in Turkey. Data came from Turkish Statistical Institute Household Budget Survey for the years 2003, 2009 and 2015. Index and curve approaches are used together; to determine inequality and inequity and Gini and Concentration indices and departure of Concentration curve from Lorenz curve analysed. Study findings show that, out-ofpocket health expenditures increased from 2003 to 2015, inequality is decreased in terms of the distribution of out-of-pocket health expenditures (Gini index: 2003 [0.75], 2009 [0.71] ve 2015 [0.69]). However, out-of-pocket health expenditures is a kind of a progressive health financing source, considering departure of Concentration curve from Lorenz curve and the level of progressivity is decreasing. Study results shows that, health financing system regulations have contributions, in terms of equal distribution of the financial burden, with an increasing number of people integrated into the health financing system. However, it is remarkable that, there exist a deterioration in progressivity pattern of health financing and there is a heavy burden on poor populations. Thus, it is advisable to increase insurance coverage and determine propoor policies to ensure sustainability of health financing system.

Democracy, political freedom and health expenditures: evidence from Eastern Mediterranean countries

Purpose– Health can be influenced by many factors. One of the factors is the political context of the country and democracy. The purpose of this paper is to examine the effects of freedom in press and polity index in overall, public, private and out of pocket health expenditures.Design/methodology/approach– A long-term panel data approach has been used to examine the relationship between democracy and health expenditures. The authors inserted polity and freedom into press indexes in the health expenditure model.Findings– Increase in freedom of the press and democracy will increase the overall, public and private health expenditures while they decrease out of pocket health expenditures.Originality/value– Polity and freedom index has a significant impact on all the health expenditure models.

The Impact of Economic Crisis on Chronic Patients’ Self-Rated Health, Health Expenditures and Health Services Utilization

There is evidence that the economic crisis in Greece has substantially affected patients and health care services, with chronic patients forming a particularly vulnerable group. The aim of this study was to investigate whether and in what way the current economic environment has affected patients with selected chronic conditions. A cross sectional study was carried out with a sample size of 1200 patients suffering from hypertension, diabetes and chronic obstructive pulmonary disease (COPD). Following a large family income decrease (35.4%) in the last 3 years, chronic patients reported decreased spending for various expenditure categories in order to maintain their ability to finance their health care needs. Among the disease groups studied, statistically significant differences were found for self-rated heath (SRH), out-of pocket health expenditures, health services utilization and the perceived need for physician services. Although need for physician visits for issues related to the chronic condition has largely been reported as met, this was achieved by increased out-of-pocket expenditures and large family budget cuts for essential household goods and services. Austerity measures and reduction of public health expenditure by the state appear to have led to high private expenditures and to de jure or de facto insurance coverage loss for primary care services.

Datapoints: U.S. out-of-pocket health care expenses for mental disorders, 1996-2011.

M disorders, characterized by sustained, abnormal changes in mood, thinking, or behavior associated with impaired functioning, contribute substantially to disability in developed countries. In 2004, approximately one in four U.S. adults reported having a mental disorder (1), and the annual economic cost in 2003 was about $300 billion (2). We tracked total per-capita and outof-pocket outpatient health care expenses for mental disorders in the privately insured population under age 65 from 1996 to 2011 using data from the Medical Expenditure Panel Survey, a nationally representative sample of the U.S. civilian noninstitutionalized population. Annual total health care expenses for mental disorders are defined as the sum of direct payments for outpatient services provided for mental disorder “events” (ICD-9 codes 290–319). Types of services include hospital outpatient care, emergency room services, and office-based services and prescriptions from medical providers. Expenses were converted to 2011 dollars. For 1996–2011, mean annual total per-capita expenses for mental disorders were $1,156 (95% confidence interval [CI]5$1,114–$1,198), with outof-pocket expenses of $338 (CI5$321– $355) accounting for 29.2% of the total. Despite some year-to-year variations, the per-capita amount showed an increasing trend from 1996 ($961, CI5 $850–$1,071) to 2009 ($1,323, CI5 $1,172–$1,474) (Figure 1). After 2009, a two-year continuous decrease was noted—to $1,119 (CI5$969–$1,269) in 2011. Annual out-of-pocket expenses first decreased from $377 (CI5$298– $456) in 1996 to $291 (CI5$234–$348) in 1999 and then increased to the baseline level in 2003. The amount then decreased continuously to $275 (CI5$244–$307) in 2011. Thus, the out-of-pocket proportion of the total steadily decreased from 39.2% in 1996 to 24.6% in 2011. Whereas the overall health care cost of mental disorders remains substantial, out-of-pocket expenses have decreased to some extent during the past decade.

Financial burden of household out-of pocket health expenditure in Viet Nam: Findings from the National Living Standard Survey 2002–2010

In Viet Nam, household direct out-of-pocket (OOP) health expenditure as a share of the total health expenditure has been always high, ranging from 50% to 70%. The high share of OOP expenditure has been linked to different inequity problems such as catastrophic health expenditure (households must reduce their expenditure on other necessities) and impoverishment. This paper aims to examine catastrophic and poverty impacts of household out-of-pocket health expenditure in Viet Nam over time and identify socio-economic indicators associated with them. Data used in this research were obtained from a nationally representative household survey, Viet Nam Living Standard Survey 2002, 2004, 2006, 2008 and 2010. The findings revealed that there were problems in health care financing in Viet Nam – many households encountered catastrophic health expenditure and/or were pushed into poverty due to health care payments. The issues were pervasive over time. Catastrophic expenditure and impoverishment problems were more common among the households who had more elderly people and those located in rural areas. Importantly, the financial protection aspect of the national health insurance schemes was still modest. Given these findings, more attention is needed on developing methods of financial protection in Viet Nam.

Healthcare Delivery and Stakeholder’s Satisfaction Under Social Health Insurance Schemes in India: An Evaluation of Central Government Health Scheme (CGHS) and Exservicemen Contributory Health Scheme (ECHS)

This study attempted to evaluate the working of the Central Government Health Scheme (CGHS) and Ex-servicemen Contributory Health Scheme (ECHS) by assessing patient satisfaction as well as the issues and concerns of empaneled private healthcare providers.The study is based on a primary survey of 1,204 CGHS and 640 ECHS principal beneficiaries, 100 empaneled private healthcare providers and 100 officials of the schemes across 12 Indian cities.We have found that patients are reasonably well satisfied with the healthcare services of both empaneled private healthcare providers and the dispensaries-polyclinics but are relatively more satisfied with the former than the latter. We also found that beneficiaries are willing to pay more for better quality services. Though the schemes provide comprehensive healthcare services, the beneficiaries incur some out-of pocket health expenditure while seeking healthcare. Furthermore, beneficiaries are not in favor of the recent proposal to replace the schemes with health insurance for several reasons. The empaneled private healthcare providers are dissatisfied with the terms and conditions of empanelment, especially the low tariffs for their services as compared to prevailing market rates and the delays in reimbursements from the schemes.We suggest that appropriate efforts be undertaken to enhance the quality of healthcare service provided in the dispensaries-polyclinics of the CGHS and ECHS as well as to address the issues and concerns of empaneled private healthcare providers to ensure better healthcare delivery and for a long-term, sustainable public-private partnership.

The Economic impact of Non-communicable Diseases on households in India

BackgroundIn India, Non Communicable Diseases (NCDs) and injuries account for an estimated 62% of the total age-standardized burden of forgone Disability Adjusted Life Years (DALYs). Public and private financing of clinical services to reduce the NCD burden is a major challenge.MethodsWe used National Sample Survey Organization (NSSO) survey data from 1995-96 and 2004 covering nearly 200 thousand households to assess healthcare utilization patterns and out of pocket health spending by disease category. For this purpose, self-reported diseases and conditions were categorized into NCDs and non-NCDs. Survey data were used to assess how households financed their overall health expenditures and related this pattern to specific health conditions. We measured catastrophic spending on NCD-related hospitalization, defined as occurring when health expenditures exceeded 40% of a household's ability to pay, that is, household consumption spending less combined survival consumption expenditure; and impoverishment when per capita expenditure within the household decreased to below the poverty line once health spending was netted out.ResultsThe share of NCDs in out of pocket health expenses incurred by households increased over time, from 31.6 percent in 1995-96 to 47.3 percent in 2004. In both years, own savings and income were the most important source of financing for many health conditions, typically between 40-60 percent of all spending, whereas 30-35 percent was from borrowing. The odds of catastrophic hospitalization expenditures for cancer was nearly 170% greater and for CVD and injuries 22 percent greater than the odds due to communicable diseases. Impoverishment patterns were similar.ConclusionsOut of pocket expenses for treating NCDs rose sharply over the period from 1995-96 to 2004. When NCDs are present, the financial risks to which Indians households are exposed are significant.

Cost-Effectiveness of Biologics Compared with Disease-Modifying Antirheumatic Drugs in Rheumatoid Arthritis

Introduction: For many rheumatoid arthritis (RA) patients, RA leads to pain and stiffness, progressive joint destruction, functional disability, and premature mortality. The economic burden of RA is significant and includes direct costs (medical visits, medications, laboratory testing, and imaging) and indirect costs (lost productivity, early mortality, and out-ofpocket health care expenses). Disease-modifying antirheumatic drugs (DMARDs) slow the progression of joint damage and loss of function associated with RA. Newer but significantly more expensive biologic agents offer greater potential to slow disease progression and extend productivity, which raises the question of whether the improved clinical outcomes with biologics are worth their higher costs. Aims: This study identified and critically appraised existing economic evaluations of biologics versus DMARDs for adults with RA. Furthermore, it examined whether the incremental cost-effectiveness ratios (ICERs) were within the range of generally accepted medical interventions.

Optimum Allocations to Health Care Flexible Spending Accounts

Models used to derive optimal contributions to health care flexible spending accounts (FSAs) typically assume an employee’s household annual out-of-pocket health care expenses are an absolutely continuously random variable. This assumption, however, ignores the fact that some employees may be able to accurately predict a portion of their household annual out-of-pocket health care expenses and often actually incur only those expenses during the plan year, implying that a mixed random variable may be more appropriate. In addition, data have shown that employees are setting contributions at lower levels than existing absolutely continuous models would suggest is optimal. Using a mixed model of household annual out-of-pocket health care expenses we prove that it is often optimal for employees to contribute an amount equal to their household annual predictable out-of-pocket expenses, thus avoiding the risk of forfeiture. We also propose a practical rule of thumb that employees may use for setting their FSA contributions. Overall, we recommend that employees use their FSAs to cover only their highly predictable out-of-pocket health care expenses rather than use their FSAs as a contingency fund to pay for unlikely or unexpected outof-pocket health care expenses.

Out-of pocket health care expense and the elderly

Out-of pocket health care expense and the elderly