Pocket Payments Research Articles

Investigating the policy Effect of Medicine Subsidy Plan (Daruyar) on Patients' Out-Of-Pocket Payments :A Case Study of the General Health Insurance Administration of Isfahan Province

Background: The policy of removing the preferred drug currency (Daruyar plan) has been with the approach of increasing the coverage ratio and insurance obligations and paying attention to patients' out of pockets, especially incurable, chronic and low-income patients. Therefore, the purpose of this research is to investigate the effect of this plan on price and consumption ,and ultimately, the out of pocket payments after its implementation. Methods: The research method of this study was descriptive-analytical. Primary sampling included 5 pharmacies selected non-randomly and purposefully. After extracting the drug data of the insured persons related to these pharmacies from the database of the Health Insurance Organization, a sample of 384 people determined from the Morgan table was determined randomly and the number of 1803 items of medicine received by them was checked. Then the data was analyzed using SPSS 17 software and Mann-Whitney test. Results: The survey of 1803 items of medicine in the two periods of November 2021 and 2022 showed that the maximum amount of out-of-pocket payment in November 2021 was equal to 184,000,000 Rials and the average of this variable was 1,357,000 Rials and the median was 177,250 Rials. This number in 2022 was 92,000,000 Rials, 1,805,000 Rials respectively and 181,050 Rials. The results of the analysis of these data showed that after the implementation of Daruyar plan, due to the allocation of compensatory subsidies, there has been no significant change in the total out-of-pocket payment of the patients. Conclusion: This study investigated the effect of Daruyar plan on price changes, consumption and out-of-pocket payments of patients. The comparison of out-of-pocket payment data in the two time frames of November 2021 and 2022 showed that eliminating the preferred drug currency and implementing the drug subsidy plan has not made a significant change regarding patients' out-of-pocket payments.

Baseline characteristics of parents enrolled in ACCL20N1CD: Financial distress during treatment for pediatric acute lymphoblastic leukemia (ALL) in the US.

220 Background: Personal costs of childhood cancer can contribute to disparities in health outcomes. The purpose of ACCL20N1CD is to examine trajectories of parental costs and the associated financial distress, cost coping behaviors, and household material hardships (HMH) during treatment for pediatric ALL. Objective is to report baseline characteristics of the parents and their households. Methods: The study used a prospective cohort design with repeated measures. Setting was Children’s Oncology Group (COG) practices at National Cancer Institute Community Oncology Research Program (NCORP) institutions. Parents who use English or Spanish, and have children newly diagnosed with ALL treated at COG NCORP practices were eligible. Parents were asked to complete surveys at 3 time points, including baseline (T1; during induction and <7 days after planned induction remission evaluation). Surveys included items about (a) parent socio‐economic status, financial distress measured by 8-item Personal Wellness Scale (PFWS), and cost coping behaviors, and (b) HMH. Factors related to high PFWS scores were evaluated by logistic regression. Results: Of 104 evaluable parents, most were female (83.7%), white (65.4%), non-Hispanic (48.1%), partnered (79.8%), > high school diploma (93.3%), used English (84.6%), worked full (48.1%) or part (5.8%) time, and paid for their child’s care with public insurance (57.7%). Median household income=$50,000 (Inter-Quartile Range/IQR 20,000-100,000) for 4 (IQR 4-5) people. Not including wages lost due to caregiving, out of pocket payments for medical care + other ALL-related costs in the prior month >15% of monthly income for 51.9% of households, which is considered financially catastrophic. 24.0% of households lacked food stability; 21% had housing insecurity. Conclusions: At baseline, sizeable proportions of parents exhibit high out of pocket costs, high financial distress level, and multiple cost coping behaviors with implications for future health and individual and household quality of life.

Sources of specialist physician fee variation: Evidence from Australian health insurance claims data

This study explores the variation in specialist physician fees and examines whether the variation can be attributed to patient risk factors, variation between physicians, medical specialties, or other factors. We use health insurance claims data from a large private health insurer in Australia. Although Australia has a publicly funded health system that provides universal health coverage, about 44 % of the population holds private health insurance. Specialist physician fees in the private sector are unregulated; physicians can charge any price they want, subject to market forces.We examine the variation in fees using two price measures: total fees charged and out-of- pocket payments. We follow a two-stage method of removing the influence of patient risk factors by computing risk-adjusted prices at patient-level, and aggregating the adjusted prices over all claims made by each physician to arrive at physician-level average prices. In the second stage, we use variance-component models to analyse the variation in the physician-level average prices.We find that patient risk factors account for a small portion of the variance in fees and out-of-pocket payments. Physician-specific variation accounts for the bulk of the vari- ance. The results underscore the importance of understanding physician characteristics in formulating policy efforts to reduce fee variation.

EE24 Analysis of out-of Pocket Payment Associated to Female Infertility in Hungary between 2015-2022

EE24 Analysis of out-of Pocket Payment Associated to Female Infertility in Hungary between 2015-2022

Is economic growth enough to propel rehabilitation expenditures? An empirical analysis of country panel data and policy implications

PurposeRehabilitation is a set of services designed to increase functioning and improve wellbeing across the life course. Despite being a core part of Universal Health Coverage, rehabilitation services often receive limited public expenditure, especially in lower income countries. This leads to limited service availability and high out of pocket payments for populations in need of care. The purpose of this research was to assess the association between macroeconomic conditions and rehabilitation expenditures across low-, middle-, and high-income countries and to understand its implications for overall rehabilitation expenditure trajectory across countries.Materials and methodsWe utilized a panel data set from the World Health Organization’s Global Health Expenditure Database comprising the total rehabilitation expenditure for 88 countries from 2016 to 2018. Basic macroeconomic and population data served as control variables. Multiple regression models were implemented to measure the relationship between macroeconomic conditions and rehabilitation expenditures. We used four different model specifications to check the robustness of our estimates: pooled data models (or naïve model) without control, pooled data models with controls (or expanded naïve model), fixed effect models with all controls, and lag models with all controls. Log-log specifications using fixed effects and lag-dependent variable models were deemed the most appropriate and controlled for time-invariant differences.ResultsOur regression models indicate that, with a 1% increase in economic growth, rehabilitation expenditure would be associated with a 0.9% and 1.3% increase in expenditure. Given low baseline levels of existing rehabilitation expenditure, we anticipate that predicted increases in rehabilitation expenditure due to economic growth may be insufficient to meet the growing demand for rehabilitation services. Existing expenditures may also be vulnerable during periods of economic recession.ConclusionThis is the first known estimation of the association between rehabilitation expenditure and macroeconomic conditions. Our findings demonstrate that rehabilitation is sensitive to macroeconomic fluctuations and the path dependency of past expenditures. This would suggest the importance of increased financial prioritization of rehabilitation services and improved institutional strengthening to expand access to rehabilitation services for populations.

Willingness to pay for antiretroviral therapy, viral load, and premium services; A contingent valuation survey of people living with HIV in southern Nigeria.

With stagnating funding for HIV and AIDS control programs in Nigeria, alternative funding models for antiretroviral therapy (ART) including out of pocket payment are being considered to sustain momentum epidemic control targets. We assessed willingness to pay for ART related services, and factors associated with willingness to pay. Between July and August 2019, we conducted a survey among people living with HIV (PLHIV) on ART in 3 states in southern Nigeria. Randomly sampled respondents on ART for at least 6 months, aged ≥ 18 years, able to communicate in English or pidgin English, and consenting to the survey were enrolled. Respondents were asked if they were willing to pay for clinical consultation, antiretroviral drugs (ARVs), viral load testing services and premium ART services (including fast track services). Respondents indicating willingness to pay for any of these services were asked the maximum amount they were willing to pay using contingent valuation methodology. We assessed the weighted proportions of PLHIV on ART willing to pay for ART and used survey-featured logistic regression measures to assess sociodemographic and ART related factors associated with willingness to pay for ART services. Overall, 1,598 PLHIV with a mean age of 39.03 years (standard deviation [SD]: 11.23 years), were included in this analysis. Of these, 65.8% (1,079), 73.9% (1,192), 61.0% (995) and 33.6% (472) were willing to pay for ART consultation, ARVs, viral load testing services and premium ART services respectively. The median maximum amount PLHIV were willing to pay for clinical consultation and for ARVs was NGN1,000 (USD equivalent of $2.78; interquartile range [IQR]: 500-2,000) respectively, and NGN2,500 (USD equivalent of $6.94; IQR: NGN1,000-5,000) and NGN2,000 (USD equivalent of $5.56; IQR: NGN1,000-3,000) for viral load testing and premium ART services respectively. Receiving ART in Lagos state, being employed and having a monthly income of NGN100,000 or more was associated with willingness to pay for the various ART services. We found generally high-level of willingness to pay for ART consultation, ARVs and viral load testing services but low willingness to pay for premium ART services among PLHIV on ART. The maximum amount PLHIV were willing to pay for various ART services fell short of benchmarks for alternative funding but can potentially supplement ART by funding differentiated service delivery models that require nominal amounts to facilitate person-centered differentiated service delivery models.

Trends and Challenges of Health Care Financing in Nigeria

Introduction: Health care financing is concerned with how financial resources are generated, allocated and used in health care system. Worldwide, every year 100 million people are pushed into poverty because they have had to pay directly for their health care. Objective: To assess the trends and challenges of health care financing in Nigeria. Methodology: A literature review was conducted. Results: In Nigeria, health care is financed through Tax revenues, out of pocket payments (user payment), health insurance (social, community-based insurance, private health care financing), donor funding, exemptions/deferrals/subsidies. Majority (69%) of the health care financing in Nigeria is from out-of-pocket payments made by the patient to the health care provider. The federal government provides 12% of health care finances. The rest of financing of health care in Nigeria come from the state governments (8%), Local Government areas (4%), and development/donor partners (3%). Nigeria allocates between 3.5% and 6.24% of her total budget to health care financing. The challenges of health care financing in Nigeria include: inefficiency of the health system across the country, limited institutional capacity, corruption, unstable and dwindling economic, and lack of political will. Conclusion: Nigeria’s expenditure on health is very low, and domestic resource mobilization for health care is weak. Nigeria’s health system has to be strengthened. Nigeria also has to inject more fund into health care for its citizens. She should embrace equitable modes of health care financing such as compulsory social insurance system for all citizens of Nigeria. The role of different levels of government in financing health care should be clearly defined. Also, prudent management of available scarce funds will go a long way in changing the Nigerian health care financing situation. The private sector (telecommunications and banks) and local philanthropists has to be involved in financing health care. There should be effective monitoring and evaluation (M&E) of performances and tracking of the use of resources, health policies and reforms.

Factors influencing public and private healthcare utilisation in Uganda.

In Uganda, health care utilisation remains very low despite a number of government reforms that have been implemented in the health sector since the 1990's such as decentralization and removal of user fees in public health facilities among others. To examine the factors influencing public and private health care utilisation in Uganda. The study used cross sectional data from the Uganda National Household Survey collected between July 2016 and June 2017. Anderson's conceptual framework was used to identify explanatory variables associated with choice of health care providers and a multinomial logistic regression model was estimated. Out of the 17,912 individuals who sought care, 36% used a government facility, 60% used private facility while 4% had self- care/treatment. The results show that out of pocket health expenditure, age, level of education, marital status, residence, and type of illness significantly influenced choice of public healthcare providers. Similarly, utilisation of private healthcare providers was associated with household welfare, level of education, residence, marital status, illness days, and type of illness. The findings highlight the need for a national health insurance scheme to reduce out of pocket payments for health care and enable the poor and vulnerable patients visit the modern health facilities.

Utilization of National Health Insurance Scheme Among Healthcare Professionals in Federal Medical Centre Asaba Delta State

The difficulties encountered in out of pocket financing of healthcare have compelled the introduction of prepaid health insurance in many countries, including Nigeria. This is borne out of a universal and equitable healthcare cover as a fundamental human right. This study assessed the utilization of the National Health Insurance Scheme among healthcare professionals in Federal Medical Centre Asaba. Descriptive cross sectional survey design was used. Three research questions and two hypotheses guided the study. A sample size of 271 respondents who met the inclusion criteria participated in the study. A structured questionnaire was used for data collection. A pilot study was carried out with a reliability index of 0.86 after face and content validation. Frequencies, percentages and chi-square were used for descriptive and inferential statistics for data analysis. Findings revealed that the majority of the respondents (92.3%) registered with NHIS. A greater proportion of the healthcare professionals have utilized the scheme. Higher level of education was found to be significantly associated with utilization of NHIS. Conversely, no association was found between healthcare professionals’ gender and their utilization of NHIS. Findings revealed a high rate of utilization of the NHIS among respondents that were enrolled and a reduction in out of pocket payment for healthcare under the NHIS. Based on the above, healthcare providers should be subjected to seminars and workshops to enlighten them on the importance of enrolling with the scheme. Intensified campaigns should emphasize on the objective, and benefits of the scheme, using the mass media as a way of reaching a vast majority of the workforce.

The financial burden of out of pocket payments on medicines among households in Ethiopia: analysis of trends and contributing factors

BackgroundIn Ethiopia, out-of-pocket (OOP) payment is the key means of healthcare financing, and expenses on medicines are a crucial component of such payment. This study aims to investigate the financial implications of OOP payments on medicines for Ethiopian households.MethodsThe study involved a secondary data analysis of the national household consumption and expenditure surveys of 2010/11 and 2015/16. The "capacity-to-pay" method was used to calculate catastrophic OOP medicine expenditures. The extent of economic status related to catastrophic medicine payment inequity was calculated using concentration index estimation. The impoverishment consequences of OOP payment on medicine were estimated using poverty headcount and poverty gap analysis methods. Logistic regression models were used to identify the variables that predict catastrophic medicine payments.ResultsMedicines accounted for the majority of healthcare spending (> 65%) across the surveys. From 2010 to 2016, the total percentage of households facing catastrophic medicine payments decreased from 1% to 0.73%. However, the actual number of people expected to have experienced catastrophic medicine payments increased from 399,174 to 401,519 people. Payment for medicines pushed 11,132 households into poverty in 2015/16. The majority of disparities were explained by economic status, place of residence, and type of health services.ConclusionOOP payment on medicine accounted for the majority of total health expenses in Ethiopia. A high medicine OOP payment continued to push households into catastrophic payments and impoverishment. Household seeking inpatient care, those with lower economic status and urban residents were among the most affected. Hence, innovative approaches to improve the supply of medicines in public facilities especially those in urban settings and risk protection mechanisms for medicine expenditures particularly for inpatient care are recommended.

Association between women’s household decision-making autonomy and health insurance enrollment in sub-saharan Africa

BackgroundOut of pocket payment for healthcare remains a barrier to accessing health care services in sub-Saharan Africa (SSA). Women’s decision-making autonomy may be a strategy for healthcare access and utilization in the region. There is a dearth of evidence on the link between women’s decision-making autonomy and health insurance enrollment. We, therefore, investigated the association between married women’s household decision making autonomy and health insurance enrollment in SSA.MethodsDemographic and Health Survey data of 29 countries in SSA conducted between 2010 and 2020 were analyzed. Both bivariate and multilevel logistic regression analyses were carried out to investigate the relationship between women’s household decision-making autonomy and health insurance enrollment among married women. The results were presented as an adjusted odds ratio (AOR) and the 95% confidence interval (CI).ResultsThe overall coverage of health insurance among married women was 21.3% (95% CI; 19.9-22.7%), with the highest and lowest coverage in Ghana (66.7%) and Burkina Faso (0.5%), respectively. The odds of health insurance enrollment was higher among women who had household decision-making autonomy (AOR = 1.33, 95% CI; 1.03–1.72) compared to women who had no household decision-making autonomy. Other covariates such as women’s age, women’s educational level, husband’s educational level, wealth status, employment status, media exposure, and community socioeconomic status were found to be significantly associated with health insurance enrollment among married women.ConclusionHealth insurance coverage is commonly low among married women in SSA. Women’s household decision-making autonomy was found to be significantly associated with health insurance enrollment. Health-related policies to improve health insurance coverage should emphasize socioeconomic empowerment of married women in SSA.

Catastrophic health expenditure and associated factors among households of non community based health insurance districts, Ilubabor zone, Oromia regional state, southwest Ethiopia

BackgroundOut-of-pocket health expenditure is the proportion of total health expenditure that is paid by individuals and households at the time of health service. Hence, the objective of this study is to assess the incidence and intensity of catastrophic health expenditure and associated factors among households in non-community-based health insurance districts in the Ilubabor zone, Oromia National Regional State, Ethiopia.MethodA community-based cross-sectional study design was employed in the Ilubabor zone on non-community-based health insurance scheme districts from August 13 to September 2, 2020, and 633 households participated in the study. A multistage one cluster sampling method was used to select three districts out of seven districts. Data was collected by using a structured mix of open and close-ended pre -tested questionnaires by face-to-face interviewing. A micro-costing/bottom up approach was used for all household expenditure. After checking its completeness, all household consumption expenditure was done by mathematical analysis using Microsoft Excel. Binary and multiple logistic were done using 95%CI and significance was declared at P < 0.05.ResultsThe number of households that participated in the study was 633, with a response rate of 99.7%. Out of 633 households surveyed, 110 (17.4%) were in catastrophe, which exceeds 10% of total household expenditure. After medical care expenses, about 5% of the households moved downward from the middle poverty line to extreme poverty. Out-of-pocket payment AOR: 31.201: 95% CI (12.965–49.673), daily income less than 1.90 USD AOR: 2.081: 95% CI (1.010–3.670), living a medium distance from a health facility AOR: 6.219: 95% CI (1.632–15.418), and chronic disease AOR: 5.647: 95% CI (1.764–18.075.ConclusionIn this study, family size, average daily income, out of pocket payment and chronic diseases were statistically significant and independent predictors for household catastrophic health expenditure. Therefore, to overcome financial risk, the Federal Ministry of Health should develop different guidelines and modalities by considering household per capita and income to improve the enrolment of community-based health insurance. Also, the regional health bureau should improve their budget share of 10% to increase the coverage of poor households. Strengthening financial risk protection mechanisms, such as community-based health insurance, could help to improve healthcare equity and quality.

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.

An assessment of out of pocket payments in public sector health facilities under the free maternal healthcare policy in Ghana

BackgroundThe free maternal healthcare policy was introduced in Ghana in 2008 under the national health insurance scheme as a social intervention to improve access to maternal health services. This study investigated the prevalence of out of pocket (OOP) payment among pregnant women with valid national health insurance who sought skilled delivery services at public sector health facilities in Ghana. The study also assessed the health system factors associated with OOP payment.MethodsWe used data from the Ghana Maternal Health Survey (GMHS), which was conducted in 2017. The study comprised 7681 women who delivered at a public sector health facility and had valid national health insurance at the time of delivery. We used multivariable logistic regression analysis to assess factors associated with OOP payment, whiles accounting for clustering, stratification, and sampling weights.ResultsThe prevalence of OOP payment for skilled delivery services was 19.0%. After adjustment at multivariable level, hospital delivery services (adjusted Odds Ratio [aOR] = 1.23, 95% Confidence Interval [CI] = 1.00, 1.52), caesarean section (aOR = 1.73, 95% CI = 1.36, 2.20), and receiving intravenous infusion during delivery (aOR = 1.31, 95% CI = 1.08, 1.60) were associated with higher odds of OOP payment. Women who were discharged home 2 to 7 days after delivery had 19% lower odds of OOP payment compared to those who were discharged within 24 hours after delivery.ConclusionThis study provides evidence of high prevalence of OOP payment among women who had skilled delivery services in public sector health facilities although such women had valid national health insurance. Government may need to institute measures to reduce OOP payment in public sector facilities especially at the hospitals and for women undergoing caesarean sections.

Comparative study of obstetric outcomes between women on health insurance scheme and women on out of pocket payment

Background: Payment methods for healthcare services in a country impact the health status of its people and the health indices of the nation. Research findings have shown that care received and obstetric outcomes of women seeking natal care and their newborns are affected by their health insurance status. Objective:Comparative study of obstetric outcomes between women on health insurance scheme and women on out -of- pocket payment. Materials and Methods: The study was a prospective observational one involving1655 women who delivered during the period of the study, out of which 33 were on health insurance and 1622 paid out of pocket for their delivery and care. The study compared the obstetric outcomes between women on health insurance and those who pay out of pocket for obstetric care services. The Statistical Package for Social Sciences (SPSS) version 20.0 was used for the data analysis. Univariate association between mode of payment and obstetric outcomes was explored using Pearson’s chi-square test with statistical significance, p-value set at p

Out-of-pocket payments and loss of income among long-term breast cancer survivors in Germany: a multi-regional population-based study

PurposeThis study aims to examine the magnitude of out of pocket (OOP) payments and income loss, as well as to identify socioeconomic and clinical factors among long-term breast cancer (BC) survivors in Germany.MethodsWe examine data from 2654 long-term BC survivors in Germany that participated in the “CAncEr Survivorship – A multi-Regional population-based study” (CAESAR) and who were at least 5 years post diagnosis. BC-related OOP payments and income loss both within the 12 months prior to the survey were analyzed. Two-part regression models were performed to identify socioeconomic and clinical factors.ResultsOOP payments were incurred by 51.9% of survivors with a total mean spending of 566 euros. Income loss was present among 9.6% of survivors and averaged 5463 euros among those reporting such. Socioeconomic and clinical factors associated with higher OOP payments (p ≤ 0.05) included age at time of diagnosis (65–79 years), education (10–11 years), (early) retirement, stage of diagnosis (stage III), time from diagnosis (more than 10 years), comorbidities (at least 1), and the use of rehabilitation services. Regarding income loss, age at time of diagnosis (50–59 years), (early) retirement, stage of diagnosis (stage II), time from diagnosis (5–7 years), comorbidities (at least 1), and receiving chemotherapy treatment were associated with higher losses.ConclusionsFor some survivors in Germany, financial burden can be considerably high despite comprehensive healthcare and support from social security.Implications for Cancer SurvivorsOOP payments related to domestic help and nursing staff as well as to outpatient care are most frequent.

Health related quality of life of patients undergoing in-centre hemodialysis in Rwanda: a cross sectional study

Background:There are few studies assessing the quality of life of patients with chronic and end stage kidney disease in sub-Saharan Africa. We aimed to describe the health-related quality of life (HRQOL) of patients undergoing in-centre maintenance hemodialysis in Rwanda using the KDQOL™-36 and determine sociodemographic and clinical factors associated with their quality of life.Methods:We conducted a multicenter, cross-sectional study between September 2020 and July 2021. Patients over the age of 18 receiving maintenance in-centre hemodialysis for at least three months at the Rwandan tertiary hospitals were administered the KDQOL™-36 questionnaire to assess physical and mental health functioning, the effect, burden and symptoms and problem of kidney disease. Sociodemographic and clinical information was collected for all eligible patients. Using mixed effects linear regression models, we explored factors associated with overall KDQOL and its domains, while accounting for clustering of patients within hemodialysis centres.Results:Eighty-nine eligible patients were included in the study. The majority of participants were younger than 60 years old (69.7%), male (66.3%), had comorbidities (91%), and 71.6% were categorized as level 3 on a 4 tier in-country poverty scale. All participants had health insurance coverage, with 67.4% bearing no out of pocket payments for hemodialysis. The median (IQR) quality of life score was 45.1 (29.4) for overall HRQOL, 35.0 (17.9) for PCS and 41.7 (17.7) for MCS. Symptoms and problem of kidney disease, effect of kidney disease, and burden of kidney disease scored 58.3 (43.8), 56.3 (18.8) and 18.8 (37.5), respectively. A notable difference of KDQOL scores between hemodialysis centres was observed. Overall KDQOL was associated with male sex (adjusted ß coefficient [aß]: 8.5, 95% confidence interval [CI]: 2.8, 14.3); being employed (aß: 8.2, 95% CI: 2.2, 14.3); dialysis vintage of 13–24 months (aß: 10.5, 95% CI: 3.6, 17.6), hemoglobin of 10-11 g/dl (aß: 7.3, 95% CI: 0.7, 13.7) and comorbidities (e.g., ≥ 3 comorbidities vs. none) (aß: -29.8, 95% CI: -41.5, -18.3).Conclusion:Patients on in-centre hemodialysis in Rwanda have reduced KDQOL scores, particularly in the burden of kidney disease and physical composite summary domains. Higher overall KDQOL mean score was associated with male sex, being employed, and dialysis vintage of 13–24 months, hemoglobin of 10-11 g/dl and absence of comorbidities. The majority of patients receiving in-centre hemodialysis have higher socioeconomic status reflecting the social and financial constraints to access and maintain dialysis in resource limited settings.

Out of pocket payments and access to NCD medication in two regions in Albania.

ObjectiveThe financial burden from noncommunicable diseases (NCDs) is a threat worldwide, alleviated only when good social protection schemes are in place. Albeit the Government in Albania has committed to Universal Healthcare Coverage (UHC), Out-of-Pockets (OOPs) persist. Through this study, we aimed to assess the OOPs related to consultations, diagnostic tests, and medicine prescriptions as self-reported by people suffering from NCDs.MethodsA household survey was conducted in two regions of Albania. The present analysis includes respondents who suffered from chronic health conditions and consulted a health care provider within the last 8 weeks (n = 898). Mixed logistic regression models with random intercepts at the level of communities were employed in order to assess the association of OOPs with age, gender, urban vs. rural residency, health insurance, marital status, barriers experienced, type of chronic condition(s) and region.ResultsOf those who consulted a provider, 95% also received a drug prescription. Among them, 94% were able to obtain all the drugs prescribed. Out-of-pocket payments occurred throughout the NCD treatment process; specifically, for consultation (36%), diagnostic tests (33%), and drugs purchased (88%). Drug expenditures accounted for 62% of all household expenditures. Respondents with health insurance were less likely to pay for consultation and drugs. The elderly (patients above 60 years old) were less likely to pay for consultations and tests. Those who lived in urban areas were less likely to pay for drugs and consultations. Patients encountering any form of barrier when seeking care had increased odds of OOPs for consultations (OR; 2.25 95%-CI; 1.57; 3.23) and tests (OR; 1.71 95%-CI; 1.19; 2.45).ConclusionOut-of-pocket payments by NCD patients principally made up through the purchase of prescribed drugs, remain important. Tackling the high costs of drugs will be important to accelerate the UHC agenda. Here, it is important to raise the population’s awareness on patients’ knowledge of their entitlements to health insurance, and on the current health reforms.

Household Catastrophic Health Care Expenditure: Evidence on the Effects of Out-of-pocket Health Care Payments on Household Income in East African Region

Out Of Pocket Payments (OOPP) refers to the amount of money a patient pays for medical expenses that are not covered by a health insurance plan (National Cancer Institute, 2022). The World Health Organization (WHO) defines OOPP as the individuals’ direct payments to healthcare providers at the time of service use (Kalantari, 2012). Developing countries are exposed to considerable socio-economic vulnerabilities. Catastrophic out-of-pocket spending has adverse effects on individual and household income, especially where policies on healthcare financing does not favor the poor. Heath care funding and the quality of healthcare outcomes in development are inseparable. The World Health Organization Assembly resolution of 2005 on universal coverage and sustainable health financing, the Paris Declaration of 2001 on greater Investments in the Health Sector, Health Insurance and Financing, and the Sustainable Development Goal number 1 on ending all forms of poverty forms the basis of this study. African Governments committed through the Abuja Declaration, to allocate and spend at least 15 percent of government funds of their National GDP on health. In June 2015, Countries in the East African Community concurrently released their National budgets for the Financial Years 2015/2016. None of the countries had fulfilled the Abuja declaration promise on healthcare investment in East African Community. This study examined how different countries in East Africa have invested in healthcare and the state of out-of-pocket spending on household income. Related literature review will be analyzed, and conclusions and the way forward in relation to household healthcare spending in East African Countries will be discussed.

Does community-based health insurance protect women from financial catastrophe after cesarean section? A prospective study from a rural hospital in Rwanda

BackgroundThe implementation of community-based health insurance in (CBHI) in Rwanda has reduced out of pocket (OOP) spending for the > 79% of citizens who enroll in it but the effect for surgical patients is not well described. For all but the poorest citizens who are completely subsidized, the OOP (out of pocket) payment at time of service is 10%. However, 55.5% of the population is below the international poverty line meaning that even this copay can have a significant impact on a family’s financial health. The aim of this study was to estimate the burden of OOP payments for cesarean sections in the context of CBHI and determine if having it reduces catastrophic health expenditure (CHE).MethodsThis study is nested in a larger randomized controlled trial of women undergoing cesarean section at a district hospital in Rwanda. Eligible patients were surveyed at discharge to quantify household income and routine monthly expenditures and direct and indirect spending related to the hospitalization. This was used in conjunction with hospital billing records to calculate the rate of catastrophic expenditure by insurance group.ResultsAbout 94% of the 340 women met the World Bank definition of extreme poverty. Of the 330 (97.1%) with any type of health insurance, the majority (n = 310, 91.2%) have CBHI. The average OOP expenditure for a cesarean section and hospitalization was $9.36. The average cost adding transportation to the hospital was $19.29. 164 (48.2%) had to borrow money and 43 (12.7%) had to sell possessions. The hospital bill alone was a CHE for 5.3% of patients. However, when including transportation costs, 15.4% incurred a CHE and including lost wages, 22.6%.ConclusionTo ensure universal health coverage (UHC), essential surgical care must be affordable. Despite enrollment in universal health insurance, cesarean section still impoverishes households in rural Rwanda, the majority of whom already lie below the poverty line. Although CBHI protects against CHE from the cost of healthcare, when adding in the cost of transportation, lost wages and caregivers, cesarean section is still often a catastrophic financial event. Further innovation in financial risk protection is needed to provide equitable UHC.