Determinants of catastrophic health expenditure in Nigeria

Background

Catastrophic health expenditure is a measure of financial risk protection and it is often incurred by households who have to pay out of pocket for health care services that are not affordable. The study assessed the determinants of catastrophic health expenditure among households in Nigeria.

Methods

Secondary data from the Harmonized Nigeria Living Standard Survey (HNLSS) of 2009/10 was utilized to assess factors associated with catastrophic health expenditure in Nigeria. Household and individual characteristics associated with catastrophic health expenditure were determined using bivariate analysis and multivariate logistic regression.

Results

Results showed that irrespective of the threshold for the two concepts of total household expenditure and non-food expenditure, having household members aged between 6 and 14 years, having household members aged between 15 and 24 years, having household members aged between 25 and 54 years, having no education, having primary education, having secondary education, lack of health insurance coverage, visiting a private health facility, households living in north central zone, households living in north east zone and having household members with non-chronic illnesses were factors that increase the risk of incurring catastrophic health expenditure among households.

Conclusions

Policy-makers and political actors need to design equitable health financing policies that will increase financial risk protection for people in both the formal and informal sectors of the economy.

     

农村人均卫生费用的影响因素研究

文章运用EViews统计分析软件对中国农村人均卫生费用的影响因素进行回归分析,研究发现新型农村合作医疗保险制度的实施没有改变农村居民家庭人均纯收入和65岁及以上老年人口占总人口比率与中国农村人均卫生费用的相关关系,但是每千人口卫生技术人员数与农村人均卫生费用由原先的负相关关系变为正相关关系。     

Measuring incidence of catastrophic out-of-pocket health expenditure: with application to India

The present paper attempts to provide a new measure of catastrophic out-of-pocket health expenditure based on consumption of necessities. In literature, catastrophic expenditure is measured as out-of-pocket health expenditure that exceeds some fixed proportion of household income or household’s capacity to pay. According the new measure proposed in this paper, OOP health expenditure is catastrophic if it reduces the non-health expenditure to a level where household is unable to maintain consumption of necessities. Based on this measure of catastrophic health expenditure, the paper examines determinants of catastrophic out-of-pocket health expenditure in India. The results show that, incidence of catastrophic OOP health expenditure increases with income, when we use the earlier measures. However, results based on the revised measure show that, the incidence of catastrophic payments goes down as income increases. Therefore, the analysis suggests that the findings are sensitive to the method used. The findings from multivariate analysis show economic and social status of Indian households are important determinants of incidence of catastrophic health expenditure. Education reduces the probability of incurring catastrophic health expenditure. Moreover, these findings are sensitive to measure of catastrophic OOP health expenditure and therefore, it is important to consider appropriate measure of catastrophic OOP health expenditure.     

Government health expenditure,out-of-pocket payment and social inequality: A cross-national analysis of China and OECD countries

This study aims to assess the association between Chinese out-of-pocket payments and government health spending, investigating their variation ratio in the context of OECD countries. Aggregated time-series data of 37 countries (from China and official OECD members) were collected from the World Bank Open Data source and analyzed using the multiple linear regression models. Benchmarking approach was applied to evaluate the causes of healthcare expenditure rise per capita. The results showed that China's government health expenditure was positively associated with out-of-pocket payment rise, with a higher variation score of 42.70%. The association was statistically significant at 5%. Likewise, the association between government expenditure and out-of-pocket payment in the OECD countries was positively significant at 1%, and their variation score was 2.41%. Health financing in OECD countries showed higher stability and equity than that in China. Policy implications for China is to reduce the distributional disparity of government health funds by tax adjustments in health services, universal health coverage, the removal of social health insurance disparities, and a single health payment method.     

Determinants of household health expenditure on western institutional health care

We try to identify determinants of illness reporting, provider choice and resulting expenditure with different econometric models using data from a representative household panel survey of 800 households in Nouna health district, Burkina Faso, during 2000–2001. The factors being an adult, married, illness occurred in rainy season and severe illness significantly increased the magnitude of health expenditure. Compared to malaria, individuals spent more on other infectious diseases, injury and the other disease category. In contrast, people were less likely to spend on chronic illness. An individual who belonged to a household headed by a female, a literate household head and with a higher household expenditure had a significantly positive association with the magnitude of expenditure. Findings from this study can be used for policy implication to improve health system performance in Burkina Faso through enhancing health care utilization.     

Trends of out-of-pocket expenditure for influenza in China Health and Nutrition Survey during 1989-2006

Objectives  

To examine the trends of out-of-pocket expenditure for influenza during 1989–2006 in China.     

Burden of out-of-pocket expenditure for road traffic injuries in urban India

ABSTRACT: BACKGROUND: Road traffic injuries (RTI) are an increasing public health problem in India where out-ofpocket (OOP) expenditures on health are among the highest in the world. We estimated the OOP expenses for RTI in a large city in India. METHODS: Information on medical and non-medical expenditure was documented for RTI cases of all ages that reported alive or dead to the emergency departments of two public hospitals and a large private hospital in Hyderabad. Differential risk of catastrophic OOP total expenditure (COPE-T) and medical expenditure (COPE-M), and distress financing was assessed for 723 RTI cases that arrived alive at the study hospitals with multiple logistic regression. Catastrophic expenditure was defined as expenditure > 25% of the RTI patient's annual household income. Variation in intensity of COPE-M in RTI was assessed using multiple classification analysis (MCA). RESULTS: The median OOP medical and non-medical expenditure was USD 169 and USD 163, respectively. The prevalence of COPE-M and COPE-T was 21.9% (95% CI 18.8-24.9) and 46% (95% CI 42-49.3), respectively. Only 22% had access to medical insurance. Being admitted to a private hospital (OR 5.2, 95% CI 2.7-9.9) and not having access to insurance (OR 3.8, 95% CI 1.9-7.6) were significantly associated with risk of having COPE - M. Similar results were seen for COPE - T. MCA analysis showed that the burden of OOP medical expenditure was mainly associated with in-patient days in hospital (Eta =0.191). Prevalence of distress financing was 69% (95% CI 65.5-72.3) with it being significantly higher for those reporting to the public hospitals (OR 2.8, 95% CI 1.7-4.6), those belonging to the lowest per capita annual household income quartile (OR 7.0, 95% CI 3.7-13.3), and for those without insurance access (OR 3.4, 95% CI 2.0-5.7). CONCLUSIONS: This paper has outlined the high burden of out-of-pocket medical and total expenditure associated with RTI in India. These data reinforce the need for implementing more effective financial protection mechanisms in India against the high out-of-pocket expenditure incurred on RTI.     

Determinants of health service use and expenditure among the elderly Finnish population

Background: There is a need to identify significant determinantsof physician and public health nurse visits, hospital in-patientand home care, use of prescribed medication and total expenditureamong elderly people for planning of health policy. Methods:The data were obtained from three annual computer-assisted telephoneinterview surveys in 1992–1994. Each year a systematicsample of approximately 2,300 non-institutionalized people aged25-79 years were interviewed. The 60-79 year old respondentswere included in our analysis (n=1,707); the response ratesin this age group were approximately 75% each year. In thisstudy we tested the suitability of four regression models: Poisson,negative binomial, logit plus zero-truncated Poisson and logitplus zero-truncated negative binomial. Results: The use of servicesincreased with age, particularly hospital in-patient and homecare. Although women were more likely to use services, particularlyprimary care, their share of total expenditure was lower thanthat for men. Significant predictors of higher expenditure wereown personal doctor, other specific doctor, perceived healthstatus, psychosomatic symptoms, chronic illness and difficultiesin functional ability. Those living alone had significantlyhigher expenditures. Conclusion: It emerged that, while a largenumber of elderly people had used services, only a small minorityhad accounted for the majority of expenditure. Although thepersonal doctor system may produce high quality of care, itcannot achieve cost savings.     

Economic burden,impoverishment and coping mechanisms associated with out-of-pocket health expenditure: analysis of rural-urban differentials in India

Aim

This article aimed to study the burden, impact and coping mechanisms associated with out-of-pocket (OOP) health expenditure in rural and urban areas in India.

Methods

National Sample Survey Organisation (NSSO) data on ‘Health and Morbidity’ gathered in 2004 and 2014 were employed to measure the catastrophic burden, impoverishment impact and various coping strategies associated with out-of-pocket health in India.

Results

Results revealed that over the study period, considerable rural-urban differentials existed in the economic burden and impact of out-of-pocket health expenditure. As a coping strategy, borrowing and other distress sources were used in higher proportions by the rural population than their urban counterparts. Overall, our results demonstrated an alarming situation regarding health care financing in India.

Conclusion

Substantial investment in public health is needed, especially in rural areas as it is here that people are facing the real brunt of catastrophic OOP health expenditures in the form of impoverishment with more dependence on distress sources including borrowing and sale of assets as coping mechanisms.

     

Catastrophic household expenditure associated with out-of-pocket payments for dental healthcare in Spain

The European Journal of Health Economics - To estimate the prevalence of catastrophic health expenditure due to dental healthcare (CHED) in Spain, quantify its intensity and examine the related...     

Urban employee health insurance reform and the impact on out-of-pocket payment in China

Since the middle of the 1990s, China has undertaken a significant reform in urban employee health insurance programs. Using data from the pilot experiment conducted in Zhenjiang, this study examines changes in the pre- and post-reform distributions of out-of-pocket (OOP) expenditures across four representative groups by chronic disease, income, education, and job status. Major findings suggested increased OOP expenditures for all groups after the reform. However, the redistributions in OOP appear to be in favor of the disadvantaged groups, suggesting a more equitable change led by the reform. This study concludes that the post-reform insurance model did not compromise equity in cost-sharing while containing cost inflation and increasing insurance coverage for the urban population.     

Determinants of catastrophic healthcare expenditure in Peru

The aims of this study were to assess factors associated with catastrophic healthcare expenditure (CHE) and the burden of out-of-pocket (OOP) payments for specific healthcare services in Peru. We used data from 30,966 households that participated in the 2016 National Household Survey (Encuesta Nacional de Hogares, ENAHO). Participants reported household characteristics and expenditure on ten healthcare services. CHE was defined as healthcare spending equal to or higher than 40% of the household’s capacity to pay. The associations of various household characteristics and OOP payments for specific healthcare services with CHE were assessed in logistic regression models. Poorer, rural and smaller households as well as those with older adults and individuals with chronic conditions had greater odds of facing CHE. According to the estimates from the adjusted regression model, healthcare services could be grouped into three groups. Medical tests, surgery and medication were in the first group with odds ratios (ORs) between 6.43 and 4.72. Hospitalisation, outpatient, dental and eye care were in the second group with ORs between 2.61 and 1.46. Child care, maternity care and other healthcare services (such as contraceptives, rehabilitation, etc.) were in the third group with non-significant ORs. Many Peruvian households are forced to finance their healthcare through OOP payments, burdening their finances to the extent of affecting their living standards.     

全国卫生总费用实际使用法研究

按照实际使用法测算的卫生总费用是按卫生服务功能划分，测算全社会卫生服务消费在接受卫生机构提供的各种卫生保健服务过程中所支付的卫生费用总额，该重点介绍了卫生费用使用总额测算的目的，意义及其具体测算方法，并根据该方法测算了1992、1997，1998三年卫生总费用，对测算结果进行了初步分析，并提出了有关建议。     

Determinants of expenditure variation in health care and care of the elderly among finnish municipalities

In Finland, municipal health care expenditure varies from FIM 3 800 per capita to FIM 7 800 per capita. The objective of this study was to estimate the impact of different economic, structural and demographic factors on the per capita costs of health services and care of the elderly. Using regression analysis we attempted to explain observed differences in expenditure by determining separately the effects of allocative and productive inefficiency and the effects of factors influencing the demand for services. We found income level of local population, generosity of central government matching grant, allocative efficiency (the mix of care between institutional and non-institutional care), productive efficiency of service providers, and factors associated with the need of services (age structure, morbidity) to be the most important determinants of health care expenditure. Our results reveal that municipalities have the means at their disposal (by shifting resources to outpatient care and increasing productivity) to significantly reduce expenditure on health services and care of the elderly.     

我国老年人医疗卫生支出影响因素研究

目的:为完善老年人医疗保障体系提供政策建议。方法:基于Andersen医疗服务利用行为模型框架,利用中国健康与养老追踪调查2011年数据,建立我国老年人医疗卫生支出影响因素的Tobit模型。结果:需要因素中的自评健康状况与是否患有慢性病,能力因素中的医疗保险、养老保险与自评生活水平,以及倾向因素中的年龄、性别、婚姻状况和城乡身份显著影响我国老年人的医疗卫生支出。结论:建议按照"堵疏结合,区别对待"的原则,构建我国老年人医疗保障体系。     

我国政府卫生支出地区公平性研究

目的:本文从均等化的视角分析我国近年来政府卫生支出的地区差异及其变化。方法:计算近10年来各省间和东、中、西部地区政府卫生支出的基尼系数和泰尔指数,并分析历年变化及原因。结果:基尼系数从2003年的0.31下降至2013年的0.11;泰尔指数从2003年的0.027 0下降至2013年的0.000 4,其中2011年及2012年有所反弹。东部地区泰尔指数由正转为负,其优势逐渐转为劣势;中部地区泰尔指数为负值但向0靠近,处于劣势但有所改善;西部地区2006年以前泰尔指数为负,但2009年以后为正,其相对劣势逐渐转化为相对优势。结论:近年来由于公共卫生服务均等化政策实施,各省间政府卫生支出的整体公平性上升,东高、中低、西较低的格局有所变化。建议:中央财政转移支付应适当增加河北、山东、广东、湖南及河南等人口大省的政府公共卫生投入。     

中国糖尿病直接卫生费用研究

目的：测算我国的糖尿病直接卫生费用。方法：采用配比的病例对照方法，调查糖尿病人群和非糖尿病人群的人均直接卫生费用比值，标化后测算出我国2004年的糖尿病直接卫生费用。结果：每位糖尿病人年直接卫生费用是非糖尿病人的2，47倍；2004年我国糖尿病直接卫生费用约为574．69亿元，约占2004年全国卫生总费用的7．57％。结论：我国糖尿病直接卫生费用在国家卫生总费用中的比例已经接近发达国家水平，必须采取有效措施，减轻患者和社会的经济负担。     

2008年内蒙古居民现金卫生支出致贫及灾难性影响研究

2008年内蒙古居民个人卫生筹资136.41亿元,占卫生总费用的44.9%。全球经验表明,当居民现金卫生支出在卫生筹资中占主导地位时,贫困人群和脆弱人群不可能被卫生保健所覆盖,即使能够获得卫生服务,     

State health insurance and out-of-pocket health expenditures in Andhra Pradesh, India

In 2007 the state of Andhra Pradesh in southern India began rolling out Aarogyasri health insurance to reduce catastrophic health expenditures in households ??below the poverty line??. We exploit variation in program roll-out over time and districts to evaluate the impacts of the scheme using difference-in-differences. Our results suggest that within the first nine months of implementation Phase I of Aarogyasri significantly reduced out-of-pocket inpatient expenditures and, to a lesser extent, outpatient expenditures. These results are robust to checks using quantile regression and matching methods. No clear effects on catastrophic health expenditures or medical impoverishment are seen. Aarogyasri is not benefiting scheduled caste and scheduled tribe households as much as the rest of the population.