119 results on '"out of pocket"'
Search Results
2. Out- Of- Pocket health expenditure and household consumption patterns in Benin: Is there a crowding out effect?
- Author
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Hilaire Gbodja Houeninvo, Venant Cossi Celestin Quenum, and Melain Modeste Senou
- Subjects
Health shocks ,Consumption patterns ,Out of Pocket ,Crowding out effect ,SURE ,Benin ,Medicine (General) ,R5-920 - Abstract
Abstract Health shocks are common and have serious consequences for households in developing countries where health insurance is lacking. In this study, we examine whether out-of-pocket health expenditures crowd out household consumption of non-healthcare necessities, such as education items in Benin using a sample of 14,952 households from the global vulnerability and food security analysis survey. We estimated a system of conditional Engel curves with three stage least squared (3SLS) and seemingly unrelated regression (SURE) for seven categories of goods using the Quadratic Almost Ideal Demand System (QUAIDS) in the form of budget shares corresponding to proportions of total non-health expenditure. Findings show that out of pocket health expenditure leads households to spend more on health care that in fine crowd out expenditure in other necessity goods such as education item. These findings highlight the need for social protection programs to mitigate the impact of health shocks on vulnerable households in Benin.
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- 2023
- Full Text
- View/download PDF
3. AN EFFECTIVE HEALTH CARE SYSTEM THROUGH HEALTH TECHNOLOGY ASSESSMENT AND AN EVIDENCE BASED PAYMENT SYSTEM IN INDIA.
- Author
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Kumar, Arya, Mathur, Rajni, Shirmila, T., More, Rahul, Kaikini, Ravindra, and Bhalerao, Kuldeep
- Subjects
TECHNOLOGY assessment ,MEDICAL technology ,PAYMENT systems ,MEDICAL care ,MEDICAL care costs - Abstract
The purpose of this research is to discuss the significance of health care insurance compensation for obtaining comprehensive medical treatment in India. Through a systematic review survey focusi ng on the keywords like out-ofpocket, health technology assessment and health care system was conducted by searching Google Scholar, Science Direct, PubMed and ProQuest Database. It is observed that India ranks among the greatest out-of-pocket (OOP) healthcare expenditure across the globe. This seems to be notwithstanding the deployment of several public health plans and the provision of a significant variety of both private and public health coverage schemes. Decrease in the treatment quality across many healthcare institutions of government is a key cause causing the typical Indian individual to constantly rely on medical services provided by private firms, heading up OOP expenses. Among the most significant problems in implementing universal health care (UHC) in India is a poor acceptance of insurance products and awareness between many Indians. The burden of large OOP expenditures on people might be lessened by increasing medical insurance acceptance, which may be accomplished by enhancing India's medical claims system. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
4. Catastrophic pharmaceutical expenditure in patients with type 2 diabetes in Iran
- Author
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Leila Zarei, Najmeh Moradi, Farzad Peiravian, Nazafarin Hatami-Mazinani, Motahareh Mahi-Birjand, Jalal Arabloo, and Zaheer-Ud-Din Babar
- Subjects
Diabetes ,Catastrophic expenditures ,Medication ,Out of pocket ,Middle-income countries ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Objectives This study aimed to assess the financial burden of out-of-pocket (OOP) payments to purchase antidiabetic medicines for type 2 patients in Iran. Method The “budget share” and “capacity to pay” approaches were employed to assess the catastrophic pharmaceutical expenditures of antidiabetic medication therapies. The catastrophic thresholds were adjusted for pharmaceutical sectors. The data was 2019 monthly household expenditures in rural and urban areas, insurance coverages of antidiabetic medicines and patients' out-of-pocket (OOP) payments in 30-day treatment schedules. Results The results show that expenditure on diabetes medication therapies in the form of mono-dual therapy and some cases triple oral therapies were not catastrophic even for rural households. Insulin puts patients at risk of catastrophic pharmaceutical expenditures when added to the treatment schedules, and lack of financial protection intensifies it. In general, the poorer households and those resistant to first-line treatments were at increased risk of catastrophic pharmaceutical expenditures. The number of treatments that put patients at risk of catastrophic pharmaceutical expenditure in "budget share" was higher than the "capacity to pay" approach. Conclusions Assessing medication treatment affordability instead of a single medicine assessment is needed. Assessment could be done by utilizing a macro-level data approach and applying adjusted pharmaceutical sector threshold values. Considering the variation between treatment schedules that put patients at risk of catastrophic pharmaceutical expenditures, targeted pharmaceutical policies and reimbursement decisions are recommended to promote Universal Health Coverage (UHC) and to protect vulnerable populations from hardship.
- Published
- 2022
- Full Text
- View/download PDF
5. Financial costs of assisted reproductive technology for patients in low- and middle-income countries: a systematic review.
- Author
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Njagi, Purity, Groot, Wim, Arsenijevic, Jelena, Dyer, Silke, Mburu, Gitau, and Kiarie, James
- Subjects
REPRODUCTIVE technology ,MIDDLE-income countries - Published
- 2023
- Full Text
- View/download PDF
6. Out- Of- Pocket health expenditure and household consumption patterns in Benin: Is there a crowding out effect?
- Author
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Houeninvo, Hilaire Gbodja, Quenum, Venant Cossi Celestin, and Senou, Melain Modeste
- Subjects
CONSUMPTION (Economics) ,HOUSEHOLD budgets ,MEDICAL care costs ,SOCIAL services ,FOOD chemistry ,HEALTH insurance - Abstract
Health shocks are common and have serious consequences for households in developing countries where health insurance is lacking. In this study, we examine whether out-of-pocket health expenditures crowd out household consumption of non-healthcare necessities, such as education items in Benin using a sample of 14,952 households from the global vulnerability and food security analysis survey. We estimated a system of conditional Engel curves with three stage least squared (3SLS) and seemingly unrelated regression (SURE) for seven categories of goods using the Quadratic Almost Ideal Demand System (QUAIDS) in the form of budget shares corresponding to proportions of total non-health expenditure. Findings show that out of pocket health expenditure leads households to spend more on health care that in fine crowd out expenditure in other necessity goods such as education item. These findings highlight the need for social protection programs to mitigate the impact of health shocks on vulnerable households in Benin. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
7. Catastrophic pharmaceutical expenditure in patients with type 2 diabetes in Iran.
- Author
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Zarei, Leila, Moradi, Najmeh, Peiravian, Farzad, Hatami-Mazinani, Nazafarin, Mahi-Birjand, Motahareh, Arabloo, Jalal, and Babar, Zaheer-Ud-Din
- Subjects
- *
MIDDLE-income countries , *HYPOGLYCEMIC agents , *MEDICAL care costs , *TYPE 2 diabetes , *ECONOMICS , *HEALTH insurance reimbursement , *FINANCIAL stress , *LOW-income countries , *PHARMACEUTICAL industry , *ENDOWMENTS , *INSURANCE - Abstract
Objectives: This study aimed to assess the financial burden of out-of-pocket (OOP) payments to purchase antidiabetic medicines for type 2 patients in Iran. Method: The "budget share" and "capacity to pay" approaches were employed to assess the catastrophic pharmaceutical expenditures of antidiabetic medication therapies. The catastrophic thresholds were adjusted for pharmaceutical sectors. The data was 2019 monthly household expenditures in rural and urban areas, insurance coverages of antidiabetic medicines and patients' out-of-pocket (OOP) payments in 30-day treatment schedules. Results: The results show that expenditure on diabetes medication therapies in the form of mono-dual therapy and some cases triple oral therapies were not catastrophic even for rural households. Insulin puts patients at risk of catastrophic pharmaceutical expenditures when added to the treatment schedules, and lack of financial protection intensifies it. In general, the poorer households and those resistant to first-line treatments were at increased risk of catastrophic pharmaceutical expenditures. The number of treatments that put patients at risk of catastrophic pharmaceutical expenditure in "budget share" was higher than the "capacity to pay" approach. Conclusions: Assessing medication treatment affordability instead of a single medicine assessment is needed. Assessment could be done by utilizing a macro-level data approach and applying adjusted pharmaceutical sector threshold values. Considering the variation between treatment schedules that put patients at risk of catastrophic pharmaceutical expenditures, targeted pharmaceutical policies and reimbursement decisions are recommended to promote Universal Health Coverage (UHC) and to protect vulnerable populations from hardship. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
8. Catastrophic health expenditure due to hospitalisation for COVID-19 treatment in India: findings from a primary survey
- Author
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Samir Garg, Kirtti Kumar Bebarta, Narayan Tripathi, and C. Krishnendhu
- Subjects
Hospitalisation ,Expenditure ,Out of pocket ,Catastrophic expenditure ,Financial protection ,COVID-19 ,Medicine ,Biology (General) ,QH301-705.5 ,Science (General) ,Q1-390 - Abstract
Abstract Objective The COVID-19 pandemic has caused widespread illness and a significant proportion of the infected required hospitalisation for treatment. People in developing countries like India were vulnerable to high hospitalisation costs. Despite its crucial importance, few primary studies are available on this aspect of the pandemic. This study was aimed at finding out the out of pocket expenditure (OOPE) and incidence of catastrophic expenditure on hospitalisation of persons infected with COVID-19. A primary survey of 492 randomly selected hospitalisations of individuals tested positive for COVID-19 in high-burden districts during August to November 2020 was carried out telephonically in Chhattisgarh state of India. Results Public hospitals accounted for 69% of the hospitalisations for COVID-19 treatment. Mean OOPE per hospitalisation was Indian Rupees (INR) 4871 in public hospitals and INR 169,504 in private hospitals. Around 3% of hospitalisations in public hospitals and 59% in private hospitals resulted in catastrophic expenditure, at a threshold of 40% of non-food annual household expenditure. Enrolment under publicly or privately funded health insurance was not effective in curtailing OOPE. Multivariate analysis showed that utilisation of private hospitals was a key determinant of incurring catastrophic expenditure.
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- 2022
- Full Text
- View/download PDF
9. Interplay of disability, caregiver impact, and out-of-pocket expenditures in Duchenne muscular dystrophy: a cohort study
- Author
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Carolyn E. Schwartz, Roland B. Stark, Katrina Borowiec, Ivana F. Audhya, and Katherine L. Gooch
- Subjects
Muscular dystrophy ,Duchenne ,Caregivers ,Quality of life ,Disability ,Out of pocket ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Providing caregiving support to people with Duchenne muscular dystrophy (DMD) is challenging, beginning in early childhood, and continuing through the progression of multidimensional disability. This study addressed the interplay between caregiver impact, out-of-pocket expenditures, and DMD disability. To examine these interconnections, we investigated the association between caregiver impact domains and out-of-pocket expenditures; and the presence of clusters in caregivers on the basis of DMD-related disability domains in the patients for whom they provided caregiving support. Methods This web-based study recruited 566 DMD caregivers (140 males, 426 females; mean age 41.6 years, SD 8.8, range 21–72), examining caregiver impact using the DMD Caregiver Impact Measure, PROMIS-derived parent-proxy (PPP) measures of their child’s disability, and items tapping out-of-pocket expenditures related to home and vehicle accommodations and assistive devices. T-tests compared caregiver impact scores by out-of-pocket expenditures incurred. Latent Profile Analyses (LPA) were conducted to generate impact profiles related to child’s disability as reported by caregiver proxies. Results Higher out-of-pocket expenditures were generally associated with worse impact on the subscales, but several expenditures (e.g., kitchen, bathroom, scooter) were associated with lower impact. LPA indicated that the four-group solution provided the best relative fit and yielded good profile separation (entropy = 0.91). Caregivers with lowest impact reported the highest mobility, cognitive, and upper extremity functioning of their DMD care recipients, whereas the highest caregiver impact was driven by their care recipient’s negative affect and fatigue. The upper-middle impact group showed great variability in proxy-disability domains, whereas the lower-middle group had similar levels of disability across domains. Profiles were represented across all child ages. Conclusion Out-of-pocket expenditures were often associated with worse caregiver impact, but some associated with milder impact (i.e., bathroom or kitchen modification, investing in a ceiling lift or medical scooter). While their son’s level of disability and age were related to impact on the DMD caregiver, the domains giving rise to highest caregiver impact were not the most visible aspects of disability, such as mobility, but rather negative affect and fatigue. Other contextual attributes are likely implicated, and will be addressed in the companion paper.
- Published
- 2022
- Full Text
- View/download PDF
10. Comparing Catastrophic Costs: Active vs. Passive Tuberculosis Case Finding in Urban Vietnam
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Luong V. Dinh, Anja M. C. Wiemers, Rachel J. Forse, Yen T. H. Phan, Andrew J. Codlin, Kristi Sidney Annerstedt, Thuy T. T. Dong, Lan Nguyen, Thuong H. Pham, Lan H. Nguyen, Ha M. T. Dang, Mac H. Tuan, Phuc Thanh Le, Knut Lonnroth, Jacob Creswell, Amera Khan, Beatrice Kirubi, Hoa B. Nguyen, Nhung V. Nguyen, and Luan N. Q. Vo
- Subjects
active case finding ,social protection ,tuberculosis ,catastrophic cost ,out of pocket ,Medicine - Abstract
Active case finding (ACF) is a strategy that aims to identify people with tuberculosis (TB) earlier in their disease. This outreach approach may lead to a reduction in catastrophic cost incurrence (costs exceeding 20% of annual household income), a main target of WHO’s End TB Strategy. Our study assessed the socio-economic impact of ACF by comparing patient costs in actively and passively detected people with TB. Longitudinal patient cost surveys were prospectively fielded for people with drug-sensitive pulmonary TB, with 105 detected through ACF and 107 passively detected. Data were collected in four Vietnamese cities between October 2020 and March 2022. ACF reduced pre-treatment (USD 10 vs. 101, p < 0.001) and treatment costs (USD 888 vs. 1213, p < 0.001) in TB-affected individuals. Furthermore, it reduced the occurrence of job loss (15.2% vs. 35.5%, p = 0.001) and use of coping strategies (28.6% vs. 45.7%, p = 0.004). However, catastrophic cost incurrence was high at 52.8% and did not differ between cohorts. ACF did not significantly decrease indirect costs, the largest contributor to catastrophic costs. ACF reduces costs but cannot sufficiently reduce the risk of catastrophic costs. As income loss is the largest driver of costs during TB treatment, social protection schemes need to be expanded.
- Published
- 2023
- Full Text
- View/download PDF
11. Medication Discount Programs
- Author
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Ramachandran, Vignesh, Cline, Abigail Elizabeth, Feldman, Steven R., Bercovitch, Lionel, editor, Perlis, Clifford S., editor, Stoff, Benjamin K., editor, and Grant-Kels, Jane M., editor
- Published
- 2021
- Full Text
- View/download PDF
12. Strategies for reducing out of pocket payments in the health system: a scoping review
- Author
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Faride Sadat Jalali, Parisa Bikineh, and Sajad Delavari
- Subjects
OOP ,Out of pocket ,Health policy ,Health system ,Financing ,Scoping review ,Medicine (General) ,R5-920 - Abstract
Abstract Background Direct out-of-pocket payments (OOP) are among the most important financing mechanisms in many health systems, especially in developing countries, adversely affecting equality and leading vulnerable groups to poverty. Therefore, this scoping review study was conducted to identify the strategies involving OOP reduction in health systems. Methods Articles published in English on strategies related to out-of-pocket payments were Searched and retrieved in the Web of Science, Scopus, PubMed, and Embase databases between January 2000 and November 2020, following PRISMA guidelines. As a result, 3710 papers were retrieved initially, and 40 were selected for full-text assessment. Results Out of 40 papers included, 22 (55%) and 18 (45%) of the study were conducted in developing and developed countries, respectively. The strategies were divided into four categories based on health system functions: health system stewardship, creating resources, health financing mechanisms, and delivering health services.As well, developing and developed countries applied different types of strategies to reduce OOP. Conclusion The present review identified some strategies that affect the OOP payments According to the health system functions framework. Considering the importance of stewardship, creating resources, the health financing mechanisms, and delivering health services in reducing OOP, this study could help policymakers make better decisions for reducing OOP expenditures.
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- 2021
- Full Text
- View/download PDF
13. Effect of Out-of-Pocket Health Expenditure on Household Welfare: Evidence from Uganda National Household Survey: 2016-2017.
- Author
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Makika, Maya D., Matovu, Fred, Matovu, Wasswa, and Araya, Mesele
- Subjects
OUT of pocket medical costs ,PUBLIC welfare ,HOUSEHOLD surveys ,INSTRUMENTAL variables (Statistics) - Abstract
Out-of-Pocket health expenditures (OOP) in Uganda are increasingly rising due to the limited share of the national budget allocation to the health sector. Using Uganda National Household Survey data (UNHS) 2016/17, this study investigates the effect of OOP health expenditures on household welfare in Uganda. Due to the presence of endogeneity, the study employs a robust sampling instrumental variable technique to control for simultaneous causality between household welfare and the OOP health expenditure variable in the model. The findings show that a unit increase in OOP health expenditure reduces household food consumption expenditure by 9% and the household asset base by 2%, respectively. This study thus recommends the effective implementation of the Uganda National Health Insurance Scheme (NHIS), increased investment in preventive care services, and promotion of activities aimed at empowering health beneficiaries in Uganda to improve [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
14. Out-Of-Pocket Expenditure Associated with Physical Inactivity, Excessive Weight, and Obesity in China: Quantile Regression Approach.
- Author
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Zhao, Yang, He, Li, Marthias, Tiara, Ishida, Marie, Anindya, Kanya, Desloge, Allissa, D'Souza, Monique, Cao, Gaofang, and Lee, John Tayu
- Subjects
SEDENTARY behavior ,QUANTILE regression ,HEALTH behavior ,OBESITY ,BODY weight - Abstract
Introduction: Previous studies exploring associations of physical inactivity, obesity, and out-of-pocket expenditure (OOPE) mainly used traditional linear regression, and little is known about the effect of both physical inactivity and obesity on OOPE across the percentile distribution. This study aims to assess the effects of physical inactivity and obesity on OOPE in China using a quantile regression approach. Methods: Study participants included 10,687 respondents aged 45 years and older from the recent wave of the China Health and Retirement Longitudinal Study in 2015. Linear regression and quantile regression models were used to examine the association of physical activity, body weight with annual OOPE. Results: Overall, the proportion of overweight and obesity was 33.2% and 5.8%, respectively. The proportion of individuals performing high-level, moderate-level, and low-level physical activity was 55.2%, 12.7%, and 32.1%, respectively. The effects of low-level physical activity on annual OOPE were small at the bottom quantiles but more pronounced at higher quantiles. Respondents with low-level activity had an increased annual OOPE of 26.9 USD, 150.3 USD, and 1,534.4 USD, at the 10th, 50th, and 90th percentiles, respectively, compared with those with high-level activity. The effects of overweight and obesity on OOPE were also small at the bottom quantiles but more pronounced at higher quantiles. Conclusion: Interventions that improve the lifestyles and unhealthy behaviors among people with obesity and physical inactivity are likely to yield substantial financial gains for the individual and health systems in China. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
15. Interplay of disability, caregiver impact, and out-of-pocket expenditures in Duchenne muscular dystrophy: a cohort study.
- Author
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Schwartz, Carolyn E., Stark, Roland B., Borowiec, Katrina, Audhya, Ivana F., and Gooch, Katherine L.
- Subjects
CAREGIVERS ,SOCIAL support ,MEDICAL care costs ,DUCHENNE muscular dystrophy ,T-test (Statistics) ,DESCRIPTIVE statistics ,RESEARCH funding ,LONGITUDINAL method ,LATENT structure analysis - Abstract
Background: Providing caregiving support to people with Duchenne muscular dystrophy (DMD) is challenging, beginning in early childhood, and continuing through the progression of multidimensional disability. This study addressed the interplay between caregiver impact, out-of-pocket expenditures, and DMD disability. To examine these interconnections, we investigated the association between caregiver impact domains and out-of-pocket expenditures; and the presence of clusters in caregivers on the basis of DMD-related disability domains in the patients for whom they provided caregiving support. Methods: This web-based study recruited 566 DMD caregivers (140 males, 426 females; mean age 41.6 years, SD 8.8, range 21–72), examining caregiver impact using the DMD Caregiver Impact Measure, PROMIS-derived parent-proxy (PPP) measures of their child's disability, and items tapping out-of-pocket expenditures related to home and vehicle accommodations and assistive devices. T-tests compared caregiver impact scores by out-of-pocket expenditures incurred. Latent Profile Analyses (LPA) were conducted to generate impact profiles related to child's disability as reported by caregiver proxies. Results: Higher out-of-pocket expenditures were generally associated with worse impact on the subscales, but several expenditures (e.g., kitchen, bathroom, scooter) were associated with lower impact. LPA indicated that the four-group solution provided the best relative fit and yielded good profile separation (entropy = 0.91). Caregivers with lowest impact reported the highest mobility, cognitive, and upper extremity functioning of their DMD care recipients, whereas the highest caregiver impact was driven by their care recipient's negative affect and fatigue. The upper-middle impact group showed great variability in proxy-disability domains, whereas the lower-middle group had similar levels of disability across domains. Profiles were represented across all child ages. Conclusion: Out-of-pocket expenditures were often associated with worse caregiver impact, but some associated with milder impact (i.e., bathroom or kitchen modification, investing in a ceiling lift or medical scooter). While their son's level of disability and age were related to impact on the DMD caregiver, the domains giving rise to highest caregiver impact were not the most visible aspects of disability, such as mobility, but rather negative affect and fatigue. Other contextual attributes are likely implicated, and will be addressed in the companion paper. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
16. National sample surveys show poor households face catastrophic expenditure for oral healthcare services in India
- Author
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Banuru Muralidhara Prasad, Jaya Prasad Tripathy, Om Prakash Bera, and Namita Shanbhag
- Subjects
catastrophe ,healthcare expenditure ,oral healthcare ,out of pocket ,Medicine - Abstract
Introduction: Globally people pay out-of-pocket (OOP) to access Oral healthcare services. In India, there is limited evidence on estimates of OOP expenditure. We undertook an analysis of national sample survey data on household health care expenditure to understand the expenditure pattern for Oral healthcare services and the catastrophic burden. Method: The expenditure reported for Oral healthcare services from two surveys: 71st round and 75th round, published by National Sample Survey Office (NSSO) was extracted. Based on monthly household consumption expenditure three economic groups were made: poor, middle- and rich-income groups. The OOP expenditure pattern while accessing day-care services and hospitalization and in public and private sector and the catastrophic expenditure were analysed. Results: A total of 204 and 155 households from two national surveys reported to have accessed day-care Oral services respectively. The median OOP expenditure in public sector remained same at US $ 4 in both surveys. Over 35% of 78 households in 71st round and 42% of 167 in 75th round used public sector hospitalization services. The median expenditure of hospitalization doubled from US$ 58 (IQR 21–263) in 71st round to US $ 125 (IQR 45-363) in 75th round. Households from poor income groups spent seven times more for Oral healthcare services during the recent survey and faced catastrophic expenditure. Conclusion: The OOP expenditure for Oral healthcare has significant catastrophic household expenditure among the poor. There is a need to increase investment in public sector and insurance to protect poor against hospitalization expenditure in private sector.
- Published
- 2021
- Full Text
- View/download PDF
17. Receipt of and Spending on Cessation Medication Among US Adults With Employer-Sponsored Health Insurance, 2010 and 2017.
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Shrestha, Sundar S., Xu, Xin, Wang, Xu, Babb, Stephen D., Armour, Brian S., King, Brian A., and Trivers, Katrina F.
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- *
EMPLOYER-sponsored health insurance , *MEDICAL care costs , *REGRESSION analysis , *DESCRIPTIVE statistics , *SMOKING , *SMOKING cessation products , *ADULTS - Abstract
Objective: Studies examining the use of smoking cessation treatment and related spending among enrollees with employer-sponsored health insurance are dated and limited in scope. We assessed changes in annual receipt of and spending on cessation medications approved by the US Food and Drug Administration (FDA) among tobacco users with employer-sponsored health insurance from 2010 to 2017. Methods: We analyzed data on 439 865 adult tobacco users in 2010 and 344 567 adult tobacco users in 2017 from the IBM MarketScan Commercial Database. We used a negative binomial regression to estimate changes in receipt of cessation medication (number of fills and refills and days of supply). We used a generalized linear model to estimate spending (total, employers', and out of pocket). In both models, covariates included year, age, sex, residence, and type of health insurance plan. Results: From 2010 to 2017, the percentage of adult tobacco users with employer-sponsored health insurance who received any cessation medication increased by 2.4%, from 15.7% to 16.1% (P <.001). Annual average number of fills and refills per user increased by 15.1%, from 2.5 to 2.9 (P <.001) and days of supply increased by 26.4%, from 81.9 to 103.5 (P <.001). The total annual average spending per user increased by 53.6%, from $286.40 to $440.00 (P <.001). Annual average out-of-pocket spending per user decreased by 70.9%, from $70.80 to $20.60 (P <.001). Conclusions: Use of smoking cessation medications is low among smokers covered by employer-sponsored health insurance. Opportunities exist to further increase the use of cessation medications by promoting the use of evidence-based cessation treatments and reducing barriers to coverage, including out-of-pocket costs. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
18. Determination of Catastrophic Health Expenditures among Elderly People in Iran
- Author
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Sara Emamgholipour, Vahid Saberzadeh, and Hossein Dargahi
- Subjects
catastrophic health expenditure ,income deciles ,employment ,out of pocket ,elderly ,Public aspects of medicine ,RA1-1270 - Abstract
Background and Aim: Given the rising trend of ageing and the vulnerability of the aged group to diseases and health costs, it is important to determine the exposure of elderly households to the burdensome costs of health. Materials and Methods: The incidence and severity of elderly costs at provincial level and income quintiles were calculated; besides, chi-square test was used to determine the relationship between household socioeconomic variables and exposure levels. The sample included 9103 elderly people aged 65 and over, and the data of their own and their households were extracted from the statistical center in 2016. Data analysis was performed using SPSS16 software. Results: The exposure rate of households with rural elderly people (9.74%) was higher than urban ones (6.2%), and the intensity of exposure was higher in rural areas than urban. In both groups, the highest exposure was in the second and the lowest in the fifth quintiles. The elderly households in Hormozgan province had the highest and in Kohgiluyeh and Boyer-Ahmad had the lowest exposure. Number of elderly people in family, place of residence, employment status, household dimension, costs of chemotherapy, addiction abandonment, orthopedics, special medications, household spending and out-of-pocket payment for health services were significantly correlated with exposure. However, elderly personchr('39')s literacy, insurance, marital status and the presence of persons under 12 years in the family did not show a significant relationship with the amount of exposure. Conclusion: The exposure rate and its intensity is higher among rural elderly people than urban ones, and the exposure of poorer elderly people is higher; these points indicate that the distribution of financial resources in the health system is not fair and requires purposeful policymaking decisions for these groups.
- Published
- 2020
19. Trends in cost-sharing and cancer treatment modality utilization among commercially insured patients with gastrointestinal cancer.
- Author
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Katayama ES, Woldesenbet S, and Pawlik TM
- Subjects
- Humans, United States, Male, Female, Middle Aged, Gastrointestinal Neoplasms therapy, Gastrointestinal Neoplasms economics, Cost Sharing, Insurance, Health statistics & numerical data, Insurance, Health economics
- Published
- 2024
- Full Text
- View/download PDF
20. Strategies for reducing out of pocket payments in the health system: a scoping review.
- Author
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Jalali, Faride Sadat, Bikineh, Parisa, and Delavari, Sajad
- Subjects
- *
MEDICAL economics , *HEALTH policy , *ONLINE information services , *MEDICAL information storage & retrieval systems , *SYSTEMATIC reviews , *MEDICAL care costs , *COST control , *MEDICAL care , *DESCRIPTIVE statistics , *LITERATURE reviews , *MEDLINE , *POLICY sciences , *HEALTH care rationing - Abstract
Background: Direct out-of-pocket payments (OOP) are among the most important financing mechanisms in many health systems, especially in developing countries, adversely affecting equality and leading vulnerable groups to poverty. Therefore, this scoping review study was conducted to identify the strategies involving OOP reduction in health systems. Methods: Articles published in English on strategies related to out-of-pocket payments were Searched and retrieved in the Web of Science, Scopus, PubMed, and Embase databases between January 2000 and November 2020, following PRISMA guidelines. As a result, 3710 papers were retrieved initially, and 40 were selected for full-text assessment. Results: Out of 40 papers included, 22 (55%) and 18 (45%) of the study were conducted in developing and developed countries, respectively. The strategies were divided into four categories based on health system functions: health system stewardship, creating resources, health financing mechanisms, and delivering health services.As well, developing and developed countries applied different types of strategies to reduce OOP. Conclusion: The present review identified some strategies that affect the OOP payments According to the health system functions framework. Considering the importance of stewardship, creating resources, the health financing mechanisms, and delivering health services in reducing OOP, this study could help policymakers make better decisions for reducing OOP expenditures. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
21. National sample surveys show poor households face catastrophic expenditure for oral healthcare services in India.
- Author
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Prasad, Banuru, Tripathy, Jaya, Bera, Om, and Shanbhag, Namita
- Subjects
- *
CONSUMPTION (Economics) , *HOUSEHOLDS , *MEDICAL care costs , *PUBLIC spending , *PUBLIC sector , *PUBLIC investments - Abstract
Introduction: Globally people pay out-of-pocket (OOP) to access Oral healthcare services. In India, there is limited evidence on estimates of OOP expenditure. We undertook an analysis of national sample survey data on household health care expenditure to understand the expenditure pattern for Oral healthcare services and the catastrophic burden. Method: The expenditure reported for Oral healthcare services from two surveys: 71st round and 75th round, published by National Sample Survey Office (NSSO) was extracted. Based on monthly household consumption expenditure three economic groups were made: poor, middle- and rich-income groups. The OOP expenditure pattern while accessing day-care services and hospitalization and in public and private sector and the catastrophic expenditure were analysed. Results: A total of 204 and 155 households from two national surveys reported to have accessed day-care Oral services respectively. The median OOP expenditure in public sector remained same at US $ 4 in both surveys. Over 35% of 78 households in 71st round and 42% of 167 in 75th round used public sector hospitalization services. The median expenditure of hospitalization doubled from US$ 58 (IQR 21–263) in 71st round to US $ 125 (IQR 45-363) in 75th round. Households from poor income groups spent seven times more for Oral healthcare services during the recent survey and faced catastrophic expenditure. Conclusion: The OOP expenditure for Oral healthcare has significant catastrophic household expenditure among the poor. There is a need to increase investment in public sector and insurance to protect poor against hospitalization expenditure in private sector. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
22. HEALTH INSURANCE AND DETERMINANT OF INPATIENT OUT OF POCKET HEALTH EXPENDITURE IN INDIA.
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KHAN, MOHAMMAD KASHIF
- Subjects
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HEALTH insurance , *GOVERNMENT insurance , *FINANCIAL planning - Abstract
This paper examines the effect of health insurance on out of pocket (OOP) health expenditure and determinant of the OOP health expenditure in India, using the 71st round of NSSO national representative from India on Social Consumption: Health. This study uses the multivariate regression model to analyse the determinant of OOP health expenditure. The study found that the coverage of government-provided health insurance is higher than private health insurance. Moreover, the study further reveals that average OOP is lower among patient with insurance in general and particularly the lowest among the government covered insurance inpatient. Finally, the study conclude that health insurance had reduced the OOP inpatient health expenditure in India. Last, study found that patients with household arrange health insurance have lowest OOP health expenditure as compared to patients without health insurance. [ABSTRACT FROM AUTHOR]
- Published
- 2021
23. Prediction of out-of-pocket health expenditures in Rwanda using machine learning techniques
- Author
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Roger Muremyi, Haughton Dominique, Kabano Ignace, and Francois Niragire
- Subjects
mars ,out of pocket ,rwanda ,validation ,accuracy ,training ,testing ,Medicine - Abstract
INTRODUCTION: in Rwanda, the estimated out of pocket health expenditure has been increased from 24.46% in 2000 to 26% in 2015. Despite the existence of guideline in estimation of out of pocket health expenditures provided by WHO (2018), the estimation of out of pocket health expenditure still have difficulties in many countries. METHODS: the purpose of this paper was to figure out the best model which predict the out of pocket health expenditures in Rwanda during the process of considering various techniques of machine learning by using the Rwanda Integrated Living Conditions Surveys (EICV5) of 14580 households (2018). RESULTS: our findings presented the models which predict the out of pocket health expenditures with higher accuracy. Furthermore, machine learning techniques were used to judge which predictor variable was important in our prediction process and comparison of the performance of the algorithms through train accuracy and test accuracy metric measures. Finally, the findings show that the tests of accuracy of the models were 50.16% for MARS model, 74% decision tree model, 87% for treenet model, 83% for random forest model, gradient boosting 81% predictor total consumption played a significant role in the model for all tested models. CONCLUSION: finally, we conclude that the total consumption of the household came out to be the most important variable which is consistently true to all the algorithms tested. The findings from our study have policy implications for policy makers in Rwanda and in the world generally. We recommend the government to significantly increase public spending on health. Domestic financial resources are key to moving closer to universal health coverage (UHC) and should be increased on a long-term basis. In addition, these results will be useful for the future to assess the out of pocket health expenditures dataset.
- Published
- 2020
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24. Evaluating the health system financing of the Eastern Mediterranean Region (EMR) countries using Grey Relation Analysis and Shannon Entropy
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Kimia Pourmohammadi, Payam Shojaei, Hamed Rahimi, and Peivand Bastani
- Subjects
Health financing ,Expenditure ,Out of Pocket ,Eastern Mediterranean Region ,Grey Relation Analysis ,Medicine (General) ,R5-920 - Abstract
Abstract Background Sufficient and sustainable financing of the health system is essential for improving the health of the community. The health systems financing of the EMR countries is facing the challenge. Assessment and ranking of healthcare financing can help identify and resolve some challenges of health systems. So, the aim of this study is to evaluate and rank the condition of the health sector financing in the EMR countries. Methods This study was a cross-sectional study. The data was of secondary type, extracted from the official WHO and World Bank data. The six healthcare financing indicators in a 10-year interval (2005–2014) in 19 EMR countries analyzed using Grey Relation Analysis and Shannon Entropy. Results On average, the countries in the EMR region spent 4.87% of their GDP on the health sector. Jordan and Qatar allocated the highest (8.313) and the lowest (2.293) percentages of their GDP to the health sector, respectively. The results showed That Qatar was in a better condition than other EMR countries during 2005–2014 in terms of the health system financing and earned the first rank. After that, the UAE and Kuwait were ranked second and third. Conclusions There is a lot of inequality among the EMR countries in terms of health financing. However, our findings confirmed that only increasing the total health expenditure in a country would not improve its financing status compared to other countries, but it also depends on financing methods.
- Published
- 2018
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25. Association between Pilot Urban Family Physician Program and Health Financial Protection Measures in Fars and Mazandaran Provinces
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V Yazdi Feyzabadi, MH Mehrolhasani, MR Baneshi, S Mirzaei, and N Oroomiei
- Subjects
urban family physician ,financial protection ,out of pocket ,catastrophic expenditures ,iran ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Background and Objectives: Urban family physician program(UFPP), a program for improving equity in access to, financing, and quality of health services, is piloting in two provinces of Fars and Mazandaran, Iran since 2012. This study aimed to examine the association between the implementation of program and financial protection measures. Methods: This cross-sectional, ecological study was performed on aggregated data of financial protection measures and some independent variables in the above provinces from 2008 to 2015. At first, the Lasso regression model was used for selecting independent variables affecting financial protection indexes. After adjusting the selected independent variables, in separate models, the association between the UFPP and financial protection measures, as outcome variables, was examined using a backward linear regression model. Results: The percentage of households facing catastrophic health expenditure(CHE) in the years of UFPP implementation was 1.82% higher than the years before implementation(P0.05). Conclusion: Despite the achievements attained by UFPP in improving physical access to health services, it seems that this program has had no success in improving financial protection measures and equitable health care financing. However, further research is warranted in this regard.
- Published
- 2018
26. Investigating the Effectiveness of the Health Services Relative Value Implementation on Out of Pocket Payment of Insured People Covered by the Health Insurance Organization in Selected Hospitals of Bushehr Province in 2014
- Author
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Houshang Golzar, Saeid Tahmasebi, and Morad Alizadeh
- Subjects
Relative value ,Health cost ,Out of pocket ,Boushehr ,Medicine (General) ,R5-920 - Abstract
Background: Most of the reforms that have taken place in world health systems are aimed at increasing the efficiency, quality, and control of costs. By implementing the health system reform plan, the actual plan of medical services tariffs by communicating the relative value of health services instruction on October 2014 was started. One of the most important goals of the reform plan was to reduce out of pocket payment. This study was conducted to determine the amount of out of pocket payment of insured people covered by the health insurance organization in the selected hospitals in Bushehr province. Methods: The present analytical study was conducted on insured people hospitalization cases of health insurance organization in selected hospitals affiliated to Bushehr University of Medical Sciences (Persian Gulf Martyrs Hospital, Shahid Ganji Hospital) in July, August, January, and February 2014 as the statistical population and the most common services used as the statistical sample. The data were collected using a researcher-made checklist and investigating the hospital records coded and analyzed by SPSS 20 software. Results: According to the results of the study, the average cost of the patient's share was 1050835 Rials in July, August to 611631 Rials in January, and February, which decreased by 42.00 %. The results of the study show that by implementing the relative value of services instruction, the share of the health insurance organization increased from 79.00 % to 84.00 % and the share of the patient's payments decreased from 8.00 % to 4.00 %. Conclusion: The results of the study show that the government has been able to achieve one of the goals of the health reform plan, which is reducing the out of pocket payment, by increasing health resources.
- Published
- 2018
27. The hospital-based socioeconomic study to assess the financial toxicity among cancer survivors.
- Author
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Pandey, Awadhesh, Vias, Poorva, Mangwana, Suraj, Kaur, Snehpreet, Dimri, Kislay, and Walia, Dinesh
- Subjects
- *
CANCER survivors , *MEDICAL economics , *INCOME , *CHI-squared test ,DEVELOPING countries - Abstract
Background: Cancer forms the second-most common cause of death worldwide. Once a patient is diagnosed with cancer, socioeconomic life of the patient is altogether changed. In developing countries, like India, as the prevalence of cancer is increasing, policies and schemes need to be incorporated to overcome the financial burden of disease. This study was aimed to know the socioeconomic burden of cancer in our country, so as to further improve the health economics. Materials and Methods: This was a prospective study done over a period of 2 years. Three thousand and twelve patients were enrolled in this study that was diagnosed with cancer on biopsy. Interview method with the help of semistructured questionnaire was used to collect the data, and IBM SPSS statistics version 20 was used to analyze this data. The Chi-square test and t-test were applied to look for correlation. Results: Three thousand and twelve patients participated in the study, and out of them, 73% of the patients were in the fourth to sixth decades. Fifty-seven percent of patients had total family income of <10,000 and when per capita income was calculated about 93% of patients had income <10,000/year. Forty-seven percent of the patients had lost fifty thousand to one lac rupees during treatment, and 73% of the patients did not receive any help from the government and were not covered under any insurance. Conclusion: Cancer is a tragic state of illness and affects generations of the patient socioeconomically in a country like India. Most of the population has to spend out-of-pocket expenditure on cancer treatment, and thus, it causes financial catastrophe on the households. Refinement of the health policies is required in concern with cancer to improve the cancer survival and to protect the families from financial hardships. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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28. تعیین میزان مواجه هی سالمندان با هزین ههای کمرشکن سلامت در ایران
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سارا امامقلی پور, وحید صابرزاده, and حسین درگاهی
- Abstract
Background and Aim: Given the rising trend of ageing and the vulnerability of the aged group to diseases and health costs, it is important to determine the exposure of elderly households to the burdensome costs of health. Materials and Methods: The incidence and severity of elderly costs at provincial level and income quintiles were calculated; besides, chi-square test was used to determine the relationship between household socioeconomic variables and exposure levels. The sample included 9103 elderly people aged 65 and over, and the data of their own and their households were extracted from the statistical center in 2016. Data analysis was performed using SPSS16 software. Results: The exposure rate of households with rural elderly people(9.74%) was higher than urban ones(6.2%), and the intensity of exposure was higher in rural areas than urban. In both groups, the highest exposure was in the second and the lowest in the fifth quintiles. The elderly households in Hormozgan province had the highest and in Kohgiluyeh and Boyer-Ahmad had the lowest exposure. Number of elderly people in family, place of residence, employment status, household dimension, costs of chemotherapy, addiction abandonment, orthopedics, special medications, household spending and out-of-pocket payment for health services were significantly correlated with exposure. However, elderly person's literacy, insurance, marital status and the presence of persons under 12 years in the family did not show a significant relationship with the amount of exposure. Conclusion: The exposure rate and its intensity is higher among rural elderly people than urban ones, and the exposure of poorer elderly people is higher; these points indicate that the distribution of financial resources in the health system is not fair and requires purposeful policymaking decisions for these groups. [ABSTRACT FROM AUTHOR]
- Published
- 2020
29. Is universal and uniform health insurance better for China? Evidence from the perspective of supply-induced demand.
- Author
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Yu, Jianxing, Qiu, Yue, and He, Ziying
- Abstract
China has achieved nearly universal social health insurance (SHI) coverage by implementing three statutory schemes, but gaps and differences in benefit levels are apparent. There is wide agreement that China should merge the three schemes into a universal and uniform SHI. However, data on the medical expenses of all inpatients in 2014 at a public Tier-three hospital suggests that supply-induced demand (SID) is a serious concern and that, under the design of the current schemes, a higher benefit level has a greater impact on the total expenses of insured patients. Thus, if SID is not effectively controlled, a universal and uniform SHI may be more harmful than beneficial in China. Finally, we suggest that China should substitute the existing fee-for-service design with a suite of bundled provider payment methods; furthermore, China should replace its current system of pricing drugs that encourages hospitals and doctors to use costlier medications. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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30. Catastrophic health expenditure due to hospitalisation for COVID-19 treatment in India: findings from a primary survey
- Author
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Garg, Samir, Bebarta, Kirtti Kumar, Tripathi, Narayan, and Krishnendhu, C.
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- 2022
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31. Estimation of Out-of-Pocket and Catastrophic Expenditures among Patients with Cardiovascular Diseases in Khuzestan
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Sara Emamgholipour, Ali Akbari Sari, Sara Geravandi, and Hoda Mazrae
- Subjects
out of pocket ,catastrophic expenditures ,logit model ,cardiovascular disease ,Public aspects of medicine ,RA1-1270 - Abstract
Background and Aim: The World Health Organization (WHO) has placed special emphasis on the protection of families against the costs of health services. Patients suffer not only from the burden of a disease, but also from the burden of their health costs. The aim of this study was to estimate out-of-pocket costs and to identify the factors that affect catastrophic expenditures among patients with cardiovascular diseases in Khuzestan Province. Materials and Methods: In this descriptive-analytic study, 100 cardiovascular patients having referred to educational hospitals in Ahwaz, Khuzestan Province, were considered. Out-of-pocket costs were estimated and using Econometrics Logit model, factors affecting catastrophic expenditures among households were identified. All analyses were performed using SPSS and Stata. Results: The average out-of-pocket cost was 16,008,936 rials per patient during one year. Also, 55% of patients faced with catastrophic expenditures. Income level and family size had a significant negative impact; however, patients’ employment status had a positive but insignificant effect on catastrophic expenditures. Conclusion: Hospital inpatient expenses and drug costs cover most of out-of-pocket expenditures and should be considered by policymakers. By increasing the income level and family size, families will encounter catastrophic expenditures less. The out-of-pocket costs among patients with cardiovascular diseases can be reduced by boosting the insurance coverage and government help.
- Published
- 2017
32. Contribution of household health care expenditure to poverty in Oyo State, South West Nigeria: A rural and urban comparison
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Olayinka Stephen Ilesanmi, Akindele Olupelumi Adebiyi, and Akinola Ayoola Fatiregun
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Cost ,Out of Pocket ,Poverty ,Expenditure ,Business ,HF5001-6182 - Abstract
Introduction: The financial burden of health care costs in Nigeria is borne almost entirely by the individuals and household members as health care financing is still mostly from out of pocket (OOP) payments. OOP payments can lead households into poverty. This study aimed to estimate the contribution of household health care expenditure to poverty in rural and urban communities in Oyo state, Nigeria. Method: This is a comparative cross-sectional study using a tested and adapted version of the Living Standard Survey questionnaire to collect data on 5,696 household members from 1,434 household representatives. Representatives were selected using a multistage sampling method. Information was collected from 714(49.8%) and 720(50.2%) households in the urban and rural Local Government Area (LGA), respectively. International poverty line of $1.25 per day was used. Poverty level was measured with and without household health expenditure. An exact McNemar’s test was used to determine the difference in the proportion of poor, gross and net payment for health care services. SPSS software was used for data analysis. Results: Health care was utilised by 1,006 (70.2%) of the 1,434 households studied. Of urban and rural households, 637(89.2%) and 369(51.3%) utilized health care services, respectively. Only 513(29.8%) were poor while 1519(88.2%) were poor after considering the cost of utilising health care. Increase in poverty of 66.2% occurred because of health care utilisation (p
- Published
- 2017
33. Some Laws Should Be Forgotten to History.
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- *
MEDICAL care costs , *INSURANCE costs - Published
- 2024
34. Financial costs of assisted reproductive technology for patients in low- and middle-income countries: a systematic review
- Subjects
INFERTILITY CARE ,CONSEQUENCES ,out of pocket ,WOMEN ,PUBLIC-HEALTH SECTOR ,EMBRYO-TRANSFER ,SERVICES ,SOUTH-AFRICA ,ECONOMIC-IMPACT ,medical costs ,systematic review ,assisted reproductive technology ,IVF ,low- and middle-income countries ,infertility ,ACCESS ,in vitro fertilization - Abstract
STUDY QUESTION What are the direct costs of assisted reproductive technology (ART), and how affordable is it for patients in low- and middle-income countries (LMICS)? SUMMARY ANSWER Direct medical costs paid by patients for infertility treatment are significantly higher than annual average income and GDP per capita, pointing to unaffordability and the risk of catastrophic expenditure for those in need. WHAT IS KNOWN ALREADY Infertility treatment is largely inaccessible to many people in LMICs. Our analysis shows that no study in LMICs has previously compared ART medical costs across countries in international dollar terms (US$PPP) or correlated the medical costs with economic indicators, financing mechanisms, and policy regulations. Previous systematic reviews on costs have been limited to high-income countries while those in LMICs have only focussed on descriptive analyses of these costs. STUDY DESIGN, SIZE, DURATION Guided by the preferred reporting items for systematic reviews and meta-analyses (PRISMA), we searched PubMed, Web of Science, Cumulative Index of Nursing and Allied Health Literature, EconLit, PsycINFO, Latin American & Caribbean Health Sciences Literature, and grey literature for studies published in all languages from LMICs between 2001 and 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS The primary outcome of interest was direct medical costs paid by patients for one ART cycle. To gauge ART affordability, direct medical costs were correlated with the GDP per capita or average income of respective countries. ART regulations and public financing mechanisms were analyzed to provide information on the healthcare contexts in the countries. The quality of included studies was assessed using the Integrated Quality Criteria for Review of Multiple Study designs. MAIN RESULTS AND THE ROLE OF CHANCE Of the 4062 studies identified, 26 studies from 17 countries met the inclusion criteria. There were wide disparities across countries in the direct medical costs paid by patients for ART ranging from USD2109 to USD18 592. Relative ART costs and GDP per capita showed a negative correlation, with the costs in Africa and South-East Asia being on average up to 200% of the GDP per capita. Lower relative costs in the Americas and the Eastern Mediterranean regions were associated with the presence of ART regulations and government financing mechanisms. LIMITATIONS, REASONS FOR CAUTION Several included studies were not primarily designed to examine the cost of ART and thus lacked comprehensive details of the costs. However, a sensitivity analysis showed that exclusion of studies with below the minimum quality score did not change the conclusions on the outcome of interest. WIDER IMPLICATIONS OF THE FINDINGS Governments in LMICs should devise appropriate ART regulatory policies and implement effective mechanisms for public financing of fertility care to improve equity in access. The findings of this review should inform advocacy for ART regulatory frameworks in LMICs and the integration of infertility treatment as an essential service under universal health coverage. STUDY FUNDING/COMPETING INTEREST(S) This work received funding from the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by the World Health Organization (WHO). The authors declare no competing interests.
- Published
- 2023
35. Financial costs of assisted reproductive technology for patients in low- and middle-income countries: a systematic review
- Author
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Purity Njagi, Wim Groot, Jelena Arsenijevic, Silke Dyer, Gitau Mburu, and James Kiarie
- Subjects
INFERTILITY CARE ,CONSEQUENCES ,out of pocket ,WOMEN ,PUBLIC-HEALTH SECTOR ,General Medicine ,EMBRYO-TRANSFER ,SERVICES ,SOUTH-AFRICA ,ECONOMIC-IMPACT ,medical costs ,systematic review ,assisted reproductive technology ,IVF ,low- and middle-income countries ,infertility ,ACCESS ,in vitro fertilization - Abstract
STUDY QUESTIONWhat are the direct costs of assisted reproductive technology (ART), and how affordable is it for patients in low- and middle-income countries (LMICS)?SUMMARY ANSWERDirect medical costs paid by patients for infertility treatment are significantly higher than annual average income and GDP per capita, pointing to unaffordability and the risk of catastrophic expenditure for those in need.WHAT IS KNOWN ALREADYInfertility treatment is largely inaccessible to many people in LMICs. Our analysis shows that no study in LMICs has previously compared ART medical costs across countries in international dollar terms (US$PPP) or correlated the medical costs with economic indicators, financing mechanisms, and policy regulations. Previous systematic reviews on costs have been limited to high-income countries while those in LMICs have only focussed on descriptive analyses of these costs.STUDY DESIGN, SIZE, DURATIONGuided by the preferred reporting items for systematic reviews and meta-analyses (PRISMA), we searched PubMed, Web of Science, Cumulative Index of Nursing and Allied Health Literature, EconLit, PsycINFO, Latin American & Caribbean Health Sciences Literature, and grey literature for studies published in all languages from LMICs between 2001 and 2020.PARTICIPANTS/MATERIALS, SETTING, METHODSThe primary outcome of interest was direct medical costs paid by patients for one ART cycle. To gauge ART affordability, direct medical costs were correlated with the GDP per capita or average income of respective countries. ART regulations and public financing mechanisms were analyzed to provide information on the healthcare contexts in the countries. The quality of included studies was assessed using the Integrated Quality Criteria for Review of Multiple Study designs.MAIN RESULTS AND THE ROLE OF CHANCEOf the 4062 studies identified, 26 studies from 17 countries met the inclusion criteria. There were wide disparities across countries in the direct medical costs paid by patients for ART ranging from USD2109 to USD18 592. Relative ART costs and GDP per capita showed a negative correlation, with the costs in Africa and South-East Asia being on average up to 200% of the GDP per capita. Lower relative costs in the Americas and the Eastern Mediterranean regions were associated with the presence of ART regulations and government financing mechanisms.LIMITATIONS, REASONS FOR CAUTIONSeveral included studies were not primarily designed to examine the cost of ART and thus lacked comprehensive details of the costs. However, a sensitivity analysis showed that exclusion of studies with below the minimum quality score did not change the conclusions on the outcome of interest.WIDER IMPLICATIONS OF THE FINDINGSGovernments in LMICs should devise appropriate ART regulatory policies and implement effective mechanisms for public financing of fertility care to improve equity in access. The findings of this review should inform advocacy for ART regulatory frameworks in LMICs and the integration of infertility treatment as an essential service under universal health coverage.STUDY FUNDING/COMPETING INTEREST(S)This work received funding from the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by the World Health Organization (WHO). The authors declare no competing interests.TRIAL REGISTRATION NUMBERThis review is registered with PROSPERO, CRD42020199312.
- Published
- 2023
36. بررسی میزان پرداخت هزینههاي عمل تعویض دریچه آئورت توسط بیماران، قبل و بعد از اجراي طرح تحول نظام سلامت در بیمارستان نمازي شیراز در سال 1395
- Author
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Kavosi, Z., Ghodrati, J., and Yusefi, A.R.
- Subjects
- *
HEALTH care reform , *HEALTH planning , *AORTIC valve , *MEDICAL care , *INSURANCE - Abstract
Background and Objectives: One of the main aims in Health Care Reform Plan is improvement of justice in household's financial participation that its tool is reduction of out-of- pocket payment. This study was conducted to compare out- of- pocket payment for aortic valve replacement (AVR) surgery before and after implementation of the Health Care Reform Plan in Shiraz Namazi Hospital in 2016. Materials and Methods: This descriptive study was conducted on 127 patients (50 patients before and 77 patients after the implementation of the plan) that underwent AVR surgery. The data were collected through the researcher's checklist and were analyzed using independent t-test and one-way ANOVA. Results: Total expenditure mean has increased significantly from 45,695,137.06 to 156,536,031.8 after the plan (p<0.001). The ratio of patients' payment to total expenditure decreased significantly from 17.67% to 7.64% after the plan (p<0.001). The out -of- pocket payment reduced significantly after adding the plan's share in patient's billing (p<0.001). Out-of-pocket payment on total expenditure ratio decreased for different insurances as 9% (p= 0.003) for Remedial Services Insurance to 11% (p<0.001) for Social Security Insurance. Conclusion: The amount of out-of-pocket payment percentage of patients has been reduced for AVR surgery after implementation of the Health Care Reform Plan, which can be an indication of the effectiveness of the out-of-pocket reduction instructions. However, the average of patients' out-of-pocket payment has been increased. [ABSTRACT FROM AUTHOR]
- Published
- 2018
37. Prevalence of distressed financing among elderly in a North Indian District
- Author
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Pavan Pandey, Shivendra Kumar Singh, and Uday Mohan
- Subjects
elderly ,out of pocket ,distressed financing ,india ,Public aspects of medicine ,RA1-1270 - Abstract
Background: In some instances health related out of pocket expenditure can be catastrophic thus compelling individuals to raise money through unusual means. Such a situation becomes unavoidable if, there are either too many illnesses or shortage of money. We carried out this study to assess the proportion of elderly who availed distressed financing while availing health care and whether or not they avoided any health care need due to shortage of money. Methods: This was a community-based cross-sectional study. The present study was conducted on a total of 404 elderly residing in both the urban and rural parts of Lucknow district. Participants were selected from the community using multistage random sampling. Data was collected with the help of a pretested questionnaire, it collected information related to health care utilization, health care financing and health care need deferred due to shortage of money. Results: Overall the children were the most common source for healthcare financing and 16.8 % study participants faced financial hardship while availing health care. Most common reason for seeking distressed financing was for buying medicine (58.8%). Conclusion: Use of distressed financing was not uncommon. Families need to be protected from catastrophic health expenditure through an effective social insurance to prevent financial hardship.
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- 2016
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38. Out-Of-Pocket Expenditure Associated with Physical Inactivity, Excessive Weight, and Obesity in China: Quantile Regression Approach
- Author
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Yang Zhao, Li He, Tiara Marthias, Marie Ishida, Kanya Anindya, Allissa Desloge, Monique D’Souza, Gaofang Cao, and John Tayu Lee
- Subjects
China ,Health (social science) ,Nutrition & Dietetics ,Physical activity ,Out of pocket ,1106 Human Movement and Sports Sciences ,Overweight ,Weight Gain ,1117 Public Health and Health Services ,Physiology (medical) ,Healthcare cost ,Humans ,1111 Nutrition and Dietetics ,Longitudinal Studies ,Obesity ,Health Expenditures ,Sedentary Behavior ,Research Article - Abstract
Introduction: Previous studies exploring associations of physical inactivity, obesity, and out-of-pocket expenditure (OOPE) mainly used traditional linear regression, and little is known about the effect of both physical inactivity and obesity on OOPE across the percentile distribution. This study aims to assess the effects of physical inactivity and obesity on OOPE in China using a quantile regression approach. Methods: Study participants included 10,687 respondents aged 45 years and older from the recent wave of the China Health and Retirement Longitudinal Study in 2015. Linear regression and quantile regression models were used to examine the association of physical activity, body weight with annual OOPE. Results: Overall, the proportion of overweight and obesity was 33.2% and 5.8%, respectively. The proportion of individuals performing high-level, moderate-level, and low-level physical activity was 55.2%, 12.7%, and 32.1%, respectively. The effects of low-level physical activity on annual OOPE were small at the bottom quantiles but more pronounced at higher quantiles. Respondents with low-level activity had an increased annual OOPE of 26.9 USD, 150.3 USD, and 1,534.4 USD, at the 10th, 50th, and 90th percentiles, respectively, compared with those with high-level activity. The effects of overweight and obesity on OOPE were also small at the bottom quantiles but more pronounced at higher quantiles. Conclusion: Interventions that improve the lifestyles and unhealthy behaviors among people with obesity and physical inactivity are likely to yield substantial financial gains for the individual and health systems in China.
- Published
- 2022
39. National sample surveys show poor households face catastrophic expenditure for oral healthcare services in India
- Author
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Namita Shanbhag, Jaya Prasad Tripathy, Om Prakash Bera, and Banuru Muralidhara Prasad
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Consumption (economics) ,business.industry ,Public sector ,out of pocket ,Survey sampling ,Sample (statistics) ,Catastrophe ,Investment (macroeconomics) ,Private sector ,oral healthcare ,healthcare expenditure ,Health care ,Medicine ,Original Article ,Limited evidence ,business ,Socioeconomics - Abstract
Introduction: Globally people pay out-of-pocket (OOP) to access Oral healthcare services. In India, there is limited evidence on estimates of OOP expenditure. We undertook an analysis of national sample survey data on household health care expenditure to understand the expenditure pattern for Oral healthcare services and the catastrophic burden. Method: The expenditure reported for Oral healthcare services from two surveys: 71st round and 75th round, published by National Sample Survey Office (NSSO) was extracted. Based on monthly household consumption expenditure three economic groups were made: poor, middle- and rich-income groups. The OOP expenditure pattern while accessing day-care services and hospitalization and in public and private sector and the catastrophic expenditure were analysed. Results: A total of 204 and 155 households from two national surveys reported to have accessed day-care Oral services respectively. The median OOP expenditure in public sector remained same at US $ 4 in both surveys. Over 35% of 78 households in 71st round and 42% of 167 in 75th round used public sector hospitalization services. The median expenditure of hospitalization doubled from US$ 58 (IQR 21–263) in 71st round to US $ 125 (IQR 45-363) in 75th round. Households from poor income groups spent seven times more for Oral healthcare services during the recent survey and faced catastrophic expenditure. Conclusion: The OOP expenditure for Oral healthcare has significant catastrophic household expenditure among the poor. There is a need to increase investment in public sector and insurance to protect poor against hospitalization expenditure in private sector.
- Published
- 2021
40. Comparing Catastrophic Costs: Active vs. Passive Tuberculosis Case Finding in Urban Vietnam.
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Dinh LV, Wiemers AMC, Forse RJ, Phan YTH, Codlin AJ, Annerstedt KS, Dong TTT, Nguyen L, Pham TH, Nguyen LH, Dang HMT, Tuan MH, Le PT, Lonnroth K, Creswell J, Khan A, Kirubi B, Nguyen HB, Nguyen NV, and Vo LNQ
- Abstract
Active case finding (ACF) is a strategy that aims to identify people with tuberculosis (TB) earlier in their disease. This outreach approach may lead to a reduction in catastrophic cost incurrence (costs exceeding 20% of annual household income), a main target of WHO's End TB Strategy. Our study assessed the socio-economic impact of ACF by comparing patient costs in actively and passively detected people with TB. Longitudinal patient cost surveys were prospectively fielded for people with drug-sensitive pulmonary TB, with 105 detected through ACF and 107 passively detected. Data were collected in four Vietnamese cities between October 2020 and March 2022. ACF reduced pre-treatment (USD 10 vs. 101, p < 0.001) and treatment costs (USD 888 vs. 1213, p < 0.001) in TB-affected individuals. Furthermore, it reduced the occurrence of job loss (15.2% vs. 35.5%, p = 0.001) and use of coping strategies (28.6% vs. 45.7%, p = 0.004). However, catastrophic cost incurrence was high at 52.8% and did not differ between cohorts. ACF did not significantly decrease indirect costs, the largest contributor to catastrophic costs. ACF reduces costs but cannot sufficiently reduce the risk of catastrophic costs. As income loss is the largest driver of costs during TB treatment, social protection schemes need to be expanded.
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- 2023
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41. Economic burden, impoverishment and coping mechanisms associated with out-of-pocket health expenditure: analysis of rural-urban differentials in India.
- Author
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Sangar, Shivendra, Dutt, Varun, and Thakur, Ramna
- Subjects
PSYCHOLOGICAL adaptation ,CONFIDENCE intervals ,HOSPITAL care ,HOSPITALS ,OUTPATIENT services in hospitals ,MEDICAL care costs ,METROPOLITAN areas ,POVERTY ,RURAL conditions ,PRIVATE sector ,PUBLIC sector ,FINANCIAL management ,CROSS-sectional method ,DESCRIPTIVE statistics - Abstract
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. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
42. Estimation of Out of Pocket Expenditure Under Janani Shishu Suraksha Karayakram (JSSK) in Rural Block of Chhattisgarh: A Community Based Cross-Sectional Study
- Author
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Aditi Chandrakar, Gopal Soni, Ashish Sinha, Kamlesh Jain, Prem Panda, and Somen Pradhan
- Subjects
Out of Pocket ,OOP ,Expenditure ,Caeserian ,OOPE ,health expenditure ,Public aspects of medicine ,RA1-1270 - Abstract
Background: In order to reduce out-of-pocket expenditure during institutional delivery, Govt. of India has launched a nationwide initiative - Janani Shishu Suraksha Karyakram (JSSK) which provides cashless services to pregnant mothers & sick infants accessing public health facilities. Objectives: To estimate out of pocket expenditure (OOPE) among mothers who availed the benefits of JSSK. Method: A community based cross sectional study was done in Dharsiwa block of Raipur district among 352 mothers having child less than one year using multistage random sampling method using predesigned pretested proforma from July 2015 to June 2016. Median OOPE was calculated and expressed in Indian National Rupee. (INR) Result: Overall median OOPE during pregnancy was INR 1220 while during antenatal and natal period, median OOPE was INR 750, INR 300 respectively. Nil OOPE incurred for admission, stay and investigation but median OOPE for transport, medicine, food, informal payments and blood transfusion was INR 200, INR 550, INR 60, INR 500 and INR 1050 respectively. Total Median OOPE incurred by JSSK beneficiaries was highest in medical college and among those who underwent C-section delivery. Conclusion: Mothers were benefitted with services mentioned under JSSK in the public health facilities; however drugs and transport contributed to the Out of Pocket expenditure.
- Published
- 2017
43. Inpatient Out-of-Pocket in Iran After Health Transformation Plan
- Author
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Sulmaz Ghahramani and Kamran Bagheri Lankarani
- Subjects
Health Transformation Plan ,Iran ,Out of Pocket ,Hospital ,Patient ,Public aspects of medicine ,RA1-1270 - Published
- 2018
- Full Text
- View/download PDF
44. Determinants of Catastrophic Health Expenditure in Iran
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M Ramezanian, P Bastani, SA Hasani, M Abolhallaje, and M Kazemian
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Catastrophic Health Expenditure ,Out of Pocket ,Determinant ,Iran ,Public aspects of medicine ,RA1-1270 - Abstract
Background: This study will provide detailed specification of those variables and determinants of unpredictable health expenditure in Iran, and the requirements to reduce extensive effects of the factors affecting households’ payments for health and other goods and services inappropriately.Method: This study aims to identify measures of fair financing of health services and determinants of fair financing contribution, regarding the required share of households that prevents their catastrophic payments. In this regard, analysis of shares of households’ expenditures on main groups of goods and services in urban and rural areas and in groups of deciles in the statistics from households’ expenditure surveys was applied.Results: The growth of spending in nominal values within the years 2002-2008 was considerably high and the rate for out-of-pocket payments is nearly the same or greater than the rate for total health expenditure. In 2008, urban and rural households in average pay 6.4% and 6.35% of their total expenditure on health services. Finally three categories of determinants of unfair and catastrophic payments by households were recognized in terms of households’ socio-economic status, equality/inequality conditions of the distribution of risk of financing, and economic aspects of health expenditure distribution.Conclusion: While extending the total share of government and prepayment sources of financing health services are considered as the simplest policy for limiting out-of-pocket payments, indicators and policies introduced in this study could also be considered important and useful for the development of health sector and easing access to health services, irrespective of health financing fairness
- Published
- 2013
45. مطالعه هزینه های کمرشکن و منجر به فقر سلامت در جمعیت شهری تهران.
- Author
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سعید باقری فرادن, محمد عرب, مسعود رودباری, عزیز رضاپور, حسین باقری فرادن, and فرید عبادی فرد آذ
- Abstract
Copyright of Journal of Health Administration is the property of Tehran University of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2016
46. A nursing care costing model for wound dressing in Nigeria
- Author
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Ogundeji, Kolawole Damilare, Risenga, Patrone Rebecca, Ogundeji, Kolawole Damilare, and Risenga, Patrone Rebecca
- Abstract
Background: Wound dressing is a major component of wound management, and it is documented to consume huge healthcare resources in most countries. In Nigeria, the cost of wound dressing for an average wound care is unknown and it is borne almost entirely by the patients as most do not have health insurance coverage. This study examined the economic burden of wound dressing among inpatients and outpatients in an acute care episode. Purpose of the study: The purpose of the study was to develop a costing model to capture cost implications of wound dressing and hospitalization in order to contribute to the knowledge gap regarding the cost of wound dressing in Nigeria. Method: The investigator examined the cost of wound dressing materials, consumables, lotion used and hospitalization incurred by patients during a minimum of four weeks acute care episode. A descriptive cross-sectional design was adopted. The study was carried out in three Teaching Hospitals South West Nigeria. The study centres were purposively selected while the respondents (n= 320: Inpatients-190, Outpatients-130) were selected via a convenient sampling technique from wards and clinics where wound dressings were performed. Every patient who had spent not less than four weeks on the ward or who were discharged or on clinic visits were interviewed. Variables of interest included: frequency of wound dressing per week, number of dressing packs used per week, cost of dressing pack, cost of consumables, cost of lotion used, cost of hospitalization, occupation, monthly income, family size and health insurance coverage. The data was entered into the Statistical Package for Social Sciences (SPSS) version 23 and analyzed by descriptive and chi-square statistics while modelling cost of wound dressing and hospitalization was done by regression model analysis at 0.05 level of significance. The results were presented in a frequency table, percentages, mean and standard deviation. 1USD= ₦515, 1ZAR= ₦45- August 2021 Res
- Published
- 2021
47. Novo Nordisk Will Lower Insulin Prices Up To 75%, Following Eli Lilly.
- Author
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Hart, Robert
- Subjects
PRICES ,INSULIN - Abstract
Novo Nordisk, along with Sanofi and Eli Lilly, make up most of the U.S. insulin market. [ABSTRACT FROM AUTHOR]
- Published
- 2023
48. WYDATKI NA OPIEKĘ ZDROWOTNĄ A EFEKTY ZDROWOTNE - ANALIZA PORÓWNAWCZA KRAJÓW EUROPEJSKICH METODĄ DEA.
- Author
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Kujawska, Justyna
- Subjects
MEDICAL care costs ,DATA envelopment analysis - Abstract
Copyright of Research Papers of the Wroclaw University of Economics / Prace Naukowe Uniwersytetu Ekonomicznego we Wroclawiu is the property of Uniwersytet Ekonomiczny we Wroclawiu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2015
- Full Text
- View/download PDF
49. Study protocol for a single-centre observational study of household wellbeing and poverty status following a diagnosis of advanced cancer in Blantyre, Malawi - ‘Safeguarding the Family’ study
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Adamson S Muula, Peter MacPherson, Bertel Squire, Stephen B. Gordon, Maya Jane Bates, Louis W. Niessen, Ewan Tomeny, and Marc Henrion
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medicine.medical_specialty ,Malawi ,Palliative care ,viruses ,cost of illness ,Medicine (miscellaneous) ,wa_395 ,Safeguarding ,Poverty status ,General Biochemistry, Genetics and Molecular Biology ,03 medical and health sciences ,Study Protocol ,0302 clinical medicine ,palliative ,Health care ,medicine ,cancer ,030212 general & internal medicine ,non-communicable disease ,Protocol (science) ,Receipt ,wa_30 ,business.industry ,Family caregivers ,Out of pocket ,1. No poverty ,Cancer ,virus diseases ,Articles ,Non-communicable disease ,qz_200 ,medicine.disease ,Advanced cancer ,3. Good health ,Single centre ,030220 oncology & carcinogenesis ,Family medicine ,Africa ,economic burden ,Household income ,Observational study ,business - Abstract
Background: Many households in low-and-middle income countries face the additional burden of crippling out-of-pocket expenditure when faced with a diagnosis of life-limiting illness. Available evidence suggests that receipt of palliative care supports cost-savings for cancer-affected households. This study will explore the relationship between receipt of palliative care, total household out-of-pocket expenditure on health and wellbeing following a first-time diagnosis of advanced cancer at Queen Elizabeth Central Hospital in Blantyre, Malawi. Protocol: Patients and their primary family caregivers will be recruited at the time of cancer diagnosis. Data on healthcare utilisation, related costs, coping strategies and wellbeing will be gathered using new and existing questionnaires (the Patient-and-Carer Cancer Cost Survey, EQ-5D-3L and the Integrated Palliative Care Outcome Score). Surveys will be repeated at one, three and six months after diagnosis. In the event of the patient’s death, a brief five-item questionnaire on funeral costs will be administered to caregivers not less than two weeks following the date of death. Descriptive and Poisson regression analyses will assess the relationship between exposure to palliative care and total household expenditure from baseline to six months. A sample size of 138 households has been calculated in order to detect a medium effect (as determined by Cohen’s f 2=0.15) of receipt of palliative care in a regression model for change in total household out-of-pocket expenditure as a proportion of annual household income. Ethics and dissemination: The study has received ethical approval. Results will be reported using STROBE guidelines and disseminated through scientific meetings, open access publications and a national stakeholder meeting. Conclusions: This study will provide data on expenditure for healthcare by households affected by advanced cancer in Malawi. We also explore whether receipt of palliative care is associated with a reduction in out-of-pocket expenditure at household level.
- Published
- 2020
50. Behavior of under the Iranian Social Security Organization-Insured Persons on Utilization of Laboratory and Imaging Services.
- Author
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Pouragha, Behrooz, Khabiri, Roghayeh, Pourreza, Abolghasem, and Zarei, Ehsan
- Abstract
Background and purpose: Diagnostic services are very important as inherent part of modern medical care; about 70% of medical diagnoses are made based on their results. This study aimed to evaluate the effect of household income, geographical access, out of pocket, physician's visits and hospitalization of Iranian Social Security Organization-insured patients on the utilization of laboratory and imaging services. Materials and methods: In analytical study, the Iranian Social Security Organization database in each province in the period of 1998-2011 was searched. Study population included 24 million people covered by this organization ferred to the direct and indirect treatment sectors for laboratory and imaging services over these years. To estimate the model the fixed effects logarithmic regression via the Eviews software was used. Results: The following factors had a significant effect on the utilization of laboratory and imaging facilities: geographical access to the laboratory (β = 0.31) and imaging (β = 0.50) facilities, household income on the utilization of the laboratory (β = 0.24) and imaging (β = 0.43) services, outpatient visits on the utilization of the laboratory (β = 0.56) and imaging (β = 0.43) services, and inpatient services on the utilization of the laboratory (β = 0.35) and imaging (β = 0.51) services. Also, amount of out of pocket for using the mentioned services and referral burden of inpatient and outpatient for direct treatment had no significant relation with utilization of the services. Conclusion: If policymakers exclusively pay attention to the out of pocket, they cannot provide the appropriate utilization of services. Sometimes, to set the used utilizations, the channels such as commands of general practitioners or specialist and/or geographical access are often forgotten. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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