Financial protection in health among the middle-aged and elderly: Evidence from the Greek economic recession

Catastrophic health expenditure associated with non-inpatient costs among middle-aged and older individuals in China

Background

Since their establishment, the two predominant social health insurance schemes in China, Urban Employee Medical Insurance (UEMIS) and Urban and Rural Residents' Medical Insurance (URRMS), have primarily focused on covering non-inpatient expenditure, while costs associated with outpatient care and pharmaceutical purchases have been largely excluded from the insurance benefit package. This study intends to analyze the distribution of non-hospitalization expenditure and assess resulting financial risks, with an objective to reform the health insurance benefit package by including coverage for non-hospitalization costs.

Methods

The primary data were obtained from the 2018 wave of CHARLS, encompassing a total of 12942 individuals for analysis. Assess the financial risk associated with non-hospitalization expenses through catastrophic health expenditures (CHE) and examine the determinants of CHE using logistic regression analysis.

Results

Over 60% of the participants availed non-inpatient services in the month preceding the investigation. A smaller proportion (14.26 and 14.28% for UEMIS and URRMS enrollee, respectively) utilized outpatient services provided by medical institutions, while a larger proportion (54.20 and 56.91% for UEMIS and URRMS enrollee, respectively) purchased medication from pharmacies. The study reveals a distinct subgroup of participants (8.91 and 6.82% for UEMIS and URRMS enrollee, respectively) who incurs substantial out-of-pocket non-inpatient expenditure, surpassing 1,000 RMB per month. However, reimbursement for non-inpatient expenditures is significantly limited under the two predominant health insurance schemes, and there is minimal disparity in the distribution of non-inpatient expenses before and after insurance reimbursement. The prevalence of CHE resulting from non-inpatient costs was substantial, particularly among participants enrolled in URRMS (25.06%) compared to those enrolled in UEMIS (14.26%). The presence of chronic diseases, advanced age, and limited financial resources are all determinants contributing to the occurrence of CHE.

Conclusion

The incorporation of non-inpatient expenses into China's fundamental health insurance plan remains a contentious issue, given the limited available evidence. This study presents empirical evidence underscoring the significance of non-inpatient expenditures as a determinant of financial risk, thereby emphasizing the imperative to adjust China's fundamental health insurance benefit package in order to address risks associated with non-inpatient costs, particularly among individuals with chronic illnesses and limited income.

Has South Korea achieved the goals of national health insurance? Trends in financial protection of households between 2011 and 2018

This study aims to investigate the evolution of financial protection of households against OOP in South Korea, where subsequent policies of expanding benefit coverage have been implemented primarily focusing on several severe diseases, by measuring catastrophic healthcare expenditure (CHE) and the characteristics of households vulnerable to CHE. Using the Korea Health Panel 2011-2018, this study analyzed CHE trends by the targeted severe diseases and other health problems and household income and examined the determinants of CHE using binary logistic regression. Our findings showed that CHE decreased in households with the targeted severe diseases but increased in households experiencing hospitalization that were not related to the targeted diseases, which appeared to have a significantly higher likelihood of CHE in 2018 than households with the targeted severe diseases. In addition, CHE was more prevalent and increased or remained stagnant among households whose heads had health problems than others. Inequalities in CHE also increased, showing increased Concentration Index (CI) and increased incidences of CHE in the lower income quartile during the study period. These results suggest that the current policies are insufficient to achieve its financial protection goals against healthcare expenditure in South Korea. In particular, benefit expansions targeting a specific disease may cause inequitable distribution of resources and may not enhance protection against households' financial burden.

Paradoxes of breast cancer incidence and mortality in two corners of Europe

BACKGROUND

Breast cancer incidence is rising globally, while mortality rates show a geographical heterogenous pattern. Early detection and treatment have been proven to have a profound impact on breast cancer prognosis. The aim of his study was to compare breast cancer incidence, mortality, and survival rates in two contrasting corners of Europe, Sweden and Crete, to better understand cancer determinants with focus on disease burden and sociocultural factors.

METHODS

Breast cancer data from Sweden and Crete was derived from registries. Incidence and mortality were expressed as Age-Standardized Incidence Rates (ASIR), Age-Standardized Mortality Rates (ASMR).

FINDINGS

Breast cancer incidence has for decades risen in Sweden and on Crete. In 2019, ASIR was 217.5 in Sweden and 58.9 on Crete, (p < 0.001). Mortality rates showed opposite trends. ASMR in Sweden was reduced from 25.5 to 16.8 (2005-2019) while on Crete, ASMR increased from 22.1 to 25.3. A successive rise in survival rate in Sweden with a 5-year survival rate of 92% since 2015, but a converse development on Crete with 85% 5-year survival rate the same year.

INTERPRETATION

The incidence of breast cancer is slowly rising in both studied regions, but mortality increases on Crete in contrast to Sweden with sinking mortality rates. The interpretation of these findings is that differences in health care systems and health policies including differences in early detection like screening programs and early treatment, as well as sociocultural factors in the two countries might play an important role on the differences found in breast cancer burden.