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Quispe Mamani JC, Cutipa Quilca BE, Cáceres Quenta R, Quispe Maquera NB, Quispe Quispe B, Mamani Flores A, Incacutipa Limachi DJ, Esteves Villanueva AR, Málaga Apaza V, Tintaya Choquehuanca O. Determinants of Out-of-Pocket Health Spending in Households in Peru in the Times of the Pandemic (COVID-19). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6759. [PMID: 37754618 PMCID: PMC10530415 DOI: 10.3390/ijerph20186759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/24/2023] [Accepted: 09/05/2023] [Indexed: 09/28/2023]
Abstract
In 2021, the expenses paid by households worldwide due to COVID-19 showed an increasing behavior and directly affected economic income since they were part of unforeseen expenses among households and became a factor that contributed to the increase in the levels of poverty mainly in households that were not part of the health system. The objective of this research was to establish the main determinants of out-of-pocket spending on health in Peruvian households in the times of the pandemic. A quantitative approach, of a nonexperimental type, with a descriptive and correlational methodological design was considered. The database of the National Household Survey of the National Institute of Statistics and Informatics for 2021 was used as a source of information, applying the binomial logit econometric model. Out-of-pocket expenses during the pandemic compared to normal periods were shared by the members of the households. Since they were part of unforeseen expenses, these expenses mainly impacted the heads of the households and strongly affected household budgets. For this reason, the type of insurance, the suffering of household members from a disease, the results of tests for COVID-19, the expenditure on individual health, the existence of permanent limitations to any member of the household, the presence of an older adult in the household, and the marital status of the head of the household determined and positively influenced out-of-pocket spending in households in Peru with 36.85, 8.48, 6.50, 0.0065, 23.73, 16.79, and 2.44 percentage units. However, the existence of a drinking water service in the household, educational level, and the area of residence determined and negatively influenced out-of-pocket spending in households in Peru with 4.81, 6.75, and 19.26 percentage units, respectively. The type of insurance, the suffering of an individual from a disease, the results of COVID-19 tests, health spending, the existence of permanent limitations, the presence of an older adult in the household, and the marital status of the head of the household positively determined out-of-pocket spending in households in Peru, while the existence of a potable water service, educational level, and the area of residence determined out-of-pocket expenses in a negative or indirect way.
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Affiliation(s)
- Julio Cesar Quispe Mamani
- Faculty of Economic Engineering, National University of Altiplano, Floral Avenue 1153, Puno 21001, Peru
| | | | - Rolando Cáceres Quenta
- Faculty of Educational Sciences, National University of Altiplano, Floral Avenue 1153, Puno 21001, Peru;
| | - Nelly Beatriz Quispe Maquera
- Faculty of Health Sciences, Professional School of Dentistry, National University of Altiplano, Floral Avenue 1153, Puno 21001, Peru; (N.B.Q.M.); (B.Q.Q.)
| | - Betsy Quispe Quispe
- Faculty of Health Sciences, Professional School of Dentistry, National University of Altiplano, Floral Avenue 1153, Puno 21001, Peru; (N.B.Q.M.); (B.Q.Q.)
| | - Adderly Mamani Flores
- Faculty of Social Sciences, National University of Altiplano, Floral Avenue 1153, Puno 21001, Peru; (A.M.F.); (D.J.I.L.); (O.T.C.)
| | - Duverly Joao Incacutipa Limachi
- Faculty of Social Sciences, National University of Altiplano, Floral Avenue 1153, Puno 21001, Peru; (A.M.F.); (D.J.I.L.); (O.T.C.)
| | | | - Vicente Málaga Apaza
- Faculty of Chemical Engineering, National University of Altiplano, Floral Avenue 1153, Puno 21001, Peru;
| | - Olimpia Tintaya Choquehuanca
- Faculty of Social Sciences, National University of Altiplano, Floral Avenue 1153, Puno 21001, Peru; (A.M.F.); (D.J.I.L.); (O.T.C.)
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Demir A, Alkan Ö, Bilgiç A, Florkowski WJ, Karaaslan A. Determinants of Turkish households' out-of-pocket expenditures on three categories of health care services: A multivariate probit approach. Int J Health Plann Manage 2022; 37:2303-2327. [PMID: 35365938 DOI: 10.1002/hpm.3470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 03/17/2022] [Accepted: 03/20/2022] [Indexed: 11/08/2022] Open
Abstract
This study identifies the driving forces that contribute to the probabilities of incidence of out-of-pocket (OOP) expenditures by households in Turkey. Factors affecting the probability of OOP expenditures on medical products/devices/supplies (MP), outpatient services (OTS), and inpatient services (ITS) are examined using the Household Budget Survey data gathered by the Turkish Statistical Institute in 2018. The study applies the multivariate probit model. The incidence of OOP spending varied with 48.9% of the households reporting OOP expenditure on MP, 22.4% on OTS, and 25.4% on ITS. The largest probability changes were associated with household disposable annual income, household type and size, age category, and having private health insurance. Gender and marital status also influenced expenditures in some categories. Lifestyle choices had small and mixed effects, with smoking and alcohol consumption lowering the probability of OOP spending. From a policy standpoint, households with the lowest incomes, large households, and those where the household head was 'others' (retiree, student, housewife, not actively working, etc.) or had a condition preventing employment seemed to report OOP expenditures less frequently and may have chosen not to receive healthcare services, leading to the need for more healthcare services later.
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Affiliation(s)
- Ayşenur Demir
- Department of Econometrics, Faculty of Economics and Administrative Sciences, Ataturk University, Erzurum, Turkey
| | - Ömer Alkan
- Department of Econometrics, Faculty of Economics and Administrative Sciences, Ataturk University, Erzurum, Turkey
| | - Abdulbaki Bilgiç
- Department of Management Information Systems, College of Economics and Administrative Sciences, Bilecik Seyh Edebali University, Bilecik, Turkey
| | - Wojciech J Florkowski
- Department of Agricultural & Applied Economics, University of Georgia, Athens, Georgia, USA
| | - Abdulkerim Karaaslan
- Department of Econometrics, Faculty of Economics and Administrative Sciences, Ataturk University, Erzurum, Turkey
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Alves JC, Law MR, Luz TCB. Prevalence and Factors Associated With Out-of-Pocket Pharmaceutical Expenditure Among Primary Healthcare Patients: Evidence From the Prover Project. Value Health Reg Issues 2022; 30:83-90. [PMID: 35306468 DOI: 10.1016/j.vhri.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 12/09/2021] [Accepted: 01/14/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study aimed to determine the prevalence and associated factors of out-of-pocket pharmaceutical expenditure (OOPPE) among primary healthcare patients. METHODS The study is part of the Prover Project, an exit survey conducted in 2017 in a large city (population 234 937) in Minas Gerais State, Brazil. A representative sample of patients (n = 1219) from pharmaceutical services based on primary healthcare was selected. Three components of OOPPE were assessed: the general prevalence, the types of medicines purchased (medicines for the treatment of chronic diseases, medicines for the treatment of acute diseases, or herbal medicines), and coverage by the National Health System. The factors associated with OOPPE were examined applying a modified Andersen's behavioral model of health services use. Data were analyzed using descriptive statistics and logistic regression. RESULTS The overall prevalence of OOPPE was 77%. Most patients who had OOPPE purchased medicines to treat chronic diseases (94%). In addition, these patients purchased medicines covered by public insurance but were out of stock (85%). OOPPE was associated with enabling factors, such as higher personal income (odds ratio [OR] 1.92; 95% confidence interval [CI] 1.02-3.62), holding health insurance (OR 1.40; 95% CI 1.01-1.95), and higher neighborhood trust (OR 1.34; 95% CI 1.01-1.79), and with need factors, that is, poorer perception of health (OR 1.63; 95% CI 1.20-2.21), multiple comorbidities (OR 1.70; 95% CI 1.18-2.46), and higher number of prescribed medicines (OR 2.84; 95% CI 1.90-4.26). CONCLUSIONS We found a high prevalence of OOPPE, identifying individuals more likely to incur these expenses. These findings are useful to inform policy makers from the healthcare system to plan and implement the needed interventions to protect primary care patients from this financial burden.
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Affiliation(s)
- Jéssica C Alves
- Grupo de Estudos Transdisciplinares em Tecnologias em Saúde e Ambiente, Fiocruz Minas, Belo Horizonte, Brazil
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Tatiana C B Luz
- Grupo de Estudos Transdisciplinares em Tecnologias em Saúde e Ambiente, Fiocruz Minas, Belo Horizonte, Brazil; Strathclyde Institute of Pharmacy and Biomedical Sciences, The University of Strathclyde, Glasgow, Scotland, UK.
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Diaz MDM, Teixeira AD, Postali FAS, Ferreira-Batista NN, Moreno-Serra R. Assessment of the Association between the Brazilian Family Health Strategy and Adult Mortality. Health Policy Plan 2022; 37:461-471. [DOI: 10.1093/heapol/czac011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 12/27/2021] [Accepted: 01/28/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
This study aimed to analyse a wide range of related health problems that respond favourably to efficient primary care treatment among adults. We evaluate the direct association of the Family Health Strategy (ESF) in Brazil on mortality of adults aged 25–64 years related to conditions for which access to effective primary care can reduce the likelihood of more severe outcomes. Additionally, we discussed heterogeneous effects associated with different intensities of the programme. To address these issues, we estimated a model with variation at the municipal level of the ESF expansion, including municipal-fixed effects, municipal specific trends and year-fixed effects. Our results show that a higher intensity of ESF is associated with reduced mortality by all conditions sensitive to primary care and for some diseases, especially after some years: avoidable conditions, asthma, heart failure, cerebrovascular diseases and gastrointestinal ulcer, infectious gastroenteritis and complications, diseases of the lower airways, hypertension, and diabetes.. As a public policy view, these results help understand how a nationwide primary care strategy can help mitigate mortality and emphasise the role of having sufficient health teams to attend to the population.
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Rahman MM, Islam MR, Rahman MS, Hossain F, Alam A, Rahman MO, Jung J, Akter S. Forgone healthcare and financial burden due to out-of-pocket payments in Bangladesh: a multilevel analysis. HEALTH ECONOMICS REVIEW 2022; 12:5. [PMID: 35006416 PMCID: PMC8751265 DOI: 10.1186/s13561-021-00348-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Ensuring access to health services for all is the main goal of universal health coverage (UHC) plan. Out-of-pocket (OOP) payment still remains the main source of funding for healthcare in Bangladesh. The association between barriers to accessing healthcare and over-reliance on OOP payments has not been explored in Bangladesh using nationally representative household survey data. This study is a novel attempt to examine the burden of OOP payment and forgone healthcare in Bangladesh, and further explores the inequalities in catastrophic health expenditures (CHE) and forgone healthcare at the national and sub-national levels. METHODS This study used data from the most recent nationally representative cross-sectional survey, Bangladesh Household Income and Expenditure Survey, conducted in 2016-17 (N = 39,124). In order to identify potential determinants of CHE and forgone healthcare, multilevel Poisson regression was used. Inequalities in CHE and forgone healthcare were measured using the slope index of inequality. RESULTS Around 25% of individuals incurred CHE and 14% of the population had forgone healthcare for any reasons. The most common reasons for forgone healthcare were treatment cost (17%), followed by none to accompany or need for permission (5%), and distance to health facility (3%). Multilevel analysis indicated that financial burden and forgone care was higher among households with older populations or chronic illness, and those who utilize either public or private health facilities. Household consumption quintile had a linear negative association with forgone care and positive association with CHE. CONCLUSION This study calls for incorporation of social safety net in health financing system, increase health facility, and gives priority to the disadvantaged population to ensure access to health services for all.
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Affiliation(s)
- Md Mizanur Rahman
- Hitotsubashi Institute for Advanced Study, Hitotsubashi University, 2-1 Naka Kunitachi, Tokyo, 186-8601, Japan.
| | - Md Rashedul Islam
- Department of Global Health Policy, School of International Health, The University of Tokyo, Tokyo, Japan
| | - Md Shafiur Rahman
- Research Centre for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Fahima Hossain
- Global Public Health Research Foundation, Dhaka, Bangladesh
| | - Ashraful Alam
- Department of Global Health Policy, School of International Health, The University of Tokyo, Tokyo, Japan
| | - Md Obaidur Rahman
- Department of Global Health Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Jenny Jung
- Global Public Health Research Foundation, Dhaka, Bangladesh
| | - Shamima Akter
- Hitotsubashi Institute for Advanced Study, Hitotsubashi University, 2-1 Naka Kunitachi, Tokyo, 186-8601, Japan
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Macedo JDB, Boing AC, Andrade JM, Saulo H, Fernandez RN, Andrade FBD. Gastos catastróficos em saúde: análise da associação com condições socioeconômicas em Minas Gerais, Brasil. CIENCIA & SAUDE COLETIVA 2022; 27:325-334. [DOI: 10.1590/1413-81232022271.40442020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/21/2020] [Indexed: 11/21/2022] Open
Abstract
Resumo O objetivo deste estudo foi avaliar os gastos catastróficos em saúde (GCS) e sua associação com condições socioeconômicas nos anos de 2009, 2011 e 2013 em Minas Gerais. Realizou-se um estudo transversal com dados da Pesquisa por Amostra de Domicílios. A variável dependente foi o GCS, em cada ano da pesquisa. Foram considerados catastróficos os gastos que ultrapassaram os limites de 10% e 25% da renda familiar. A associação entre o gasto catastrófico e as variáveis independentes foi testada por meio de regressão de Poisson. As prevalências de GCS variaram de 9,0% a 11,3% e 18,9% a 24,4% nos limites de 10% e 25%, sendo que o ano de 2011 apresentou os menores valores. A maior proporção dos gastos com saúde (94%) foi relativa aos gastos com medicamentos. A prevalência de CGS foi menor entre responsáveis pelo domicílio com maior escolaridade quando comparados àqueles sem estudo nos limites de 10% e 25%. Famílias com maior escore de riqueza apresentaram, nos dois limites, prevalência de GCS menores do que aquelas do primeiro quintil. Concluiu-se que os gastos com saúde afetaram significativamente o orçamento das famílias em Minas Gerais, sendo o gasto com medicamentos o principal componente dos gastos. Os achados reforçam o papel do SUS para minimizar o GCS e reduzir as desigualdades socioeconômicas.
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Syamkumar V, Bhat P, Nair R, Suresh K, Kumbla S, Nair A. Assessment of oral health care-related expenditure among people of Kerala: A cross-sectional study. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2022; 14:S479-S482. [PMID: 36110667 PMCID: PMC9469320 DOI: 10.4103/jpbs.jpbs_716_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/01/2021] [Accepted: 12/17/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Aims and Objectives: Materials and Methods: Results: Conclusion:
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Ahmadi R, Shafiei M, Ameri H, Askari R, Fallahzadeh H. Catastrophic Health Expenditure before and after of the Implementation of Health Sector Evolution Plan in Iran. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2021; 58:469580211050210. [PMID: 34647464 PMCID: PMC8524689 DOI: 10.1177/00469580211050210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Introduction: One of the fundamental goals of health transportation
plan (HTP) in Iran is to improve household’s financial protection against
catastrophic health expenditures (CHE). The aim of this study was to calculate
the percentage of catastrophic health expenditures after implementing the plan
and compare it with CHE before the plan for the same households.
Methods: Data were collected through face-to-face interviews
for 400 households. The CHE was calculated using the WHO approach, and
relationships between CHE and the variables (having member ≥65 years old, having
member ≤5 years old, having disabled member, economic status, health insurance
status, dentistry services usage, and inpatient and outpatient services usage)
were examined by the Fisher’s exact test. Moreover, the impacts of the variables
on CHE were assessed by logistic regression model. Stata version 15 was used for
data analyses. Results: The exposure of the households to CHE
increased from 8.3% in 2011 to 14.2% in 2020, and percentage of the impoverished
households due to health expenditures in 2020 was more than that of the 2011
(4.3% vs 7.5%). The economic status, having members ≥65 years, and using dental
and inpatient services were the key factors determining the CHE. The most
important determinant affecting the exposure to CHE was dental services
utilization in 2011 (92.64) and 2020 (122.68). Conclusion: The
results showed a negative incremental change for the households facing CHE in
this period. The dental and inpatient services need to be more widely covered by
basic health insurance and households having members ≥65 years along with the
poor households should be exempted from paying some of the healthcare
expenditures for improving their financial protection against CHE.
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Affiliation(s)
- Razieh Ahmadi
- Health Policy and Management Research Center, Department of Health Services Management, School of Public Health, 48516Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Milad Shafiei
- Health Policy and Management Research Center, Department of Health Services Management, School of Public Health, 48516Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hosein Ameri
- Health Policy and Management Research Center, Department of Health Services Management, School of Public Health, 48516Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Roohollah Askari
- Health Policy and Management Research Center, Department of Health Services Management, School of Public Health, 48516Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Fallahzadeh
- Department of Biostatistics and Epidemiology, Research Center of Prevention and Epidemiology of Non-Communicable Disease, Faculty of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Ravangard R, Jalali FS, Bayati M, Palmer AJ, Jafari A, Bastani P. Household catastrophic health expenditure and its effective factors: a case of Iran. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:59. [PMID: 34530840 PMCID: PMC8444555 DOI: 10.1186/s12962-021-00315-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 09/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) has placed special emphasis on protecting households from health care expenditures. Many households face catastrophic health expenditures (CHEs) from a combination of economic poverty and financing the treatment of medical conditions. The present study aimed to measure the percentage of households facing catastrophic CHEs and the factors associated with the occurrence of CHEs in Shiraz, Iran in 2018. METHODS The present cross-sectional study was performed on 740 randomly selected households from different districts of Shiraz, Iran in 2018 using a multi-stage sampling method. Data were collected using the Persian version of the "WHO Global Health Survey" questionnaire. CHEs were defined as health expenditures exceeding 40% of households' capacity to pay. Households living below the poverty line before paying for health services were excluded from the study. The associations between the households' characteristics and facing CHEs were determined using the Chi-Square test as well as multiple logistic regression modeling in SPSS 23.0 at the significance level of 5%. RESULTS The results showed that 16.48% of studied households had faced CHEs. The higher odds of facing CHEs were observed in the households living in rented houses (OR = 3.14, P-value < 0.001), households with disabled members (OR = 27.98, P-value < 0.001), households with children under 5 years old (OR = 2.718, P-value = 0.02), and those without supplementary health insurance coverage (OR = 1.87, P-value = 0.01). CONCLUSION CHEs may be reduced by increasing the use of supplementary health insurance coverage by individuals and households, increasing the support of the Social Security and the State Welfare Organizations for households with disabled members, developing programs such as the Integrated Child Care Programs, and setting home rental policies and housing policies for tenants.
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Affiliation(s)
- Ramin Ravangard
- Health Human Resources Research Centre, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Health Services Management, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Faride Sadat Jalali
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Bayati
- Health Human Resources Research Centre, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.,Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Abdosaleh Jafari
- Health Human Resources Research Centre, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Peivand Bastani
- Health Human Resources Research Centre, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Botelho CH, Estevez-Diz MDP, Campolina AG. Cost-effectiveness analysis of trastuzumab for early breast cancer in Brazil. Expert Rev Pharmacoecon Outcomes Res 2021; 22:63-72. [PMID: 34319216 DOI: 10.1080/14737167.2021.1909478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Adjuvant chemotherapy with trastuzumab for HER2 positive breast cancers has brought considerable benefits to disease-free survival and overall survival.Objective: To conduct a cost-effectiveness analysis of the treatment of patients with early and locally advanced HER2 positive breast cancer, within the scope of the Brazilian public health system, comparing adjuvant chemotherapy with and without trastuzumab, for 1 year of treatment.Methods: A 4-state Markov model was developed to estimate strategy costs and outcomes.Results: Based on the proposed model, we verified an incremental benefit of trastuzumab therapy compared to treatment without trastuzumab with 0.84 quality-adjusted life years (QALY) and 1.16 life years gained (LYG). The use of adjuvant chemotherapy with trastuzumab has an ICER of US$19,599.26 for each quality-adjusted life year and US$14,180.68 for each life year gained in relation to chemotherapy without trastuzumab.Conclusion: In Brazil, adjuvant chemotherapy with trastuzumab may be considered cost-effective only if a cost-effectiveness threshold is stipulated with the value starting at three times the Brazilian GDP per capita for QALY or two times the Brazilian GDP per capita for LYG, from health system perspective.
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Affiliation(s)
- Carlos Henrique Botelho
- Department of Radiology and Oncology, Cancer Institute of the State of Sao Paulo/Faculty of Medicine at the University of Sao Paulo, Sao Paulo, Brazil
| | - Maria Del Pilar Estevez-Diz
- Department of Radiology and Oncology, Cancer Institute of the State of Sao Paulo/Faculty of Medicine at the University of Sao Paulo, Sao Paulo, Brazil
| | - Alessandro Gonçalves Campolina
- Center for Translational Research in Oncology, Cancer Institute of the State of Sao Paulo/Faculty of Medicine of the University of Sao Paulo, São Paulo, Brazil
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Özçelik EA, Massuda A, Castro MC, Barış E. A Comparative Case Study: Does the Organization of Primary Health Care in Brazil and Turkey Contribute to Reducing Disparities in Access to Care? Health Syst Reform 2021; 7:e1939931. [PMID: 34402403 DOI: 10.1080/23288604.2021.1939931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Brazil and Turkey are among the few high-middle-income countries that explicitly chose to strengthen their primary health care (PHC) systems as the centerpiece of much broader health system reforms aiming to narrow inequities in access to care. This comparative case study reviews the organization of Brazil and Turkey's PHC systems to derive lessons that can apply to other countries that may consider reforming the organization of PHC systems as a way to address health inequities. The analysis uses the Flagship Framework to investigate how the organization of PHC delivery in Brazil and Turkey can lead to measurable improvements in access to care. It compares (1) the degree of decentralization in PHC service delivery responsibilities, (2) the use of multi-professional PHC teams, and (3) patient impanelment strategies. The comparative analysis offers three important lessons. First, changes in the organization of PHC systems can contribute to observable improvements in the level and distribution of health outcomes, but organizational strategies do not guarantee eliminating disparities in access. Second, PHC systems can operate in health systems with varying degrees of decentralization, but the level of decentralization may influence implementation. Third, relying on multi-professional PHC teams that serve geographically empaneled populations can improve equitable access to care, but course corrections may be needed to address evolving health demands.
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Affiliation(s)
- Ece A Özçelik
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Adriano Massuda
- São Paulo School of Business Administration, Fundação Getulio Vargas, São Paulo, Brazil
| | - Marcia C Castro
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Enis Barış
- Health, Nutrition and Population, World Bank Group, Washington, DC, USA
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Sabermahani A, Sirizi MJ, Zolala F, Nazari S. Out-of-Pocket Costs and Importance of Nonmedical and Indirect Costs of Inpatients. Value Health Reg Issues 2021; 24:141-147. [PMID: 33578362 DOI: 10.1016/j.vhri.2020.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/11/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Out-of-pocket (OOP) costs are a major part of the expenditures for healthcare services. In most cases, patient financial protection plans cover only direct medical costs and not other expenses by patients. METHODS This cross-sectional study was conducted on 800 patients referring medical centers of Kerman to analyse all aspects of OOP, especially after the Health Transformation Plan in Iran. Using the probability proportional to the size of the medical center, samples from each ward in each medical center were determined in accordance with the previous year's patient number. Randomly selected medical records of the last 2 weeks of patients discharged were collected, information was extracted, and telephone interviews were conducted. RESULTS The mean total OOP costs of a one-time hospitalization in all medical centers in Kerman was equal to 7 561 977 Iranian rials. Assuming a 5% threshold, 37% of patients in public centers were faced with catastrophic health expenditures for a one-time hospitalization. Based on the results of the regression model, reduction of length of stay, elimination of the need for the presence of next of kin, and provision of healthcare services out of hospitals can greatly reduce OOP expenditures. CONCLUSION Although direct medical costs are of special importance, and it is very necessary to protect patients against such costs, patients usually incur a variety of costs when receiving inpatient services. Inattention to direct nonmedical costs and indirect costs due to patients' and their next of kin's absenteeism may cause households to face catastrophic expenditures.
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Affiliation(s)
- Asma Sabermahani
- Department of Management, Health Policy and Health Economics, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Farzaneh Zolala
- Department of Management, Health Policy and Health Economics, Kerman University of Medical Sciences, Kerman, Iran; Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Sonia Nazari
- Department of Management, Health Policy and Health Economics, Kerman University of Medical Sciences, Kerman, Iran.
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Guttier MC, Tejada CAO, Wehrmeister FC, Silveira MF, Domingues MR, Barros AJD, Santos IS, Matijasevich A, Bassani DG, Bertoldi AD. [Expenditures on childbirth care: a comparison of the 2004 and 2015 birth cohorts in Pelotas, Rio Grande do Sul State, Brazil]. CAD SAUDE PUBLICA 2020; 36:e00120019. [PMID: 32638880 DOI: 10.1590/0102-311x00120019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 12/02/2019] [Indexed: 11/22/2022] Open
Abstract
Although most childbirth care in Brazil is financed by the Brazilian Unified National Health System (SUS), there are out-of-pocket expenditures (private personal costs) involved in births. This study aims to compare maternal out-of-pocket expenditures in births of children from the Pelotas Birth Cohorts of 2004 and 2015. The study drew on information collected right after birth and at three months of age. The target variables include sociodemographic and economic data, private health plan coverage, and expenditures related to the birth. Values from 2004 were adjusted to 2015 by the general price index. There was an increase in private health plan coverage from 33.4% (95%CI: 31.9-34.9) to 45.1% (95%IC: 43.6-46.7) in the target period, directly associated with the families' socioeconomic status (p < 0.001). There was an increase in mean expenditures on hospitalization for the birth, from BRL 60.38 (SD = 288.66) to BRL 171.15 (SD = 957.07), and in additional medical expenditures, from BRL 191.60 (SD = 612.86) to BRL 1,424.80 (SD = 4,459.16) among mothers admitted to hospital under their private health plans (and there was no significant difference in these expenditures for mothers that opted for direct payment). There was an important increase in expenditures for childbirth care, especially among mothers admitted to hospital under private health plans.
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Affiliation(s)
- Marília Cruz Guttier
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil
| | | | - Fernando C Wehrmeister
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil
| | | | - Marlos R Domingues
- Programa de Pós-graduação em Educação Física, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Aluísio J D Barros
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Iná S Santos
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil
| | | | - Diego G Bassani
- Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Andréa Dâmaso Bertoldi
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil
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Simon A, Nobelika AA. An observational study to find the patterns of out-of-pocket expenditure for oral healthcare among sanitary workers in Coimbatore, India. JOURNAL OF INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY 2020. [DOI: 10.4103/jiaphd.jiaphd_78_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Ortiz-Prado E, Cevallos-Sierra G, Teran E, Vasconez E, Borrero-Maldonado D, Ponce Zea J, Simbaña-Rivera K, Gómez-Barreno L. Drug prices and trends before and after requesting compulsory licenses: the Ecuadorian experience. Expert Opin Ther Pat 2019; 29:653-662. [PMID: 31298053 DOI: 10.1080/13543776.2019.1643323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: The Ecuadorian Institute of Intellectual Property (IEPI) granted several compulsory licenses between 2011 and 2017. In 2009, the President of Ecuador signed a decree that was intended to facilitate the request of compulsory licenses (CL) in the country, not only for Enfarma EP but for any privately owned local company in order to produce more accessible medicines. Areas covered: The national and international regulatory framework of pharmaceutical patents and the local applicability of CL in Ecuador. The authors also analyzed the results of requesting unplanned and epidemiologically unnecessary CL at a national level. Finally, the authors reviewed the effects of requesting, granting or denying CL on price per unit in the last 7 years of available data. Expert opinion: The authors think that compulsory licenses are useful tools when negotiating drug prices or when the demand cannot be satisfied due to economic constrain within the local health system. However, the authors' experience suggests that Ecuador did not have an established and reliable production system neither an adequate plan before requesting CL, therefore the positive effects of this measure were not clearly established.
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Affiliation(s)
- Esteban Ortiz-Prado
- a OneHealth Research Group, Faculty of Medicine, Universidad De Las Americas , Quito , Ecuador
| | - Gabriel Cevallos-Sierra
- a OneHealth Research Group, Faculty of Medicine, Universidad De Las Americas , Quito , Ecuador
| | - Enrique Teran
- b Colegio de Ciencias de la Salud, Universidad San Francisco de Quito , Quito , Ecuador
| | - Eduardo Vasconez
- a OneHealth Research Group, Faculty of Medicine, Universidad De Las Americas , Quito , Ecuador
| | | | - Jorge Ponce Zea
- c Department of Clinical Laboratory, Faculty of Medical Science, Universidad Estatal del Sur de Manabí , Jipijapa , Ecuador
| | | | - Lenin Gómez-Barreno
- a OneHealth Research Group, Faculty of Medicine, Universidad De Las Americas , Quito , Ecuador
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Massenburg BB, Saluja S, Jenny HE, Raykar NP, Ng-Kamstra J, Guilloux AGA, Scheffer MC, Meara JG, Alonso N, Shrime MG. Assessing the Brazilian surgical system with six surgical indicators: a descriptive and modelling study. BMJ Glob Health 2017; 2:e000226. [PMID: 28589025 PMCID: PMC5444087 DOI: 10.1136/bmjgh-2016-000226] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 03/13/2017] [Accepted: 03/15/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Brazil boasts a health scheme that aspires to provide universal coverage, but its surgical system has rarely been analysed. In an effort to strengthen surgical systems worldwide, the Lancet Commission on Global Surgery proposed a collection of 6 standardised indicators: 2-hour access to surgery, surgical workforce density, surgical volume, perioperative mortality rate (POMR) and protection against impoverishing and catastrophic expenditure. This study aims to characterise the Brazilian surgical health system with these newly devised indicators while gaining understanding on the complexity of the indicators themselves. METHODS Using Brazil's national healthcare database, commonly reported healthcare variables were used to calculate or simulate the 6 surgical indicators. Access to surgery was calculated using hospital locations, surgical workforce density was calculated using locations of surgeons, anaesthesiologists and obstetricians (SAO), and surgical volume and POMR were identified with surgical procedure codes. The rates of protection against impoverishing and catastrophic expenditure were modelled using cost of surgical inpatient hospitalisations and a γ distribution of incomes based on Gini and gross domestic product/capita. FINDINGS In 2014, SAO density was 34.7/100 000 population, surgical volume was 4433 procedures/100 000 people and POMR was 1.71%. 79.4% of surgical patients were protected against impoverishing expenditure and 84.6% were protected against catastrophic expenditure due to surgery each year. 2-hour access to surgery was not able to be calculated from national health data, but a proxy measure suggested that 97.2% of the population has 2-hour access to a hospital that may be able to provide surgery. Geographic disparities were seen in all indicators. INTERPRETATION Brazil's public surgical system meets several key benchmarks. Geographic disparities, however, are substantial and raise concerns of equity. Policies should focus on stimulating appropriate geographic allocation of the surgical workforce and better distribution of surgical volume. In some cases, where benchmarks for each indicator are met, supplemental analysis can further inform our understanding of health systems. This measured and systematic evaluation should be encouraged for all nations seeking to better understand their surgical systems.
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Affiliation(s)
- Benjamin B Massenburg
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Saurabh Saluja
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Hillary E Jenny
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Nakul P Raykar
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Josh Ng-Kamstra
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Aline G A Guilloux
- Departamento de Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Mário C Scheffer
- Departamento de Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Nivaldo Alonso
- Departamento de Cirurgia Plástica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Mark G Shrime
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.,Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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Luiza VL, Tavares NUL, Oliveira MA, Arrais PSD, Ramos LR, Pizzol TDSD, Mengue SS, Farias MR, Bertoldi AD. Catastrophic expenditure on medicines in Brazil. Rev Saude Publica 2016; 50:15s. [PMID: 27982383 PMCID: PMC5157912 DOI: 10.1590/s1518-8787.2016050006172] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 08/09/2016] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To describe the magnitude of the expenditure on medicines in Brazil according to region, household size and composition in terms of residents in a situation of dependency. METHODS Population-based data from the national household survey were used, with probabilistic sample, applied between September 2013 and February 2014 in urban households. The expenditure on medicines was the main outcome of interest. The prevalence and confidence intervals (95%CI) of the outcomes were stratified according to socioeconomic classification and calculated according to the region, the number of residents dependent on income, the presence of children under five years and residents in a situation of dependency by age. RESULTS In about one of every 17 households (5.3%) catastrophic health expenditure was reported and, in 3.2%, the medicines were reported as one of the items responsible for this situation. The presence of three or more residents (3.6%) and resident in a situation of dependency (3.6%) were the ones that most reported expenditure on medicines. Southeast was the region with the lowest prevalence of expenditure on medicines. The prevalence of households with catastrophic health expenditure and on medicines in relation to the total of households showed a regressive tendency for economic classes. CONCLUSIONS Catastrophic health expenditure was present in 5.3%, and catastrophic expenditure on medicines in 3.2% of the households. Multi-person households, presence of residents in a situation of economic dependency and belonging to the class D or E had the highest proportion of catastrophic expenditure on medicines. Although the problem is important, permeated by aspects of iniquity, Brazilian policies seem to be protecting families from catastrophic expenditure on health and on medicine. OBJETIVO Descrever a magnitude do gasto catastrófico em medicamentos no Brasil segundo região, tamanho das famílias e composição familiar em termos de moradores em situação de dependência. MÉTODOS Utilizados dados de inquérito domiciliar nacional, de base populacional, com amostra probabilística, aplicado entre setembro de 2013 e fevereiro de 2014 em domicílios urbanos. O gasto catastrófico em medicamentos foi o principal desfecho de interesse. As prevalências e intervalos de confiança de 95% (IC95%) desses desfechos foram estratificados segundo classificação socioeconômica e calculadas de acordo com a região, o número de moradores dependentes da renda, a presença de crianças menores de cinco anos e de moradores em situação de dependência, por idade. RESULTADOS Em cerca de um de cada 17 domicílios (5,3%) foi relatado gasto catastrófico em saúde e, em 3,2%, os medicamentos foram reportados como um dos itens responsáveis por esta situação. Presença de três ou mais moradores (3,6%) e morador em situação de dependência jovem (3,6%) foram as situações com maior relato de gasto catastrófico em medicamentos. O Sudeste foi a região com menor prevalência de gasto catastrófico em medicamentos. As prevalências de domicílios com gasto catastrófico em saúde e medicamentos em relação ao total de domicílios apresentaram tendência regressiva para as classes econômicas. CONCLUSÕES O gasto catastrófico em saúde esteve presente em 5,3% e o gasto catastrófico em medicamentos, em 3,2% dos domicílios. Domicílios pluripessoais, presença de moradores em situação de dependência econômica e pertencimento à classe D ou E tiveram a maior proporção de gasto catastrófico em medicamentos. Ainda que o problema se mostre importante, permeado por aspectos de iniquidade, as políticas brasileiras parecem estar protegendo as famílias do gasto catastrófico em saúde e em medicamentos.
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Affiliation(s)
- Vera Lucia Luiza
- Departamento de Política de Medicamentos e Assistência Farmacêutica. Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Noemia Urruth Leão Tavares
- Departamento de Farmácia. Faculdade de Ciências da Saúde. Universidade de Brasília. Brasília, DF, Brasil
| | - Maria Auxiliadora Oliveira
- Departamento de Política de Medicamentos e Assistência Farmacêutica. Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Paulo Sergio Dourado Arrais
- Departamento de Farmácia. Faculdade de Farmácia, Odontologia e Enfermagem. Universidade Federal do Ceará. Fortaleza, CE, Brasil
| | - Luiz Roberto Ramos
- Departamento de Medicina Preventiva. Escola Paulista de Medicina. Universidade Federal de São Paulo. São Paulo, SP, Brasil
| | - Tatiane da Silva Dal Pizzol
- Departamento de Produção e Controle de Medicamentos. Faculdade de Farmácia. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Sotero Serrate Mengue
- Programa de Pós-Graduação em Epidemiologia. Faculdade de Medicina. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Mareni Rocha Farias
- Departamento de Ciências Farmacêuticas. Centro de Ciências da Saúde. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
| | - Andréa Dâmaso Bertoldi
- Departamento de Medicina Social. Faculdade de Medicina. Universidade Federal de Pelotas. Pelotas, RS, Brasil
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Mendonça CS, Diercks MS, Kopittke L. O fortalecimento da Atenção Primária à Saúde nos municípios da Região Metropolitana de Porto Alegre, Brasil, após a inserção no Programa Mais Médicos: uma comparação intermunicipal. CIENCIA & SAUDE COLETIVA 2016; 21:2871-8. [DOI: 10.1590/1413-81232015219.16622016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 06/22/2016] [Indexed: 11/21/2022] Open
Abstract
Resumo Este artigo visa propor uma adaptação da metodologia utilizada por Starfield e Shy (2002) para avaliar a qualidade da atenção primária em saúde (APS) dos municípios que aderiram ao Programa Mais Médicos. Os indicadores foram adaptados para cada um dos nove critérios propostos na metodologia original e aplicados para os municípios de médio e grande porte da Região Metropolitana de Porto Alegre, antes e depois destes integrarem o Programa Mais Médicos. Em 2014, os municípios foram agregados em três grupos, conforme seus escores. As análises de correlações entre diferentes grupos de escores dos municípios e os indicadores de saúde avaliados não se mostraram significativas, porém, as médias dos indicadores avaliados são melhores no grupo de municípios caracterizados com os melhores escores da APS. Em relação aos indicadores de renda, os maiores gastos per capita em saúde estão relacionados à melhor performance da APS nesses municípios. A adaptação desta metodologia pode indicar melhor compreensão das políticas relacionadas à determinação da saúde.
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Beogo I, Huang N, Gagnon MP, Amendah DD. Out-of-pocket expenditure and its determinants in the context of private healthcare sector expansion in sub-Saharan Africa urban cities: evidence from household survey in Ouagadougou, Burkina Faso. BMC Res Notes 2016; 9:34. [PMID: 26795567 PMCID: PMC4721044 DOI: 10.1186/s13104-016-1846-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 01/08/2016] [Indexed: 11/10/2022] Open
Abstract
Background Conventional wisdom suggests that out-of-pocket (OOP) expenditure reduces healthcare utilization. However, little is known about the expenditure borne in urban settings with the current development of the private health sector in sub-Saharan Africa. In an effort to update knowledge on medical expenditure, this study investigated the level and determinants of OOP among individuals reporting illness or injury in Ouagadougou, Burkina Faso and who either self-treated or received healthcare in either a private or public facility. Methods A cross-sectional study was conducted with a representative sample of 1017 households (5638 individuals) between August and November 2011. Descriptive statistics and multivariate techniques including generalized estimating equations were used to analyze the data. Results Among the surveyed sample, 29.6 % (n = 1666) persons reported a sickness or injury. Public providers were the single most important providers of care (36.3 %), whereas private and informal providers (i.e.: self-treatment, traditional healers) accounted for 29.8 and 34.0 %, respectively. Almost universally (96 %), households paid directly for care OOP. The average expenditure per episode of illness was 8404XOF (17.4USD) (median 3750XOF (7.8USD). The total expenditure was higher for those receiving care in private facilities compared to public ones [14,613.3XOF (30.3USD) vs. 8544.1XOF (17.7USD); p < 0.001], and the insured patients’ bill almost tripled uninsured (p < 0.001). Finally, medication was the most expensive component of expenditure in both public and private facilities with a mean of 8022.1XOF (16.7USD) and 12,270.5 (25.5USD), respectively. Conclusion OOP was the principal payment mechanism of households. A significant difference in OOP was found between public and private provider users. Considering the importance of private healthcare in Burkina Faso, regulatory oversight is necessary. Furthermore, an extensive protection policy to shield households from catastrophic health expenditure is required.
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Affiliation(s)
- Idrissa Beogo
- École Nationale de Santé Publique, Ouagadougou, Burkina Faso. .,Faculté Des Sciences Infirmières, Université Laval, Pavillon Ferdinand-Vandry, 1050, Avenue de la Médecine, Quebec, G1V 0A6, Canada.
| | - Nicole Huang
- International Health Program, National Yang-Ming University, 155, Sec 2, Linong St, 112, Taipei, Taiwan.
| | - Marie-Pierre Gagnon
- Faculté Des Sciences Infirmières, Université Laval, Pavillon Ferdinand-Vandry, 1050, Avenue de la Médecine, Quebec, G1V 0A6, Canada.
| | - Djesika D Amendah
- African Population and Health Research Center, APHRC Campus, 2nd Flore Manga Close, Off Kiwara Road, PO Box 10787-00100, Nairobi, Kenya.
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Abstract
OBJECTIVE The past few decades have been marked by a bold increase in national health spending across the globe. Rather successful health reforms in leading emerging markets such as BRICS reveal a reshaping of their medical care-related expenditures. There is a scarcity of evidence explaining differences in long-term medical spending patterns between top ranked G7 traditional welfare economies and the BRICS nations. METHODS A retrospective observational study was conducted on a longitudinal WHO Global Health Expenditure data-set based on the National Health Accounts (NHA) system. Data were presented in a simple descriptive manner, pointing out health expenditure dynamics and differences between the two country groups (BRICS and G7) and individual nations in a 1995-2013 time horizon. RESULTS Average total per capita health spending still remains substantially higher among G7 (4747 Purchase Power Parity (PPP) $PPP in 2013) compared to the BRICS (1004 $PPP in 2013) nations. The percentage point share of G7 in global health expenditure (million current PPP international $US) has been falling constantly since 1995 (from 65% in 1995 to 53.2% in 2013), while in BRICS nations it grew (from 10.7% in 1995 to 20.2% in 2013). Chinese national level medical spending exceeded significantly that of all G7 members except the US in terms of current $PPP in 2013. CONCLUSIONS Within a limited time horizon of only 19 years it appears that the share of global medical spending by the leading emerging markets has been growing steadily. Simultaneously, the world's richest countries' global share has been falling constantly, although it continues to dominate the landscape. If the contemporary global economic mainstream continues, the BRICS per capita will most likely reach or exceed the OECD average in future decades. Rising out-of-pocket expenses threatening affordability of medical care to poor citizens among the BRICS nations and a too low percentage of GDP in India remain the most notable setbacks of these developments.
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Jakovljevic MB. BRIC's Growing Share of Global Health Spending and Their Diverging Pathways. Front Public Health 2015; 3:135. [PMID: 26000273 PMCID: PMC4421927 DOI: 10.3389/fpubh.2015.00135] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 04/20/2015] [Indexed: 11/13/2022] Open
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Garcia LP, Ocké-Reis CO, Magalhães LCGD, Sant'Anna AC, Freitas LRSD. Gastos com planos de saúde das famílias brasileiras: estudo descritivo com dados das Pesquisas de Orçamentos Familiares 2002-2003 e 2008-2009. CIENCIA & SAUDE COLETIVA 2015; 20:1425-34. [DOI: 10.1590/1413-81232015205.07092014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/01/2014] [Indexed: 11/21/2022] Open
Abstract
As despesas com planos de saúde correspondem a uma parcela importante dos gastos privados com saúde no Brasil. Este estudo teve como objetivo descrever a evolução dos gastos com planos de saúde das famílias brasileiras, segundo sua renda. Foram utilizados dados das Pesquisas de Orçamentos Familiares (POF) de 2002-2003 e 2008-2009. Para a comparação dos valores dos gastos entre as POF, foi feita correção mediante o Índice de Preços ao Consumidor Amplo (IPCA). A proporção de famílias que tiveram gastos com planos de saúde permaneceu estável, nas duas POF estudadas (2002-2003 e 2008-2009), em torno de 24%. Todavia, o valor do gasto das famílias com planos de saúde aumentou. Entre aquelas que tiveram gasto com planos de saúde, o valor médio elevou-se de R$ 154,35 para R$ 183,97. O gasto médio com planos de saúde foi maior à medida que aumentava a renda das famílias, assim como as parcelas da renda e da despesa comprometidas com esses gastos. O gasto com planos de saúde está concentrado entre as famílias com maior renda. Para estas, os planos de saúde foram o principal componente do gasto total com saúde.
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Boing AC, Bertoldi AD, de Barros AJD, Posenato LG, Peres KG. Socioeconomic inequality in catastrophic health expenditure in Brazil. Rev Saude Publica 2014; 48:632-41. [PMID: 25210822 PMCID: PMC4181092 DOI: 10.1590/s0034-8910.2014048005111] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 02/26/2014] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To analyze the evolution of catastrophic health expenditure and the inequalities in such expenses, according to the socioeconomic characteristics of Brazilian families. METHODS Data from the National Household Budget 2002-2003 (48,470 households) and 2008-2009 (55,970 households) were analyzed. Catastrophic health expenditure was defined as excess expenditure, considering different methods of calculation: 10.0% and 20.0% of total consumption and 40.0% of the family's capacity to pay. The National Economic Indicator and schooling were considered as socioeconomic characteristics. Inequality measures utilized were the relative difference between rates, the rates ratio, and concentration index. RESULTS The catastrophic health expenditure varied between 0.7% and 21.0%, depending on the calculation method. The lowest prevalences were noted in relation to the capacity to pay, while the highest, in relation to total consumption. The prevalence of catastrophic health expenditure increased by 25.0% from 2002-2003 to 2008-2009 when the cutoff point of 20.0% relating to the total consumption was considered and by 100% when 40.0% or more of the capacity to pay was applied as the cut-off point. Socioeconomic inequalities in the catastrophic health expenditure in Brazil between 2002-2003 and 2008-2009 increased significantly, becoming 5.20 times higher among the poorest and 4.17 times higher among the least educated. CONCLUSIONS There was an increase in catastrophic health expenditure among Brazilian families, principally among the poorest and those headed by the least-educated individuals, contributing to an increase in social inequality.
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Affiliation(s)
- Alexandra Crispim Boing
- Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil, Programa de Pós-Graduação em Saúde Pública. Centro de Ciências da Saúde. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
| | - Andréa Dâmaso Bertoldi
- Universidade Federal de Pelotas, Pelotas, RS, Brasil, Programa de Pós-Graduação em Epidemiologia. Universidade Federal de Pelotas. Pelotas, RS, Brasil
| | - Aluísio Jardim Dornellas de Barros
- Departamento de Medicina Social, Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, RS, Brasil, Departamento de Medicina Social. Faculdade de Medicina. Universidade Federal de Pelotas. Pelotas, RS, Brasil
| | - Leila Garcia Posenato
- Diretoria de Estudos Setoriais, Instituto de Pesquisa Econômica Aplicada, Brasília, DF, Brasil, Diretoria de Estudos Setoriais. Instituto de Pesquisa Econômica Aplicada. Brasília, DF, Brasil
| | - Karen Glazer Peres
- Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil, Programa de Pós-Graduação em Saúde Pública. Centro de Ciências da Saúde. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
- Australian Research Centre for Population Oral Health, School of Dentistry, The University of Adelaide, Adelaide, Australia, Australian Research Centre for Population Oral Health. School of Dentistry. The University of Adelaide. Adelaide, Australia
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Cataife G, Courtemanche C. Income-based disparities in health care utilisation under universal health coverage in Brazil, 2002-2003. Glob Public Health 2014; 9:394-410. [PMID: 24720271 DOI: 10.1080/17441692.2014.891631] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Since Brazil's adoption of universal health care in 1988, the country's health care system has consisted of a mix of private providers and free public providers. We test whether income-based disparities in medical visits and medications remain in Brazil despite universal coverage using a nationally representative sample of over 48,000 households. Additional income is associated with less public sector utilisation and more private sector utilisation, both using simple correlations and regressions controlling for household characteristics and local area fixed effects. Importantly, the increase in private care use is greater than the drop in public care use. Also, income and unmet medical needs are negatively associated. These results suggest that access limitations remain for low-income households despite the availability of free public care.
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Affiliation(s)
- Guido Cataife
- a Department of Health Division , IMPAQ International , Columbia , MD , USA
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Bertoldi AD, Kanavos P, França GVA, Carraro A, Tejada CAO, Hallal PC, Ferrario A, Schmidt MI. Epidemiology, management, complications and costs associated with type 2 diabetes in Brazil: a comprehensive literature review. Global Health 2013; 9:62. [PMID: 24299125 PMCID: PMC4220809 DOI: 10.1186/1744-8603-9-62] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 11/11/2013] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND With an estimated 74% of all deaths attributable to non-communicable diseases (NCDs) in 2010, NCDs have become a major health priority in Brazil. The objective of the study was to conduct a comprehensive literature review on diabetes in Brazil; specifically: the epidemiology of type 2 diabetes, the availability of national and regional sources of data (particularly in terms of direct and indirect costs) and health policies for the management of diabetes and its complications. METHODS A literature search was conducted using PubMed to identify articles containing information on diabetes in Brazil. Official documents from the Brazilian government and the World Health Organization, as well as other grey literature and official government websites were also reviewed. RESULTS From 2006 to 2010, an approximate 20% increase in the prevalence of self-reported diabetes was observed. In 2010, it was estimated that 6.3% of Brazilians aged 18 years or over had diabetes. Diabetes was estimated to be responsible for 278,778 years of potential life lost for every 100,000 people. In 2013, it is estimated that about 7% of patients with diabetes has had one or more of the following complications: diabetic foot ulcers, amputation, kidney disease, and fundus changes. The estimated annual direct cost of diabetes was USD $3.952 billion in 2000; the estimated annual indirect cost was USD $18.6 billion. The two main sources of data on diabetes are the information systems of the Ministry of Health and surveys. In the last few years, the Brazilian Ministry of Health has invested considerably in improving surveillance systems for NCDs as well as implementing specific programmes to improve diagnosis and access to treatment. CONCLUSIONS Brazil has the capacity to address and respond to NCDs due to the leadership of the Ministry of Health in NCD prevention activities, including an integrated programme currently in place for diabetes. Strengthening the surveillance of NCDs is a national priority along with recognising the urgent need to invest in improving the coverage and quality of mortality data. It is also essential to conduct regular surveys of risk factors on a national scale in order to design effective preventive strategies.
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Affiliation(s)
- Andréa D Bertoldi
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 3° piso, Pelotas, RS, Brazil, 96.020-220
| | - Panos Kanavos
- LSE Health, London School of Economics and Political Science, London, UK
- Department of Social Policy, London School of Economics and Political Science, London, UK
| | - Giovanny V A França
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 3° piso, Pelotas, RS, Brazil, 96.020-220
- MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge, UK
| | - André Carraro
- Programa de Pós-Graduação em Organizações e Mercados, Universidade Federal de Pelotas, RS, Brazil
| | | | - Pedro C Hallal
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 3° piso, Pelotas, RS, Brazil, 96.020-220
| | - Alessandra Ferrario
- LSE Health, London School of Economics and Political Science, London, UK
- Department of Social Policy, London School of Economics and Political Science, London, UK
| | - Maria Inês Schmidt
- Programa de Pós-graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Iwaya L, Gomes M, Simplício M, Carvalho T, Dominicini C, Sakuragui R, Rebelo M, Gutierrez M, Näslund M, Håkansson P. Mobile health in emerging countries: A survey of research initiatives in Brazil. Int J Med Inform 2013; 82:283-98. [DOI: 10.1016/j.ijmedinf.2013.01.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 12/11/2012] [Accepted: 01/17/2013] [Indexed: 11/29/2022]
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Wirtz VJ, Santa-Ana-Tellez Y, Servan-Mori E, Avila-Burgos L. Heterogeneous effects of health insurance on out-of-pocket expenditure on medicines in Mexico. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2012; 15:593-603. [PMID: 22867767 DOI: 10.1016/j.jval.2012.01.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 01/21/2012] [Accepted: 01/24/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Given the importance of health insurance for financing medicines and recent policy changes designed to reduce health-related out-of-pocket expenditure (OOPE) in Mexico, our study examined and analyzed the effect of health insurance on the probability and amount of OOPE for medicines and the proportion spent from household available expenditure (AE) funds. METHODS We conducted a cross-sectional analysis by using the Mexican National Household Survey of Income and Expenditures for 2008. Households were grouped according to household medical insurance type (Social Security, Seguro Popular, mixed, or no affiliation). OOPE for medicines and health costs, and the probability of occurrence, were estimated with linear regression models; subsequently, the proportion of health expenditures from AE was calculated. The Heckman selection procedure was used to correct for self-selection of health expenditure; a propensity score matching procedure and an alternative procedure using instrumental variables were used to correct for heterogeneity between households with and without Seguro Popular. RESULTS OOPE in medicines account for 66% of the total health expenditures and 5% of the AE. Households with health insurance had a lower probability of OOPE for medicines than their comparison groups. There was heterogeneity in the health insurance effect on the proportion of OOPE for medicines out of the AE, with a reduction of 1.7% for households with Social Security, 1.4% for mixed affiliation, but no difference between Seguro Popular and matched households without insurance. CONCLUSION Medicines were the most prevalent component of health expenditures in Mexico. We recommend improving access to health services and strengthening access to medicines to reduce high OOPE.
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Affiliation(s)
- Veronika J Wirtz
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
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Bertoldi AD, Helfer AP, Camargo AL, Tavares NUL, Kanavos P. Is the Brazilian pharmaceutical policy ensuring population access to essential medicines? Global Health 2012; 8:6. [PMID: 22436555 PMCID: PMC3511298 DOI: 10.1186/1744-8603-8-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 02/05/2012] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate medicine prices, availability and affordability in Brazil, considering the differences across three types of medicines (originator brands, generics and similar medicines) and different types of facilities (private pharmacies, public sector pharmacies and “popular pharmacies”). Methods Data on prices and availability of 50 medicines were collected in 56 pharmacies across six cities in Southern Brazil using the World Health Organization / Health Action International methodology. Median prices obtained were divided by international reference prices to derive the median price ratio (MPR). Results In the private sector, prices were 8.6 MPR for similar medicines, 11.3 MRP for generics and 18.7 MRP for originator brands, respectively. Mean availability was 65%, 74% and 48% for originator brands, generics and similar medicines, respectively. In the public sector, mean availability of similar medicines was 2–7 times higher than that of generics. Mean overall availability in the public sector ranged from 68.8% to 81.7%. In “popular pharmacies”, mean availability was greater than 90% in all cities. Conclusions Availability of medicines in the public sector does not meet the challenge of supplying essential medicines to the entire population, as stated in the Brazilian constitution. This has unavoidable repercussions for affordability, particularly amongst the lower socio-economic strata.
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Affiliation(s)
- Andréa Dâmaso Bertoldi
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160, 96020-220, Pelotas, Brazil.
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Barros AJD, Bastos JL, Dâmaso AH. Catastrophic spending on health care in Brazil: private health insurance does not seem to be the solution. CAD SAUDE PUBLICA 2012; 27 Suppl 2:S254-62. [PMID: 21789417 DOI: 10.1590/s0102-311x2011001400012] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 11/24/2010] [Indexed: 12/15/2022] Open
Abstract
The objective of this study was to estimate catastrophic healthcare expenditure in Brazil, using different definitions, and to identify vulnerability indicators. Data from the 2002-2003 Brazilian Household Budget Survey were used to derive total household consumption, health expenditure and household income. Socioeconomic position was defined by quintiles of the National Economic Indicator using reference cut-off points for the country. Analysis was restricted to urban households. Catastrophic health expenditure was defined as expenditure in excess of 10% and 20% of total household consumption, and in excess of 40% of household capacity to pay. Catastrophic health expenditure varied from 2% to 16%, depending on the definition. For most definitions, it was highest among the poorer. The highest proportions of catastrophic health expenditure were found to be in the Central region of Brazil, while the South and the Southeast had the lowest. Presence of an elderly person, health insurance and socioeconomic position were associated with the outcome, and coverage by health insurance did not protect from catastrophic health expenditure.
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Affiliation(s)
- Aluísio J D Barros
- Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, Brasil.
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Kavosi Z, Rashidian A, Pourreza A, Majdzadeh R, Pourmalek F, Hosseinpour AR, Mohammad K, Arab M. Inequality in household catastrophic health care expenditure in a low-income society of Iran. Health Policy Plan 2012; 27:613-23. [PMID: 22279081 DOI: 10.1093/heapol/czs001] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We assessed change in household catastrophic health care expenditures (CHE) and inequality in facing such expenditures in south-west Tehran. METHODS A cluster-sampled survey was conducted in 2003 using the World Health Survey questionnaire. We repeated the survey on the same sample in 2008 (635 and 603 households, respectively). We estimated the proportion of households facing CHE using the 'household's capacity to pay'. We identified the determinants of the household CHE using regression analysis and used the concentration index to measure socio-economic inequality and decompose it into its determinants factors. RESULTS Findings showed that the proportion of household facing CHE had no significant change in this period (12.6% in 2003 vs 11.8% in 2008). The key determinants of CHE for both years were health care utilization and health care insurance status. Socio-economic status was the main contributor to inequality in CHE, while unequal utilization of dentistry and outpatient services had reduced the inequality in CHE between socio-economic groups. CONCLUSIONS We observed no significant change in the CHE proportion despite policy interventions aimed at reducing such expenditures. Any solution to the problem of CHE should include interventions aimed at the determinants of CHE. It is essential to increase the depth of social insurance coverage by expanding the basic benefit package and reducing co-payments.
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Affiliation(s)
- Zahra Kavosi
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Boing AC, Bertoldi AD, Peres KG. Desigualdades socioeconômicas nos gastos e comprometimento da renda com medicamentos no Sul do Brasil. Rev Saude Publica 2011; 45:897-905. [DOI: 10.1590/s0034-89102011005000054] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 05/04/2011] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Descrever as desigualdades socioeconômicas referentes ao uso, gastos e comprometimento de renda com a compra de medicamentos. MÉTODOS: Estudo transversal de base populacional com 1.720 adultos de área urbana de Florianópolis, SC, em 2009. Realizou-se a seleção da amostra por conglomerados e as unidades primárias foram os setores censitários. Investigou-se o uso de medicamentos e os gastos com sua compra nos 30 dias anteriores, por meio de entrevista. Uso, gasto e comprometimento de renda devido a medicamentos foram analisados segundo a renda familiar per capita, a cor da pele auto-referida, idade e o sexo dos indivíduos, ajustado para amostra complexa. RESULTADOS: A prevalência de uso de medicamentos foi de 76,5% (IC95%: 73,8;79,3), maior entre as mulheres e naqueles com maior idade. A média de gastos com medicamentos foi igual a R$ 46,70, com valores mais elevados entre as mulheres, os brancos, os com idade mais elevada e entre os mais ricos. Enquanto 3,1% dos mais ricos comprometeram mais de 15% de seus rendimentos na compra de medicamentos, esse valor chegou a 9,6% nos mais pobres. A proporção de pessoas que tiveram de comprar medicamentos após tentativa fracassada de obtenção pelo Sistema Único de Saúde foi maior entre os mais pobres (11,0%), mulheres (10,2%) e naqueles com maior idade (11,1%). Grande parte dos adultos comprou medicamentos contidos na Relação Nacional de Medicamentos Essenciais (19,9%) ou na Relação Municipal de Medicamentos Essenciais (28,6%), com diferenças significativas segundo sexo, idade e renda. CONCLUSÕES: Existe desigualdade socioeconômica, de idade e de gênero no comprometimento de renda com a compra de medicamentos, com piores condições para os mais pobres, os de maior idade e para as mulheres.
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Bertoldi AD, Barros AJD, Camargo AL, Hallal PC, Vandoros S, Wagner A, Ross-Degnan D. Household expenditures for medicines and the role of free medicines in the Brazilian public health system. Am J Public Health 2010; 101:916-21. [PMID: 20724692 DOI: 10.2105/ajph.2009.175844] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to investigate, across different socioeconomic groups, the proportion of household medicine expenses that were paid by households and the proportion paid by the Brazilian national health system. METHODS We carried out a survey in Porto Alegre, Brazil, that included 2988 individuals of all ages. We defined 2 expenditure variables: "out-of-pocket medicines value" (the sum of retail prices of all medicines used by family members within the previous 15 days and paid for out of pocket) and "free medicines value" (a similar definition for medicines obtained without charge). RESULTS In 2003, the Brazilian national health system provided, free of charge, 78% of the monetary value of medicines reported (79% in the bottom wealth quintile and 32% in the top 2 quintiles). The mean out-of-pocket expense for medicines was 6 times greater among the top wealth quintiles compared with those in lower quintiles, but free medicines constituted a 3-times-greater proportion of potential expenditures for medicines among the bottom quintile than among the top 2 quintiles. CONCLUSIONS Free provision of medicines seems to be saving substantial amounts of medicine expenditures for poor people in Brazil.
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Affiliation(s)
- Andréa D Bertoldi
- Programa de Pós-graduação em Saúde Coletiva, Universidade do Vale do Rio dos Sinos, São Leopoldo, Brazil.
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Victora CG, Matijasevich A, Silveira M, Santos I, Barros AJD, Barros FC. Socio-economic and ethnic group inequities in antenatal care quality in the public and private sector in Brazil. Health Policy Plan 2010; 25:253-61. [PMID: 20123940 DOI: 10.1093/heapol/czp065] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Socio-economic inequalities in maternal and child health are ubiquitous, but limited information is available on how much the quality of care varies according to wealth or ethnicity in low- and middle-income countries. Also, little information exists on quality differences between public and private providers. METHODS Quality of care for women giving birth in 2004 in Pelotas, Brazil, was assessed by measuring how many of 11 procedures recommended by the Ministry of Health were performed. Information on family income, self-assessed skin colour, parity and type of provider were collected. RESULTS Antenatal care was used by 98% of the 4244 women studied (mean number of visits 8.3), but the number of consultations was higher among better-off and white women, who were also more likely to start antenatal care in the first trimester. The quality of antenatal care score ranged from 0 to 11, with an overall mean of 8.3 (SD 1.7). Mean scores were 8.9 (SD 1.5) in the wealthiest and 7.9 (SD 1.8) in the poorest quintiles (P < 0.001), 8.4 (SD 1.6) in white and 8.1 (SD 1.9) in black women (P < 0.001). Adjusted analyses showed that these differences seemed to be due to attendance patterns rather than discrimination. Mean quality scores were higher in the private 9.3 (SD 1.3) than in the public sector 8.1 (SD 1.6) (P < 0.001); these differences were not explained by maternal characteristics or by attendance patterns. CONCLUSIONS Special efforts must be made to improve quality of care in the public sector. Poor and black women should be actively encouraged to start antenatal care early in pregnancy so that they can fully benefit from it. There is a need for regular monitoring of antenatal attendances and quality of care with an equity lens, in order to assess how different social groups are benefiting from progress in health care.
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Miranda JJ, Kinra S, Casas JP, Davey Smith G, Ebrahim S. Non-communicable diseases in low- and middle-income countries: context, determinants and health policy. Trop Med Int Health 2008; 13:1225-34. [PMID: 18937743 PMCID: PMC2687091 DOI: 10.1111/j.1365-3156.2008.02116.x] [Citation(s) in RCA: 232] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The rise of non-communicable diseases and their impact in low- and middle-income countries has gained increased attention in recent years. However, the explanation for this rise is mostly an extrapolation from the history of high-income countries whose experience differed from the development processes affecting today's low- and middle-income countries. This review appraises these differences in context to gain a better understanding of the epidemic of non-communicable diseases in low- and middle-income countries. Theories of developmental and degenerative determinants of non-communicable diseases are discussed to provide strong evidence for a causally informed approach to prevention. Health policies for non-communicable diseases are considered in terms of interventions to reduce population risk and individual susceptibility and the research needs for low- and middle-income countries are discussed. Finally, the need for health system reform to strengthen primary care is highlighted as a major policy to reduce the toll of this rising epidemic.
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Affiliation(s)
- J J Miranda
- Non-communicable Disease Epidemiology Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Ebrahim S. Latin America: old and new challenges. Int J Epidemiol 2008; 37:689-91. [DOI: 10.1093/ije/dyn141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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