Minimizing the Risk of Catastrophic Health Expenditure in China: A Multi-Dimensional Analysis of Vulnerable Groups

Financial hardship among patients suffering from neglected tropical diseases: A systematic review and meta-analysis of global literature

INTRODUCTION

Neglected tropical diseases (NTDs) mainly affect underprivileged populations, potentially resulting in catastrophic health spending (CHS) and impoverishment from out-of-pocket (OOP) costs. This systematic review aimed to summarize the financial hardship caused by NTDs.

METHODS

We searched PubMed, EMBASE, EconLit, OpenGrey, and EBSCO Open Dissertations, for articles reporting financial hardship caused by NTDs from database inception to January 1, 2023. We summarized the study findings and methodological characteristics. Meta-analyses were performed to pool the prevalence of CHS. Heterogeneity was evaluated using the I2 statistic.

RESULTS

Ten out of 1,768 studies were included, assessing CHS (n = 10) and impoverishment (n = 1) among 2,761 patients with six NTDs (Buruli ulcer, chikungunya, dengue, visceral leishmaniasis, leprosy, and lymphatic filariasis). CHS was defined differently across studies. Prevalence of CHS due to OOP costs was relatively low among patients with leprosy (0.0-11.0%), dengue (12.5%), and lymphatic filariasis (0.0-23.0%), and relatively high among patients with Buruli ulcers (45.6%). Prevalence of CHS varied widely among patients with chikungunya (11.9-99.3%) and visceral leishmaniasis (24.6-91.8%). Meta-analysis showed that the pooled prevalence of CHS due to OOP costs of visceral leishmaniasis was 73% (95% CI; 65-80%, n = 2, I2 = 0.00%). Costs of visceral leishmaniasis impoverished 20-26% of the 61 households investigated, depending on the costs captured. The reported costs did not capture the financial burden hidden by the abandonment of seeking healthcare.

CONCLUSION

NTDs lead to a substantial number of households facing financial hardship. However, financial hardship caused by NTDs was not comprehensively evaluated in the literature. To develop evidence-informed strategies to minimize the financial hardship caused by NTDs, studies should evaluate the factors contributing to financial hardship across household characteristics, disease stages, and treatment-seeking behaviors.

Rural health dialogue for the sustainability of help-seeking behaviors among older patients: grounded theory approach

BACKGROUND

Help-seeking behaviors (HSBs) are essential for disease prevention and health promotion. Dialogues with peers and medical professionals can improve HSBs, both qualitatively and quantitatively. Rural communities lacking healthcare resources require effective HSBs for healthcare sustainability. The current study aimed to investigate the effect of health dialogues between medical professionals and rural citizens on their HSBs.

METHODS

All procedures complied with the Declaration of Helsinki and its subsequent amendments. The Unnan City Hospital Clinical Ethics Committee approved the study protocol (No. 20,220,002). A grounded theory approach was employed for the health dialogue participants in rural communities. Health dialogues with family physicians were conducted once a month at rural community centers. The dialogues and focus group interviews were recorded and coded to investigate changes in participants' perceptions and behaviors regarding HSBs.

RESULTS

Twenty-one dialogues were conducted in two rural community centers, with a total of 112 participants. The average age of the participants was 70.2 years (standard deviation = 5.4), with 24% being males. Analysis of the grounded theory approach revealed four themes, namely joy-driven dialogue driving the realization of HSBs, reflection on personal HSBs through learning from others, revising HSBs based on rural social resources, and familiarity with physicians, hence motivating safe and secure HSBs.

CONCLUSIONS

Mitigation of barriers between citizens and medical professionals and improvement of psychological safety in communities can drive effective HSBs in rural communities.

Effects of multimorbidity patterns and socioeconomic status on catastrophic health expenditure of widowed older adults in China

Background

The high multimorbidity and lower socioeconomic status (SES) of older adults, can lead to catastrophic health expenditures (CHEs) for older adults' households. However, whether widowed older adults will bear such a financial burden has yet to be explored. The aim of this study was to investigate the influence of multimorbidity patterns and SES on CHE in Chinese widowed older adults.

Methods

Data was obtained from the 2018 China Health and Retirement Longitudinal Study (CHARLS). This is a cross-sectional study. A total of 1,721 widowed participants aged 60 years and older were enrolled in the study. Latent class analysis was performed based on 14 self-reported chronic diseases to identify multimorbidity patterns. The logistic model and Tobit model were used to analyze the influence of multimorbidity patterns and SES on the incidence and intensity of CHE, respectively.

Results

About 36.72% of widowed older adults generated CHE. The incidence and intensity of CHE were significantly higher in the cardiovascular class and multisystem class than in the minimal disease class in multimorbidity patterns (cardiovascular class, multisystem class, and minimal disease class). Among SES-related indicators (education, occupation and household per capita income), respondents with a middle school and above education level were more likely to generate CHE compared to those who were illiterate. Respondents who were in the unemployed group were more likely to generate CHE compared to agricultural workers. In addition, respondents aged 70-79 years old, geographically located in the east, having other medical insurance, or having fewer family members are more likely to generate CHE and have higher CHE intensity.

Conclusion

Widowed older adults are at high risk for CHE, especially those in the cardiovascular and multisystem disease classes, and those with low SES. Several mainstream health insurances do not provide significant relief. In addition, attention should be paid to the high-risk characteristics associated with CHE. It is necessary to carry out the popularization of chronic disease knowledge, improve the medical insurance system and medical service level, and provide more policy preferences and social support to widowed older adults.

Health expenditures, environmental quality, and economic development: State-of-the-art review and findings in the context of COP26

There are numerous factors that affect human health. Among others, environmental degradation, bad governance, and extensive economic growth are regarded as more destructive for health-related issues. To explore the nexus of the said factors and extend the scholarly literature, the current study aims to analyze the influence of greenhouse gas (GHG) emissions, governance indicators, and gross domestic product (GDP) on human health expenditures-captured by domestic health expenditures and capital health expenditures. Specifically, this study contrasted variables including regulatory quality (RQ), rule of law (RL), GDP, GHG emissions, and human capital (HC) with that of human health expenditure. Covering the period from 1996 to 2020, this study uses time series specifications in the case of China, which is one of the largest pollution-emitting economies across the globe. The empirical results found that the long-run equilibrium relationship exists between the variables. For the long-run coefficients, this study utilizes the fully modified ordinary least square, dynamic ordinary least square, and canonical cointegration regression, suggesting that economic development and RQ are adversely affecting human health expenditure. However, GHG emissions, RQ, and HC significantly improve human health by increasing health expenditure in China. Based on the empirical results, policies are suggested regarding human health improvement, improved governance quality, and environmental sustainability. The study discusses the empirical conclusions and implications as per COP26 declarations.

The Impact of Multimorbidities on Catastrophic Health Expenditures among Patients Suffering from Hypertension in China: An Analysis of Nationwide Representative Data

Background: Patients with hypertension are sensitive to multimorbidities (i.e., the existence of ≥2 chronic diseases), and the related treatment can create enormous economic burdens. We sought to examine the distribution of multimorbidities, the prevalence and factors of catastrophic health expenditure (CHE), the impact of multimorbidities on CHE, and the variation in this relationship across age groups, work status, and combinations of socioeconomic status and health insurance types. Methods: Socioeconomic-related inequality associated with CHE was estimated by concentration curve and concentration index. We examined the determinants of CHE and the impact of age groups, work status, and combinations of socioeconomic groups and health insurance schemes against the relationship with multimorbidities and CHE using logistic regression. Results: 5693 (83.3%) participants had multimorbidities. In total, 49.8% of families had experienced CHE, and the concentration index was −0.026 (95% confidence interval [CI], −0.032 to −0.020). Multimorbidities were related to the increased odds of CHE (odds ratio [OR], 1.21; 95% CI, 1.18–1.25). The relationship between multimorbidities and CHE persisted across age groups, work status, and combinations of socioeconomic status and health insurance schemes. Conclusions: More than 80% of patients with hypertension had multimorbidities. The protection of health insurance schemes against financial risks is very limited.