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Ryder C, D'Angelo S, Sharpe P, Mackean T, Cominos N, Coombes J, Bennett-Brook K, Cameron D, Gloede E, Ullah S, Stephens J. Experiences and impacts of out-of-pocket healthcare expenditure on remote Aboriginal families. Rural Remote Health 2024; 24:8328. [PMID: 38670163 DOI: 10.22605/rrh8328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Aboriginal Australians face significant health disparities, with hospitalisation rates 2.3 times greater, and longer hospital length of stay, than non-Indigenous Australians. This additional burden impacts families further through out-of-pocket healthcare expenditure (OOPHE), which includes additional healthcare expenses not covered by universal taxpayer insurance. Aboriginal patients traveling from remote locations are likely to be impacted further by OOPHE. The objective of this study was to examine the impacts and burden of OOPHE for rurally based Aboriginal individuals. METHODS Participants were recruited through South Australian community networks to participate in this study. Decolonising methods of yarning and deep listening were used to centralise local narratives and language of OOPHE. Qualitative analysis software was used to thematically code transcripts and organise data. RESULTS A total of seven yarning sessions were conducted with 10 participants. Seven themes were identified: travel, barriers to health care, personal and social loss, restricted autonomy, financial strain, support initiatives and protective factors. Sleeping rough, selling assets and not attending appointments were used to mitigate or avoid OOPHE. Government initiatives, such as the patient assistance transport scheme, did little to decrease OOPHE burden on participants. Family connections, Indigenous knowledges and engagement with cultural practices were protective against OOPHE burden. CONCLUSION Aboriginal families are significantly burdened by OOPHE when needing to travel for health care. Radical change of government initiative and policies through to health professional awareness is needed to ensure equitable healthcare access that does not create additional financial hardship in communities already experiencing economic disadvantage.
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Affiliation(s)
- Courtney Ryder
- College of Medicine and Public Health, Flinders University, GPO Box 2100, SA 5001, Australia
- Flinders Health and Medical Research Institute, Flinders University, GPO Box 2100, SA 5001, Australia
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Rd, NSW 2050, Australia
- School of Population Health, UNSW, Sydney, NSW 2052, Australia
| | - Shane D'Angelo
- College of Medicine and Public Health, Flinders University, GPO Box 2100, SA 5001, Australia
- Flinders Health and Medical Research Institute, Flinders University, GPO Box 2100, SA 5001, Australia
| | - Patrick Sharpe
- Far West Community Partnerships, PO Box 730, Ceduna, SA 5690, Australia
| | - Tamara Mackean
- College of Medicine and Public Health, Flinders University, GPO Box 2100, SA 5001, Australia
- Flinders Health and Medical Research Institute, Flinders University, GPO Box 2100, SA 5001, Australia
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Rd, NSW 2050, Australia
| | - Nayia Cominos
- College of Medicine and Public Health, Flinders University, GPO Box 2100, SA 5001, Australia
| | - Julieann Coombes
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Rd, NSW 2050, Australia
| | - Keziah Bennett-Brook
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Rd, NSW 2050, Australia
| | - Darryl Cameron
- Moorundi Aboriginal Community Controlled Health Service, South Australia Health, Murray Bridge, Australia
| | - Emily Gloede
- College of Medicine and Public Health, Flinders University, GPO Box 2100, SA 5001, Australia
| | - Shahid Ullah
- College of Medicine and Public Health, Flinders University, GPO Box 2100, SA 5001, Australia
- Flinders Health and Medical Research Institute, Flinders University, GPO Box 2100, SA 5001, Australia
| | - Jacqueline Stephens
- College of Medicine and Public Health, Flinders University, GPO Box 2100, SA 5001, Australia
- Flinders Health and Medical Research Institute, Flinders University, GPO Box 2100, SA 5001, Australia
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Gallaway MS, Aseret-Manygoats T, Tormala W. Disparities of Access, Use, and Barriers to Seeking Health Care Services in Arizona. Med Care 2022; 60:113-118. [PMID: 35030560 PMCID: PMC8974357 DOI: 10.1097/mlr.0000000000001665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Access to health care (HC) services is important for promoting and maintaining health, preventing and managing disease, reducing unnecessary disability and premature death, and achieving health equity for all persons. OBJECTIVES We assess social indicators among people living in Arizona that are associated with access, use, and barriers to seeking HC services. RESEARCH DESIGN We analyzed data (n=8073) from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) to describe demographic and health characteristics among persons by HC access and use, and for whom costs were a barrier to seeking care. RESULTS Among Arizona adults, 13.5% reported lacking HC coverage, 28.7% reported lacking a personal doctor, and medical costs were a barrier to seeking care for 14.1%. Arizonans aged 18-34 years or with a high school education or less more often reported lacking HC coverage, a personal doctor, or not visiting a doctor because of costs. Past year medical and dental checkups were less common among less educated (≤high school) and never married persons. Hispanic persons more often reported lacking HC coverage or not visiting a doctor because of costs, and less often reported past year dental checkups. CONCLUSIONS BRFSS can be analyzed to identify and quantify unique HC disparities, and the findings can serve as the basis for improving HC in communities. Expansion of HC services and providers may be achieved, in part, through incentives for providers to work in designated health professional shortage areas and/or leveraging telehealth/telemedicine in rural and urban underserved communities.
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Affiliation(s)
- Michael Shayne Gallaway
- Arizona Department of Health Services, Phoenix, AZ
- Centers for Disease Control and Prevention, Atlanta, GA
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van Duinen AJ, Westendorp J, Ashley T, Hagander L, Holmer H, Koroma AP, Leather AJM, Shrime MG, Wibe A, Bolkan HA. Catastrophic expenditure and impoverishment after caesarean section in Sierra Leone: An evaluation of the free health care initiative. PLoS One 2021; 16:e0258532. [PMID: 34653191 PMCID: PMC8519447 DOI: 10.1371/journal.pone.0258532] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 09/29/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Utilizing surgical services, including caesarean sections, can result in catastrophic expenditure and impoverishment. In 2010, Sierra Leone introduced the Free Health Care Initiative (FHCI), a national financial risk protection program for the most vulnerable groups. Aim of this study was to investigate catastrophic expenditure and impoverishment related to caesarean section in Sierra Leone and evaluate the impact of the FHCI. METHODS Women who delivered by caesarean section in nine hospitals were followed up with home visits one month after surgery, and data on medical and non-medical expenditures were collected. Individual income was estimated based on household characteristics and used to determine catastrophic expenditure and impoverishment for each patient. The impact of the FHCI was assessed by comparing actual expenditure with counterfactual expenditures had the initiative not existed. RESULTS For the 1146 patients in the study, the median expenditure was 23 (IQR 4; 56) international dollars (Int$). Patients in the poorest quintile spent a median Int$ 59 (IQR 28; 76), which was significantly more than patients in the richest quintile, who spent a median Int$ 17 (IQR 2; 38, p<0.001). Travel (32.9%) and food (28.7%) were the two largest expenses. Catastrophic expenditure was encountered by 12.0% and 4.0% (10% and 25% threshold, respectively) of the women. Without the FHCI, 66.1% and 28.8% of the women would have encountered catastrophic expenditure. CONCLUSION Many women in Sierra Leone face catastrophic expenditure related to caesarean section, mainly through food and travel expenses, and the poor are disproportionally affected. The FHCI is effective in reducing the risk of catastrophic expenditure related to caesarean section, but many patients are still exposed to financial hardship, suggesting that additional support is needed for Sierra Leone's poorest patients.
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Affiliation(s)
- Alex J. van Duinen
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Surgery, St Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway
- * E-mail:
| | - Josien Westendorp
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Thomas Ashley
- Kamakwie Wesleyan Hospital, Kamakwie, Sierra Leone
- Department of Surgery, Connaught Hospital, Freetown, Sierra Leone
| | - Lars Hagander
- Centre for Surgery and Public Health, Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
| | - Hampus Holmer
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Alimamy P. Koroma
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Obstetrics and Gynaecology, Princess Christian Maternity Hospital (PCMH), University Teaching Hospitals Complex, University of Sierra Leone, Freetown, Sierra Leone
| | - Andrew J. M. Leather
- King’s Centre for Global Health & Health Partnerships, King’s College London, London, United Kingdom
| | - Mark G. Shrime
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, United States of America
| | - Arne Wibe
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Surgery, St Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Håkon A. Bolkan
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Surgery, St Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway
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Lenzen S, Bakx P, Bom J, van Doorslaer E. Health Care Use and Out-of-pocket Spending by Persons With Dementia Differ Between Europe and the United States. Med Care 2021; 59:543-549. [PMID: 33827110 DOI: 10.1097/mlr.0000000000001539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Persons with dementia need much care, but what care is used and how the burden of financing is divided between persons with dementia, caregivers, and public programs may differ between countries. OBJECTIVE The objective of this study was to compare how health care use and out-of-pocket (OOP) spending associated with dementia differ between the United States and Europe, with and without controlling for background characteristics. RESEARCH DESIGN We use prospectively collected survey data from the United States-based Health and Retirement Study (n=48,877) and the Survey of Health, Ageing, and Retirement in Europe (n=98,971) including all adults over the age of 70 years. Dementia status is imputed using a validated algorithm. After first reporting the observed differences in care use, we analyze how care use is associated with dementia using multivariate regressions, controlling for other health conditions and background characteristics. RESULTS Persons with dementia in the United States use 50% less formal home care per year than persons living with dementia in Europe [mean (SD)=236.8 h (1047.4) vs. 463.3 h (1371.2)], but use more nursing home care [75.1 d (131.4) vs. 45.5 d (119.4)). Dementia is associated with higher OOP spending in the United States than Europe [4406 USD (95% confidence interval, 3914-4899) vs. 246 USD (73-418)-2017 price levels]. CONCLUSIONS Health care use and OOP spending differ between Europe and the United States. The far greater reliance on nursing home care in the United States likely causes much higher expenditures for people with dementia and insurance programs alike.
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Affiliation(s)
- Sabrina Lenzen
- School of Economics, Centre for the Business and Economics of Health, The University of Queensland, St Lucia, QLD, Australia
| | - Pieter Bakx
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam (EUR)
| | - Judith Bom
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam (EUR)
| | - Eddy van Doorslaer
- Department of Health Economics, Erasmus School of Health Policy & Management, Erasmus School of Economics, Erasmus University Rotterdam (EUR)
- Tinbergen Institute, Rotterdam, The Netherlands
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Newhouse JP. Commentary on: The effects of coding intensity in Medicare advantage on plan benefits and finances. Health Serv Res 2021; 56:175-177. [PMID: 33730765 PMCID: PMC7968941 DOI: 10.1111/1475-6773.13639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Joseph P. Newhouse
- Health Care PolicyHarvard Medical SchoolBostonMassachusettsUSA
- Health Policy and ManagementHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Harvard Kennedy SchoolCambridgeMassachusettsUSA
- National Bureau of Economic ResearchCambridgeMassachusettsUSA
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Abstract
OBJECTIVE To assess how beneficiary premiums, expected out-of-pocket costs, and plan finances in the Medicare Advantage (MA) market are related to coding intensity. DATA SOURCES/STUDY SETTING MA plan characteristics and administrative records from the Centers for Medicare and Medicaid Services (CMS) for the sample of beneficiaries enrolled in both MA and Part D between 2008 and 2015. Medicare claims and drug utilization data for Traditional Medicare (TM) beneficiaries were used to calibrate an independent measure of health risk. STUDY DESIGN Coding intensity was measured by comparing the CMS risk score for each MA contract with a contract level risk score developed using prescription drug data. We conducted regressions of plan outcomes, estimating the relationship between outcomes and coding intensity. To develop prescription drug scores, we assigned therapeutic classes to beneficiaries based on their prescription drug utilization. We then regressed nondrug spending for TM beneficiaries in 2015 on demographic and therapeutic class identifiers for 2014 and used the coefficients to predict relative risk. PRINCIPAL FINDINGS We found that, for each $1 increase in potential revenue resulting from coding intensity, MA plan bid submissions declined by $0.10 to $0.19, and another $0.21 to $0.45 went toward reducing plans' medical loss ratios, an indication of higher profitability. We found only a small impact on beneficiary's projected out-of-pocket costs in a plan, which serves as a measure of the generosity of plan benefits, and a $0.11 to $0.16 reduction in premiums. As expected, coding intensity's effect on bids was substantially larger in counties with higher levels of MA competition than in less competitive counties. CONCLUSIONS While coding intensity increases taxpayers' costs of the MA program, enrollees and plans both benefit but with larger gains for plans. The adoption of policies to more completely adjust for coding intensity would likely affect both beneficiaries and plan profits.
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Affiliation(s)
- Paul D. Jacobs
- Agency for Healthcare Research and QualityCenter for Financing, Access, and Cost TrendsRockvilleMarylandUSA
| | - Richard Kronick
- Herbert Wertheim School of Public HealthUniversity of California San DiegoLa JollaCaliforniaUSA
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Fan H, Yan Q, Liu S, Cai J, Coyte PC. Childhood Nutrition in Rural China: What Impact Does Public Health Insurance Have? Value Health 2021; 24:317-324. [PMID: 33641764 DOI: 10.1016/j.jval.2020.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 05/28/2020] [Accepted: 06/25/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To investigate the impact of public health insurance coverage, specifically the New Cooperative Medical Scheme (NCMS), on childhood nutrition in poor rural households in China, and to identify the mechanisms through which health insurance coverage affects nutritional intake. METHODS Longitudinal data on 3291 children were taken from four time periods (2004, 2006, 2009, and 2011) from the China Health and Nutrition Survey (CHNS). Panel data analysis was performed with the fixed-effect model and the propensity score matching with difference-in-differences (PSM-DID) approach. RESULTS The introduction of the NCMS was associated with a decline in calories, fat, and protein intake, and an increase in the intake of carbohydrates. The NCMS had the greatest negative effect on children aged 0 to 5 years, particularly girls. Out-of-pocket medical expenses were identified as the main channel through which the NCMS affected the nutritional intake of children. CONCLUSIONS The study showed that the NCMS neither significantly improved the nutritional status of children nor enhanced intake of high-quality nutrients among rural poor households. These findings were attributed to the way in which health-seeking behavior was modified in the light of NCMS coverage. Specifically, NCMS coverage tended to increase healthcare utilization, which in turn increased out-of-pocket medical expenditures. This encouraged savings to aid financial risk protection and resulted in less disposable income for food consumption.
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Affiliation(s)
- Hongli Fan
- School of Insurance, Shandong University of Finance and Economics, Jinan, Shandong, China
| | - Qingyue Yan
- School of Insurance, Shandong University of Finance and Economics, Jinan, Shandong, China
| | - Suchun Liu
- School of Insurance, Shandong University of Finance and Economics, Jinan, Shandong, China
| | - Jiaoli Cai
- School of Economics and Management, Beijing Jiaotong University, Beijing, China.
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Abstract
This cross-sectional study examines whether efforts to limit out-of-pocket spending for enrollees in nonsubsidized Medicare Part D plans are associated with insulin adherence rates among these patients.
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Affiliation(s)
- Erin Trish
- University of Southern California Schaeffer Center for Health Policy and Economics, Los Angeles, California
- University of Southern California, School of Pharmacy, Los Angeles, California
| | - Katrina Kaiser
- University of Southern California Schaeffer Center for Health Policy and Economics, Los Angeles, California
| | - Geoffrey Joyce
- University of Southern California Schaeffer Center for Health Policy and Economics, Los Angeles, California
- University of Southern California, School of Pharmacy, Los Angeles, California
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Boima V, Agyabeng K, Ganu V, Dey D, Yorke E, Amissah-Arthur MB, Wilson AA, Yawson AE, Mate-Kole CC, Nonvignon J. Willingness to pay for kidney transplantation among chronic kidney disease patients in Ghana. PLoS One 2020; 15:e0244437. [PMID: 33378327 PMCID: PMC7773273 DOI: 10.1371/journal.pone.0244437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/09/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Kidney transplantation is the preferred treatment for patients with end stage renal disease. However, it is largely unavailable in many sub-Sahara African countries including Ghana. In Ghana, treatment for end stage renal disease including transplantation, is usually financed out-of-pocket. As efforts continue to be made to expand the kidney transplantation programme in Ghana, it remains unclear whether patients with Chronic Kidney Disease (CKD) would be willing to pay for a kidney transplant. AIM The aim of the study was to assess CKD patients' willingness to pay for kidney transplantation as a treatment option for end stage renal disease in Ghana. METHODS A facility based cross-sectional study conducted at the Renal Outpatient clinic and Dialysis Unit of Korle-Bu Teaching Hospital among 342 CKD patients 18 years and above including those receiving haemodialysis. A consecutive sampling approach was used to recruit patients. Structured questionnaires were administered to obtain information on demographic, socio-economic, knowledge about transplant, perception of transplantation and willingness to pay for transplant. In addition, the INSPIRIT questionnaire was used to assess patients' level of religiosity and spirituality. Contingent valuation method (CVM) method was used to assess willingness to pay (WTP) for kidney transplantation. Logistic regression model was used to determine the significant predictors of WTP. RESULTS The average age of respondents was 50.2 ± 17.1 years with most (56.7% (194/342) being male. Overall, 90 out of the 342 study participants (26.3%, 95%CI: 21.7-31.3%) were willing to pay for a kidney transplant at the current going price (≥ $ 17,550) or more. The median amount participants were willing to pay below the current price was $986 (IQR: $197 -$1972). Among those willing to accept (67.3%, 230/342), 29.1% (67/230) were willing to pay for kidney transplant at the prevailing price. Wealth quintile, social support in terms of number of family friends one could talk to about personal issues and number of family members one can call on for help were the only factors identified to be significantly predictive of willingness to pay (p-value < 0.05). CONCLUSION The overall willingness to pay for kidney transplant is low among chronic kidney disease patients attending Korle-Bu Teaching Hospital. Patients with higher socio-economic status and those with more family members one can call on for help were more likely to pay for kidney transplantation. The study's findings give policy makers an understanding of CKD patients circumstances regarding affordability of the medical management of CKD including kidney transplantation. This can help develop pricing models to attain an ideal poise between a cost effective but sustainable kidney transplant programme and improve patient access to this ultimate treatment option.
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Affiliation(s)
- V. Boima
- Department of Medicine and Therapeutics University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
- * E-mail: ,
| | - K. Agyabeng
- Departments of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - V. Ganu
- Department of Medicine and therapeutics, Korle-Bu Teaching Hospital, Accra, Ghana
| | - D. Dey
- Department of Medicine and Therapeutics University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - E. Yorke
- Department of Medicine and Therapeutics University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - M. B. Amissah-Arthur
- Department of Medicine and Therapeutics University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - A. A. Wilson
- Departemnt of Public Health, Greater Accra regional Hospital, Ghana Health Service, Accra, Ghana
| | - A. E. Yawson
- Departments of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - C. C. Mate-Kole
- Department of Medicine and Therapeutics University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
- Department of Psychology/Center for ageing studies, College of Humanities, University of Ghana, Legon, Ghana
| | - J. Nonvignon
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
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Fung V, Price M, Nierenberg AA, Hsu J, Newhouse JP, Cook BL. Assessment of Behavioral Health Services Use Among Low-Income Medicare Beneficiaries After Reductions in Coinsurance Fees. JAMA Netw Open 2020; 3:e2019854. [PMID: 33030552 PMCID: PMC7545309 DOI: 10.1001/jamanetworkopen.2020.19854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Medicare has historically imposed higher beneficiary coinsurance for behavioral health services than for medical and surgical care but gradually introduced parity between 2009 and 2014. Although Medicare insures many people with serious mental illness (SMI), there is limited information on the impact of coinsurance parity in this population. OBJECTIVE To examine the association between coinsurance parity and outpatient behavioral health care use among low-income beneficiaries with SMI. DESIGN, SETTING, AND PARTICIPANTS This cohort study used Medicare claims data for a 50% national sample of lower-income Medicare beneficiaries from January 1, 2007, to December 31, 2016. The study sample included patients with SMI (schizophrenia, bipolar disorder, or major depressive disorder). Data analysis was performed from August 1, 2018, to July 15, 2020. EXPOSURES Reduction in behavioral health care coinsurance from 50% to 20% between January 1, 2009, and January 1, 2014. MAIN OUTCOMES AND MEASURES Total annual spending for outpatient behavioral health care visits and the percentage of beneficiaries with an annual outpatient behavioral health care visit overall, with a prescriber, and with a psychiatrist. A difference-in-difference approach was used to compare outcomes before and after the reduction in coinsurance for beneficiaries with and without cost-sharing decreases. Linear regression models with beneficiary fixed effects that adjusted for time-changing beneficiary- and area-level covariates were used to examine changes in outcomes. RESULTS The study included 793 275 beneficiaries with SMI in 2008; 518 893 (65.4%) were younger than 65 years (mean [SD] age, 57.6 [16.1] years), 511 265 (64.4%) were female, and 552 056 (69.6%) were White. In 2008, the adjusted percentage of beneficiaries with an outpatient behavioral health care visit was 40.7% (95% CI, 40.4%-41.0%) among those eligible for the cost-sharing reduction and 44.9% (95% CI, 44.9%-45.0%) among those with free care. The mean adjusted out-of-pocket costs for outpatient behavioral health care visits decreased from $132 (95% CI, $129-$136) in 2008 to $64 (95% CI, $61-$66) in 2016 among those with reductions in cost-sharing. The adjusted percentage of beneficiaries with behavioral health care visits increased to 42.2% (95% CI, 41.9%-42.5%) in the group with a reduction in coinsurance and to 47.2% (95% CI, 47.0%-47.3%) in the group with free care. The cost-sharing reduction was not positively associated with visits (eg, relative change of -0.76 percentage points [95% CI, -1.12 to -0.40 percentage points] in the percentage of beneficiaries with outpatient behavioral health care visits in 2016 vs 2008). CONCLUSIONS AND RELEVANCE This cohort study found that beneficiary costs for outpatient behavioral health care decreased between 2009 and 2014. There was no association between cost-sharing reductions and changes in behavioral health care visits. Low levels of use in this high-need population suggest the need for other policy efforts to address additional barriers to behavioral health care.
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Affiliation(s)
- Vicki Fung
- The Mongan Institute, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Mary Price
- The Mongan Institute, Massachusetts General Hospital, Boston
| | - Andrew A. Nierenberg
- Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Boston
| | - John Hsu
- The Mongan Institute, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Joseph P. Newhouse
- Harvard Medical School, Boston, Massachusetts
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Harvard Kennedy School, Cambridge, Massachusetts
| | - Benjamin L. Cook
- Harvard Medical School, Boston, Massachusetts
- Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts
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Mavrodi A, Aletras V. A Contingent Valuation Study for Eliciting a Monetary Value of a Quality-Adjusted Life-Year in the General Greek Population. Value Health Reg Issues 2020; 22:36-43. [PMID: 32731168 DOI: 10.1016/j.vhri.2020.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 12/24/2019] [Accepted: 03/13/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To elicit a willingness-to-pay (WTP) per quality-adjusted life-year (QALY) estimate for the general Greek population and assess the impact of individuals' socio-demographic characteristics and motives on this estimate. METHODS A telephone-based survey was carried out employing a representative sample of the general Greek population (n = 1342). A computer-assisted telephone-interview method was adopted to ensure random sampling. A total of 528 participants reported a WTP value for a utility improvement from their current health to perfect health. Those individuals' motives were assessed through predefined statements. Test-retest reliability was assessed using intraclass correlation coefficient (ICC). Multiple linear regression (MLR) and one-way analysis of variance (ANOVA) tests were conducted to assess the effect of socioeconomic/demographic determinants and motive statements, respectively, on WTP/QALY. MLR was re-estimated considering as dependent variable the WTP/QALY estimate calculated for participants: (1) stating a WTP value ≤ their household income and (2) presenting higher certainty regarding stated WTP value (sensitivity analysis). RESULTS Analysis revealed good reliability for WTP/QALY estimates and motive statements (ICC values > 0.8). Mean WTP/QALY was €26 280. The respective 5% trimmed value was €14 862. Being a student and household income affected WTP/QALY. Sensitivity analysis did not produce markedly different WTP/QALY predictors, implying the robustness of results, irrespective of the participant group considered. Individuals who indicated the inability to cover basic family needs or pay tax claims as motives reported lower WTP/QALY values compared with those not viewing these aspects as motives. CONCLUSIONS Findings confirm that the World Health Organization's criterion used currently in Greek cost-effectiveness studies is not unreasonable. Additional research is essential to further explore WTP/QALY estimates in the Greek setting and facilitate informed decision making.
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Affiliation(s)
- Afentoula Mavrodi
- Department of Business Administration, University of Macedonia, Thessaloniki, Greece.
| | - Vassilis Aletras
- Department of Business Administration, University of Macedonia, Thessaloniki, Greece
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Hernández-Vásquez A, Rojas-Roque C, Vargas-Fernández R, Rosselli D. Measuring Out-of-pocket Payment, Catastrophic Health Expenditure and the Related Socioeconomic Inequality in Peru: A Comparison Between 2008 and 2017. J Prev Med Public Health 2020; 53:266-274. [PMID: 32752596 PMCID: PMC7411247 DOI: 10.3961/jpmph.20.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/20/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Describe out-of-pocket payment (OOP) and the proportion of Peruvian households with catastrophic health expenditure (CHE) and evaluate changes in socioeconomic inequalities in CHE between 2008 and 2017. METHODS We used data from the 2008 and 2017 National Household Surveys on Living and Poverty Conditions (ENAHO in Spanish), which are based on probabilistic stratified, multistage and independent sampling of areas. OOP was converted into constant dollars of 2017. A household with CHE was assumed when the proportion between OOP and payment capacity was ≥0.40. OOP was described by median and interquartile range while CHE was described by weighted proportions and 95% confidence intervals (CIs). To estimate the socioeconomic inequality in CHE we computed the Erreygers concentration index. RESULTS The median OOP reduced from 205.8 US dollars to 158.7 US dollars between 2008 and 2017. The proportion of CHE decreased from 4.9% (95% CI, 4.5 to 5.2) in 2008 to 3.7% (95% CI, 3.4 to 4.0) in 2017. Comparison of socioeconomic inequality of CHE showed no differences between 2008 and 2017, except for rural households in which CHE was less concentrated in richer households (p<0.05) and in households located on the rest of the coast, showing an increase in the concentration of CHE in richer households (p<0.05). CONCLUSIONS Although OOP and CHE reduced between 2008 and 2017, there is still socioeconomic inequality in the burden of CHE across different subpopulations. To reverse this situation, access to health resources and health services should be promoted and guaranteed to all populations.
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Affiliation(s)
- Akram Hernández-Vásquez
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Lima, Peru
| | | | | | - Diego Rosselli
- Clinical Epidemiology and Biostatistics Department, Pontificia Universidad Javeriana, Medical School, Bogota, Colombia
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Khan JAM, Ahmed S, Sultana M, Sarker AR, Chakrovorty S, Rahman MH, Islam Z, Rehnberg C, Niessen LW. The effect of a community-based health insurance on the out-of-pocket payments for utilizing medically trained providers in Bangladesh. Int Health 2020; 12:287-298. [PMID: 31782795 PMCID: PMC7322207 DOI: 10.1093/inthealth/ihz083] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND We aimed to estimate the effect of the community-based health insurance (CBHI) scheme on the magnitude of out-of-pocket (OOP) payments for the healthcare of the informal workers and their dependents. The CBHI scheme was piloted through a cooperative of informal workers, which covered seven unions in Chandpur Sadar Upazila, Bangladesh. METHODS A quasi-experimental study was conducted using a case-comparison design. In total 1292 (646 insured and 646 uninsured) households were surveyed. Propensity score matching was done to minimize the observed baseline differences in the characteristics between the insured and uninsured groups. A two-part regression model was applied using both the probability of OOP spending and magnitude of such spending for healthcare in assessing the association with enrolment status in the CBHI scheme while controlling for other covariates. RESULTS The OOP payment was 6.4% (p < 0.001) lower for medically trained provider (MTP) utilization among the insured compared with the uninsured. However, no significant difference was found in the OOP payments for healthcare utilization from all kind of providers, including the non-trained ones. CONCLUSIONS The CBHI scheme could reduce OOP payments while providing better quality healthcare through the increased use of MTPs, which consequently could push the country towards universal health coverage.
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Affiliation(s)
- Jahangir A M Khan
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, United Kingdom
- Universal Health Coverage Programme, Health Systems and Population Studies Division, icddr, b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
- Health Economics and Policy Research Group, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Tomtebodavägen 18a, 171 65 Solna, Sweden
| | - Sayem Ahmed
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, United Kingdom
- Universal Health Coverage Programme, Health Systems and Population Studies Division, icddr, b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
- Health Economics and Policy Research Group, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Tomtebodavägen 18a, 171 65 Solna, Sweden
| | - Marufa Sultana
- Universal Health Coverage Programme, Health Systems and Population Studies Division, icddr, b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
- Deakin Health Economics, School of Health and Social Development, Deakin University, 221 Burwood Highway Burwood VIC 3125 Melbourne, Australia
| | - Abdur Razzaque Sarker
- Health Economics and Financing Research, Population Studies Division, Bangladesh Institute of Development Studies (BIDS), E-17, Shahid Shahabuddin Shorok, Agargaon, Dhaka 1207, Bangladesh
| | - Sanchita Chakrovorty
- Universal Health Coverage Programme, Health Systems and Population Studies Division, icddr, b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
- Department of Agricultural Economics, Purdue University, Room # 631, Krannert Building, 403 West State Street, West Lafayette, Indiana 47906, USA
| | - Mohammad Hafizur Rahman
- Health Economics Unit, Ministry of Health and Family Welfare, 14/2 Topkhana Road (3rd–4th Floor), Dhaka 1000, Bangladesh
| | - Ziaul Islam
- Universal Health Coverage Programme, Health Systems and Population Studies Division, icddr, b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
| | - Clas Rehnberg
- Health Economics and Policy Research Group, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Tomtebodavägen 18a, 171 65 Solna, Sweden
| | - Louis W Niessen
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, United Kingdom
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Attoye TE, Adebobola PA, Inem V. An Assessment of Glycaemic Control and Modes of Health Financing among Type 2 Diabetic Patients Attending a Teaching Hospital in South-western Nigeria. West Afr J Med 2020; 37:237-247. [PMID: 32476117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus can be a major drain on resources due to lifelong treatment and risk of catastrophic expenditure from treatment of complications. The prevalence has been projected to rise to alarming levels in developing countries. This study aimed to assess the levels of, and associations between good glycaemic control among patients with type 2 diabetes and their modes of financing healthcare. METHODS In this hospital based descriptive cross-sectional study, 260 patients being managed for type 2 diabetes at the outpatient clinics of Lagos University Teaching Hospital, Lagos were recruited by systematic random sampling method. All participants received a HBA1C test to assess glycaemic control and a composite interviewer administered questionnaire adapted from the MMAS-8 and diabetes care profile to assess medication adherence, modes of financing and other factors related to disease management. RESULTS Of the 260 study participants, 34.62% (90) had good glycaemic control. In the mode of health care financing only 15% (39) paid by health insurance (NHIS), while 85% of the respondents' payment was by out-of-pocket (OOP) payment. About half of these OOP payments were made by family, friends and others (in this study, a proxy for informal means of pooling finances). Significant associations were found between glycaemic control and adherence (2 13.93, p=0.001), glycaemic control and mode of payment (2 15.30, p=0.0000) and also adherence and mode of payment (2 16.59, p =0.002). CONCLUSION In this study, only about a third of patients with type 2 diabetes achieved good glycaemic control, most patients used OOP financing and patients with OOP financing had poorer adherence and poorer glycaemic control. There is a need to scale up health insurance to improve health outcomes in diabetes management and protect people in developing countries from the burden of health care costs of chronic diseases like type 2 diabetes.
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Affiliation(s)
- T E Attoye
- Department of Family Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - P A Adebobola
- Department of Family Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - V Inem
- Department of Community Health and Primary Care, College of Medicine University of Lagos, Nigeria
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Fischer FB, Mengliboeva Z, Karimova G, Abdujabarov N, Prytherch H, Wyss K. Out of pocket expenditures of patients with a chronic condition consulting a primary care provider in Tajikistan: a cross-sectional household survey. BMC Health Serv Res 2020; 20:546. [PMID: 32546162 PMCID: PMC7298845 DOI: 10.1186/s12913-020-05392-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Within its reform efforts, the Government of Tajikistan is embracing the essential role of primary health care (PHC) in decreasing out of pocket (OOP) expenditures and increasing equity in access to health services. In the light of the increasing burden of disease relating to chronic conditions, we investigated OOP expenditures of patients with chronic conditions within a PHC setting; and if and how those expenditures are impacted by several interventions currently being implemented within Tajikistan. METHODS A cross-sectional survey among 1600 adult patients who had visited a PHC facility was conducted. The data obtained through interviews were descriptively analysed, and logistic regressions and gamma generalized linear models were performed. RESULTS The total OOP expenditures related to a patient's last visit to the PHC facility were 17.2 USD for those with chronic conditions and 13.9 USD for those visiting due to an acute condition. Adjustment for potential confounders reduced the discrepancy from 3.3 USD to 0.5 USD. This convergence of costs was only observed in districts covered by the Basic Benefit Package (BBP), a governmental pilot project, aiming to standardise exemptions for payment and formal co-payments for health care services. Hence, we found the BBP to have a protective impact for patients with chronic conditions. However, considering the demographics of these patients (older in age, with greater dependency on pensions and social aid, and lower socio-economic status) in combination with the 40% higher utilisation rate of PHC and the high rate of onward referrals to specialists; it is clear that patients with chronic conditions continue to face substantial long-term costs and disadvantages. CONCLUSIONS After accounting for confounders, patients with chronic and acute conditions faced similar costs related to a single visit to a PHC facility in districts covered by the BBP. However, greater efforts are required to ensure that citizens are well informed about their rights to health care, the BBP and the services that should be provided at no cost at the point of delivery. Moreover, the needs of patients with chronic conditions warrant a more integrative approach that takes long-term expenditures and services beyond the level of PHC into account.
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Affiliation(s)
- Fabienne B. Fischer
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Zulfira Mengliboeva
- Swiss Agency for Development and Cooperation’s Enhancing Primary Health Care Services Project (Project Sino), Dushanbe, Tajikistan
| | - Gulzira Karimova
- Swiss Agency for Development and Cooperation’s Enhancing Primary Health Care Services Project (Project Sino), Dushanbe, Tajikistan
| | - Nasrullo Abdujabarov
- Swiss Agency for Development and Cooperation’s Enhancing Primary Health Care Services Project (Project Sino), Dushanbe, Tajikistan
| | - Helen Prytherch
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kaspar Wyss
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Silverstein M, Zhang W. Grandparents' Financial Contributions to Grandchildren in Rural China: The Role of Remittances, Household Structure, and Patrilineal Culture. J Gerontol B Psychol Sci Soc Sci 2020; 75:1042-1052. [PMID: 30698810 PMCID: PMC7931852 DOI: 10.1093/geronb/gbz009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 01/18/2019] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES This investigation examined predictors of monetary transfers made by grandparents for the benefit of their grandchildren in rural China. Predictors included family factors related to financial supply (remittances received from the parents of grandchildren), household demand (living in a skipped-generation household), and patrilineal culture (targeting sons and grandsons). METHOD The 2015 wave of the Longitudinal Study of Older Adults in Anhui Province was used to study financial transfers made by 831 grandparents to grandchildren in the families of 1,633 parents. Two-part random-effects regression was used to predict whether a transfer was made and the value of transfers, given that one occurred. RESULTS Grandparents provided higher value transfers to grandchildren whose parents provided greater remittances and with whom they coresided in skipped-generation households. The likelihood of making a transfer fully followed the male lineage, and was greatest to grandson-only families in which parents were first-born sons. DISCUSSION Results show that economic, household, and cultural factors are independently associated with the largesse of grandparents. We conclude that grandparents' economic contributions to grandchildren in rural China are shaped by family demands in a highly mobile society, intergenerational interdependence, and a persistent patrilineal gender system that reaches to the level of grandchildren.
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Affiliation(s)
- Merril Silverstein
- Department of Sociology, Syracuse University, New York
- Department of Human Development, and Family Science, Syracuse University, New York
- Aging Studies Institute, Syracuse University, New York
| | - Wencheng Zhang
- Department of Sociology, Syracuse University, New York
- Aging Studies Institute, Syracuse University, New York
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Ahmed S, Sarker AR, Sultana M, Roth F, Mahumud RA, Kamruzzaman M, Hasan MZ, Mirelman AJ, Islam Z, Niessen LW, Rehnberg C, Khan AA, Gyr N, Khan JAM. Do employer-sponsored health insurance schemes affect the utilisation of medically trained providers and out-of-pocket payments among ready-made garment workers? A case-control study in Bangladesh. BMJ Open 2020; 10:e030298. [PMID: 32132134 PMCID: PMC7059493 DOI: 10.1136/bmjopen-2019-030298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 12/02/2019] [Accepted: 12/17/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We estimated the effect of an employer-sponsored health insurance (ESHI) scheme on healthcare utilisation of medically trained providers and reduction of out-of-pocket (OOP) expenditure among ready-made garment (RMG) workers. DESIGN We used a case-control study design with cross-sectional preintervention and postintervention surveys. SETTINGS The study was conducted among workers of seven purposively selected RMG factories in Shafipur, Gazipur in Bangladesh. PARTICIPANTS In total, 1924 RMG workers (480 from the insured and 482 from the uninsured, in each period) were surveyed from insured and uninsured RMG factories, respectively, in the preintervention (October 2013) and postintervention (April 2015) period. INTERVENTIONS We tested the effect of a pilot ESHI scheme which was implemented for 1 year. OUTCOME MEASURES The outcome measures were utilisation of medically trained providers and reduction of OOP expenditure among RMG workers. We estimated difference-in-difference (DiD) and applied two-part regression model to measure the association between healthcare utilisation, OOP payments and ESHI scheme membership while controlling for the socioeconomic characteristics of workers. RESULTS The ESHI scheme increased healthcare utilisation of medically trained providers by 26.1% (DiD=26.1; p<0.01) among insured workers compared with uninsured workers. While accounting for covariates, the effect on utilisation significantly reduced to 18.4% (p<0.05). The DiD estimate showed that OOP expenditure among insured workers decreased by -3700 Bangladeshi taka and -1100 Bangladeshi taka compared with uninsured workers when using healthcare services from medically trained providers or all provider respectively, although not significant. The multiple two-part models also reported similar results. CONCLUSION The ESHI scheme significantly increased utilisation of medically trained providers among RMG workers. However, it has no significant effect on OOP expenditure. It can be recommended that an educational intervention be provided to RMG workers to improve their healthcare-seeking behaviours and increase their utilisation of ESHI-designated healthcare providers while keeping OOP payments low.
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Affiliation(s)
- Sayem Ahmed
- Health Economics and Financing Research, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Health Economics and Policy, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Abdur Razzaque Sarker
- Health Economics and Financing Research, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Department of Management Science, University of Strathclyde, Glasgow, UK
- Health Economics and Financing Research, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
| | - Marufa Sultana
- Deakin Health Economics, School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Felix Roth
- Swiss Micro Insurance Consultancy Group (SMCG), Basel, Switzerland
| | - Rashidul Alam Mahumud
- Health Economics and Financing Research, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
| | | | - Md Zahid Hasan
- Health Economics and Financing Research, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Ziaul Islam
- Health Economics and Financing Research, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Louis W Niessen
- Liverpool School of Tropical Medicine, Liverpool, UK
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Clas Rehnberg
- Health Economics and Policy, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Ak Azad Khan
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Niklaus Gyr
- Department of Internal Medicine, University of Basel, Basel, Switzerland
| | - Jahangir A M Khan
- Health Economics and Policy, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
- Liverpool School of Tropical Medicine, Liverpool, UK
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Guerra ME, Jean RA, Chiu AS, Johnson DC. The effect of sociodemographic factors on outcomes and time to discharge after bariatric operations. Am J Surg 2020; 219:571-577. [PMID: 32147020 DOI: 10.1016/j.amjsurg.2020.02.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 02/19/2020] [Accepted: 02/23/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Bariatric surgery is an effective treatment for obesity resulting in both sustained weight loss and reduction in obesity-related comorbidities. It is uncertain how sociodemographic factors affect postoperative outcomes. METHODS The National Inpatient Sample was queried for patients undergoing Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) from 2005 to 2014. Factors associated with selection of SG over RYGB, increased postoperative length of stay (LOS) greater than 3 days, and inpatient mortality were compared by race, insurance status, and other clinical and hospital factors. RESULTS The database captured 781,413 patients, of which 525,986 had a RYGB and 255,428 had SG. There was an increase in the incidence of SG over RYGB over time. Among the self-pay/uninsured, the increased incidence began several years earlier than other groups. Black patients had greater odds of increased postoperative LOS (OR 1.40) and in-hospital mortality (OR 2.11). CONCLUSION Sociodemographic factors are associated with differences in temporal trends in the adoption of SG versus RYGB for surgical weight loss.
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Affiliation(s)
| | - Raymond A Jean
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
| | - Alexander S Chiu
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Dirk C Johnson
- Section of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Yale School of Medicine, USA
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Tumlinson K, Gichane MW, Curtis SL. "If the Big Fish are Doing It Then Why Not Me Down Here?": Informal Fee Payments and Reproductive Health Care Provider Motivation in Kenya. Stud Fam Plann 2020; 51:33-50. [PMID: 32043621 DOI: 10.1111/sifp.12107] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Informal fees are payments made by patients to their health care provider that are over and above the official cost of services. Payments may be motivated by a combination of factors such as low supervision, weak sanctions, and inadequate provider salaries. The practice of soliciting informal fees from patients may result in restricted access to medical care and reduced care-seeking behavior among vulnerable populations. The objective of this study is to examine nuanced health care provider perspectives on informal fee payments solicited from reproductive health patients in Kenya. We conducted in-depth semistructured interviews in 2015-2016 among a sample of 20 public and private-sector Kenyan health care workers. Interviews were coded and analyzed using an iterative thematic approach. More than half of participants reported that solicitation of informal fees is common practice in health care facilities. Providers reported low public-sector wages were a primary driver of informal fee solicitation coupled with collusion among senior staff. Additionally, patients may be unaware that they are being asked to pay more than the official cost of services. Strategies for reducing this behavior include more adequate and timely remuneration within the public sector, educating patient populations of free or low-cost services, and evidence-based methods to increase provider motivation.
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Gotanda H, Jha AK, Kominski GF, Tsugawa Y. Out-of-pocket spending and financial burden among low income adults after Medicaid expansions in the United States: quasi-experimental difference-in-difference study. BMJ 2020; 368:m40. [PMID: 32024637 PMCID: PMC7190017 DOI: 10.1136/bmj.m40] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the association between expansion of the Medicaid program under the Affordable Care Act and changes in healthcare spending among low income adults during the first four years of the policy implementation (2014-17). DESIGN Quasi-experimental difference-in-difference analysis to examine out-of-pocket spending and financial burden among low income adults after Medicaid expansions. SETTING United States. PARTICIPANTS A nationally representative sample of individuals aged 19-64 years, with family incomes below 138% of the federal poverty level, from the 2010-17 Medical Expenditure Panel Survey. MAIN OUTCOMES AND MEASURES Four annual healthcare spending outcomes: out-of-pocket spending; premium contributions; out-of-pocket plus premium spending; and catastrophic financial burden (defined as out-of-pocket plus premium spending exceeding 40% of post-subsistence income). P values were adjusted for multiple comparisons. RESULTS 37 819 adults were included in the study. Healthcare spending did not change in the first two years, but Medicaid expansions were associated with lower out-of-pocket spending (adjusted percentage change -28.0% (95% confidence interval -38.4% to -15.8%); adjusted absolute change -$122 (£93; €110); adjusted P<0.001), lower out-of-pocket plus premium spending (-29.0% (-40.5% to -15.3%); -$442; adjusted P<0.001), and lower probability of experiencing a catastrophic financial burden (adjusted percentage point change -4.7 (-7.9 to -1.4); adjusted P=0.01) in years three to four. No evidence was found to indicate that premium contributions changed after the Medicaid expansions. CONCLUSION Medicaid expansions under the Affordable Care Act were associated with lower out-of-pocket spending and a lower likelihood of catastrophic financial burden for low income adults in the third and fourth years of the act's implementation. These findings suggest that the act has been successful nationally in improving financial risk protection against medical bills among low income adults.
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Affiliation(s)
- Hiroshi Gotanda
- Division of General Internal Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA
| | - Ashish K Jha
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Gerald F Kominski
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- UCLA Center for Health Policy Research, Los Angeles, CA, USA
| | - Yusuke Tsugawa
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- UCLA Center for Health Policy Research, Los Angeles, CA, USA
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Pourtaleb A, Jafari M, Seyedin H, Akhavan Behbahani A. New insight into the informal patients' payments on the evidence of literature: a systematic review study. BMC Health Serv Res 2020; 20:14. [PMID: 31902368 PMCID: PMC6943960 DOI: 10.1186/s12913-019-4647-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 10/16/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Nowadays, a growing literature reveals how patients use informal payments to seek either better treatment or additional services, but little systematic review has been accomplished for synthesizing the main factors. The purpose of this study was to analyze the content of literatures to demonstrate the factors for informal patient payments. METHODS In this systematic review study, PubMed, Web of Science, Wiley Online Library, Science Direct, Ovid, Scopus, and Iranian databases were investigated without time limitation for eligible English and Persian studies. Achieved data were analyzed using content analysis approach and MAXQDA 10 software. RESULTS Themes related to informal payments in external context of health system were demographic features of health service consumers, patient's personality features and social & cultural backgrounds of the community. Health system challenges' themes were about stewardship weakness, and sustainable financing and social protection weakness. These were followed by human resources' organizational behavior challenges, drugs, medical products, and services delivery provision process challenges and finally change management weakness for reducing and dealing with IPs. CONCLUSION It appears that improving the quality of health care services and accurate monitoring of delivery processes, along with performing some strategies for regulating payroll and medical tariffs, strict rules and regulations and improving health staff motivation, would be effective ways against informal payments. Improving the health insurance contribution, promoting transparency & accountability in health system especially in financing, identify precise control mechanism, using empower patient/public related approach, modifying community perception, reinforcing social resistance to unofficial payments and rebuilt lost social capital in health care are some of the other recommendations in this field. To practice these strategies, a comprehensive and systemic vision and approach is needed, however, the key point is that before applying any strategy the impact of this strategy on access, efficiency, equity, and other health systems' goals and policies should be investigated due to the consideration.
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Affiliation(s)
- Arefeh Pourtaleb
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
- Health Managers Development Institute, Ministry of Health and Medical Education, Tehran, Iran
| | - Mehdi Jafari
- Health Managers Development Institute, Ministry of Health and Medical Education, Tehran, Iran
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hesam Seyedin
- Department of Health in Disaster and Emergencies, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Maman D, Rosenhek Z. Responsibility, planning and risk management: moralizing everyday finance through financial education. Br J Sociol 2019; 70:1996-2019. [PMID: 31372977 DOI: 10.1111/1468-4446.12698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/15/2019] [Indexed: 06/10/2023]
Abstract
The individualization, privatization and marketization of risk management represent a fundamental dimension of the financialization of everyday life. As individuals are required to engage with financial products and services as the main way of protecting themselves from risks and uncertainties, their economic welfare and security are construed as depending largely on their own financial decisions. Within this setting, the concept of financial literacy and accompanying practices of financial education have emerged as a prominent institutional field handling the formulation and communication of the attributes and dispositions that arguably constitute the proper financial actor. This article analyzes financial education programmes currently conducted by state agencies in Israel, examining the notions and principles they articulate when defining and explaining proper financial conduct. The study indicates that moral themes and categories occupy a salient place in the formulation of the character traits that constitute the desired literate financial actor. Notions of individual responsibility, planning ahead and rational risk management are presented not merely as instrumental resources, but as moral imperatives. Through these notions, the programmes moralize a broad array of everyday practices of personal finance such as saving, investing, borrowing and budget management, thereby connecting the sphere of financial matters to the domain of moral virtues. Offering a representation of particular modes of financial conduct as constitutive components of morally virtuous personhood, these practices imbue the financial field as a whole, especially its current generalized logic of individualized and marketized risk management, with moral meanings, hence contributing to the normalization and depoliticization of the financialization of everyday life.
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Affiliation(s)
- Daniel Maman
- Department of Sociology and Anthropology, Ben-Gurion University of the Negev
| | - Zeev Rosenhek
- Department of Sociology, Political Science and Communication, The Open University of Israel
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Devine A, Pasaribu AP, Teferi T, Pham HT, Awab GR, Contantia F, Nguyen TN, Ngo VT, Tran TH, Hailu A, Gilchrist K, Green JA, Koh GCKW, Thriemer K, Taylor WRJ, Day NPJ, Price RN, Lubell Y. Provider and household costs of Plasmodium vivax malaria episodes: a multicountry comparative analysis of primary trial data. Bull World Health Organ 2019; 97:828-836. [PMID: 31819291 PMCID: PMC6883272 DOI: 10.2471/blt.18.226688] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 08/08/2019] [Accepted: 08/20/2019] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To determine household and health-care provider costs associated with Plasmodium vivax infection across a range of endemic settings. METHODS We collected cost data alongside three multicentre clinical trials of P. vivax treatment in Afghanistan, Brazil, Colombia, Ethiopia, Indonesia, Philippines, Peru, Thailand and Viet Nam conducted between April 2014 to December 2017. We derived household costs from trial participant surveys administered at enrolment and again 2 weeks later to determine the costs of treatment and transportation, and the number of days that patients and their household caregivers were unable to undertake their usual activities. We determined costs of routine care by health-care providers by micro-costing the resources used to diagnose and treat P. vivax at the study sites. FINDINGS The mean total household costs ranged from 8.7 United States dollars (US$; standard deviation, SD: 4.3) in Afghanistan to US$ 254.7 (SD: 148.4) in Colombia. Across all countries, productivity losses were the largest household cost component, resulting in mean indirect costs ranging from US$ 5.3 (SD: 3.0) to US$ 220.8 (SD: 158.40). The range of health-care provider costs for routine care was US$ 3.6-6.6. The cost of administering a glucose-6-phosphate-dehydrogenase rapid diagnostic test, ranged from US$ 0.9 to 13.5, consistently lower than the costs of the widely-used fluorescent spot test (US$ 6.3 to 17.4). CONCLUSION An episode of P. vivax malaria results in high costs to households. The costs of diagnosing and treating P. vivax are important inputs for future cost-effectiveness analyses to ensure optimal allocation of resources for malaria elimination.
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Affiliation(s)
- Angela Devine
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory 0811, Australia
| | | | | | - Huong-Thu Pham
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
| | | | | | - Thuy-Nhien Nguyen
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
| | - Viet-Thanh Ngo
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
| | - Tinh-Hien Tran
- Oxford University Clinical Research Unit, University of Oxford, Oxford, England
| | - Asrat Hailu
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kim Gilchrist
- GlaxoSmithKline, Collegeville, Pennsylvania, United States of America
| | - Justin A Green
- GlaxoSmithKline Research & Development, Uxbridge, England
| | - Gavin CKW Koh
- GlaxoSmithKline Research & Development, Uxbridge, England
| | - Kamala Thriemer
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory 0811, Australia
| | - Walter RJ Taylor
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Nicholas PJ Day
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Ric N Price
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory 0811, Australia
| | - Yoel Lubell
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
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Terlizzi EP, Cohen RA. Differences in Select Measures of Health Care Access, Utilization, and Financial Burden by Urbanicity, 2017. Natl Health Stat Report 2019:1-13. [PMID: 32510305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Objective-This report examines select measures of health care access, utilization, and financial burden by metropolitan statistical area (MSA) status among adults aged 18-64. Methods-Data from the 2017 National Health Interview Survey were used to examine how a usual place to go for care, visits to a doctor or emergency room in the past year, unmet medical need due to cost, inability to afford prescription medications, and problems paying medical bills differed by MSA status among adults aged 18-64. Estimates are presented for adults living in a large MSA (population of 1 million or more), living in a small MSA (less than 1 million in population), and not living in an MSA. Results-In 2017, adults not living in an MSA generally had reduced access to or use of health care, and a higher financial burden associated with their care, compared with those in more populous areas. However, after controlling for selected sociodemographic and health characteristics, it was found that for the measures examined, adults not living in MSAs were more likely to have a usual place to go for care but less likely to have financial burden associated with their care compared with those in small or large MSAs. Conclusion-The unadjusted results show that adults not living in an MSA are more likely to have financial burden associated with their health care and reduced access to or use of health care services compared with those in large MSAs. However, the differences in the measures examined may be due to differential distributions of poverty levels, insurance coverage status, or other sociodemographic or health characteristics between the MSA status categories rather than MSA status itself.
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Fiestas Navarrete L, Ghislandi S, Stuckler D, Tediosi F. Inequalities in the benefits of national health insurance on financial protection from out-of-pocket payments and access to health services: cross-sectional evidence from Ghana. Health Policy Plan 2019; 34:694-705. [PMID: 31539034 PMCID: PMC6880330 DOI: 10.1093/heapol/czz093] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2019] [Indexed: 11/13/2022] Open
Abstract
A central pillar of universal health coverage (UHC) is to achieve financial protection from catastrophic health expenditure. There are concerns, however, that national health insurance programmes with premiums may not benefit impoverished groups. In 2003, Ghana became the first sub-Saharan African country to introduce a National Health Insurance Scheme (NHIS) with progressively structured premium charges. In this study, we test the impact of being insured on utilization and financial risk protection compared with no enrolment, using the 2012-13 Ghana Living Standards Survey (n = 72 372). Consistent with previous studies, we observed that participating in health insurance significantly decreased the probability of unmet medical needs by 15 percentage points (p.p.) and that of incurring catastrophic out-of-pocket (OOP) health payments by 7 p.p. relative to no enrolment in the NHIS. Households living outside a 1-h radius to the nearest hospital had lower reductions in financial risk from excess OOP medical spending relative to households living closer (-5 p.p. vs -9 p.p.). We also find evidence that in Ghana, the scheme was highly pro-poor. Once insured, the poorest 40% of households experienced significantly larger improvements in medical utilization (18 p.p. vs. 8 p.p.) and substantively larger reductions in catastrophic OOP health expenditure (-10 p.p. vs. -6 p.p.) compared with that of the richest households. However, health insurance did not benefit vulnerable persons equally from financial risk. Once insured, poor, low-educated and self-employed households living far from hospitals had significantly lower reductions in catastrophic OOP medical spending compared with their counterparts living closer. Taken together, we show that enrolment in the NHIS is associated with improved financial protection but less so among geographically remote vulnerable groups. Efforts to boost not just insurance uptake but also health service delivery may be needed as a supplement for insurance schemes to accelerate progress towards UHC.
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Affiliation(s)
- Lucia Fiestas Navarrete
- Department of Social and Political Science, Bocconi University, Via Roentgen 1, Milan, Italy
- Canadian Centre for Health Economics, 155 College Street, Toronto, ON, Canada
| | - Simone Ghislandi
- Department of Social and Political Science, Bocconi University, Via Roentgen 1, Milan, Italy
- Centre for Research on Health and Social Care Management, Bocconi University, Via Roentgen 1, Milan, Italy
- Carlo F. Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Via Roentgen 1, Milan, Italy
| | - David Stuckler
- Department of Social and Political Science, Bocconi University, Via Roentgen 1, Milan, Italy
- Carlo F. Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Via Roentgen 1, Milan, Italy
| | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute, University of Basel, Socinstrasse 57, Basel, Switzerland
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Zhou Z, Verdery AM, Margolis R. No Spouse, No Son, No Daughter, No Kin in Contemporary China: Prevalence, Correlates, and Differences in Economic Support. J Gerontol B Psychol Sci Soc Sci 2019; 74:1453-1462. [PMID: 29688560 PMCID: PMC6777770 DOI: 10.1093/geronb/gby051] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 04/21/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES China's recent demographic and social changes might undermine the sustainability of its family-oriented system for elder care. We investigate kin availability among adults aged 45+ in contemporary China, with an emphasis on child gender. METHOD Using nationally representative survey data from the China Health and Retirement Longitudinal Study (2011), we examine the prevalence and correlates of lacking different kin types and combinations, and we test associations between kin availability and received economic support. RESULTS Kinlessness is low in China (less than 2% lack a spouse/partner and children), but kin availability is patterned by gender, age group, and sociodemographic characteristics. More than twice as many older adults have no spouse/partner and no daughter (3.2%) as those who have no spouse/partner and no son (1.4%). Adults without close kin are disadvantaged across health, wealth, and economic support. In contrast to traditional expectations, we find that those with only daughters are more similar to those with mixed sex children, whereas those with only sons are more similar to those without children in receipt of economic support. DISCUSSION Access to kin forms the basis of an emergent system of stratification in China, which will be amplified as cohorts with only one child age into older adulthood.
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Affiliation(s)
- Zhangjun Zhou
- Department of Sociology and Criminology, The Pennsylvania State University, University Park
| | - Ashton M Verdery
- Department of Sociology and Criminology, The Pennsylvania State University, University Park
| | - Rachel Margolis
- Department of Sociology, The University of Western Ontario, London, Canada
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Abstract
Using a novel data set from a major credit bureau, we examine the early effects of the Affordable Care Act Medicaid expansions on personal finance. We analyze less common events such as personal bankruptcy, and more common occurrences such as medical collection balances, and change in credit scores. We estimate triple-difference models that compare individual outcomes across counties that expanded Medicaid versus counties that did not, and across expansion counties that had more uninsured residents versus those with fewer. Results demonstrate financial improvements in states that expanded their Medicaid programs as measured by improved credit scores, reduced balances past due as a percent of total debt, reduced probability of a medical collection balance of $1,000 or more, reduced probability of having one or more recent medical bills go to collections, reduction in the probability of experiencing a new derogatory balance of any type, reduced probability of incurring a new derogatory balance equal to $1,000 or more, and a reduction in the probability of a new bankruptcy filing.
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Ettner SL, Xu H, Azocar F. What Happens When Employers Switch from a "Carve-Out" to a "Carve-In" Model of Managed Behavioral Health? J Ment Health Policy Econ 2019; 22:85-94. [PMID: 31811752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 07/24/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Since the introduction and soaring popularity of the managed behavioral healthcare (BH) "carve-out" model in the 1980s, policymakers have been concerned with their impact on access. In carve-outs, BH and medical benefits are administered separately. Earlier literature found they reduced intensity of service use while maintaining penetration rates. Recently it has become more common for employers to drop existing carve-out contracts, partly due to the Mental Health Parity and Addiction Equity Act (MHPAEA), which placed a greater administrative burden on carve-outs for parity compliance. Although prior studies focused exclusively on the impact of moving from carve-in to carve-out models, it is now more policy-relevant to understand the effects of the move from carve-out to carve-in, which may not be symmetric. Moreover, the natural experiment resulting from MHPAEA implementation may attenuate concerns about selection bias. STUDY AIMS This study examines how specialty BH care patterns change when employees and dependents are moved from a "carve-out" plan to a "carve-in" plan. METHODS Linked insurance claims, eligibility, plan and employer data from 2008-14 were obtained for three Optum( employers who dropped their carve-out contracts but retained their carve-in plans. A longitudinal "difference-in-differences" study design was used to compare changes in BH services use over time among individuals who were: (i) moved to carve-in plans when the employer dropped its carve-out contract (N=177,653); and (ii) enrolled in carve-in plans before and after the transition (N=58,658). Outcomes included total and inpatient expenditures, broken down by plan, patient, and total; outpatient visits for assessment, individual psychotherapy, family psychotherapy, and medication management; and days of structured outpatient care, day treatment, residential care, and acute inpatient care. We pooled person-year observations and estimated regressions including individual fixed effects, year dummies and interactions between indicators for post-transition period and whether transitioned from carve-out to carve-in. RESULTS Relative to individuals continuously in carve-in plans, those who were transitioned experienced significant increases in inpatient utilization (beta =.02; p=.05) and patient inpatient costs (beta =2.35; p=.01) and decreases in day treatment (beta =-0.01; p=.02). Our conclusions proved robust against potential biases due to differing secular time trends and differential changes in benefits resulting from MHPAEA. DISCUSSION The increased inpatient utilization associated with switching from carve-out to carve-in plans is consistent with previous literature. Carve-outs may use day treatment to reduce inpatient care so that increased inpatient utilization post-transition reduced demand for day treatment. Limitations include possible selection bias at the employer level; lack of data on medication and generalist use, quality, clinical endpoints and quality of life; and potential lack of generalizability. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE The reduction in the use of carve-out contracts by private employers associated with MHPAEA implementation likely did not have a net negative impact and may have actually increased access to care among former carve-out enrollees in need of inpatient services. IMPLICATIONS FOR HEALTH POLICIES Policymakers should consider and evaluate possible unintended consequences of legislation designed to improve access to care. IMPLICATIONS FOR FURTHER RESEARCH Future work should replicate these analyses with a more representative sample.
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Affiliation(s)
- Susan L Ettner
- Division of General Internal Medicine and Health Services Research, Dept. of Medicine, David Geffen School of Medicine, University of California Los Angeles. Address: 1100 Glendon Ave., Suite 850 - Room 879, Los Angeles, CA 90024, USA,
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Tang W, Xie J, Kong F, Malone DC. Per-Prescription Drug Expenditure by Source of Payment and Income Level in the United States, 1997 to 2015. Value Health 2019; 22:871-877. [PMID: 31426927 DOI: 10.1016/j.jval.2019.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To evaluate expenditures and sources of payment for prescription drugs in the United States from 1997 to 2015. METHODS The Medical Expenditures Panel Survey (MEPS) was used for this analysis. Individuals with one or more prescription medicines were eligible for inclusion. Outcomes were the inflation-adjusted cost per prescription across all payment sources (self or family, public, private, and other sources) before and after the Medicare Part D benefit and the Affordable Care Act. RESULTS The cost per prescription increased from $38.56 in 1997 to $73.34 in 2015. Nevertheless, consumers' out-of-pocket expenditures decreased from $18.19 to $9.61, whereas public program expenditures per prescription increased from $5.61 to $34.43 over this time. Out-of-pocket expenditures of individuals in the low-income group and near-poor group had larger declined percentages from 51.4% to 20.4% and 46.5% to 17.2% relative to individuals in higher-income groups before and after implementation of the Medicare Part D, respectively. Over 90% prescription purchases were covered by medical insurance by 2015. The per-prescription cost for medications consumed by uninsured individuals increased at a lower rate from $31.83 to $54.96 versus $40.12 to $75.58 for privately insured and $36.00 to $70.96 for publicly insured (P < .001). CONCLUSIONS Prescription drugs expenditures have increased over the past 2 decades, but public sources now pay for a growing proportion of prescription drugs cost regardless of health insurance coverage or income level. Out-of-pocket expenditures have significantly decreased for persons with lower incomes since the implementation of Medicare Part D and the Affordable Care Act.
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Affiliation(s)
- Wenxi Tang
- Department of Health Economics, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China; Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Arizona, USA
| | - Jing Xie
- Department of Health Economics, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Fanxin Kong
- Department of Health Economics, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Daniel C Malone
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Arizona, USA.
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Nipp RD, Lee H, Gorton E, Lichtenstein M, Kuchukhidze S, Park E, Chabner BA, Moy B. Addressing the Financial Burden of Cancer Clinical Trial Participation: Longitudinal Effects of an Equity Intervention. Oncologist 2019; 24:1048-1055. [PMID: 30988039 PMCID: PMC6693715 DOI: 10.1634/theoncologist.2019-0146] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 03/26/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The financial burden experienced by patients with cancer represents a barrier to clinical trial participation, and interventions targeting patients' financial concerns are needed. We sought to assess the impact of an equity intervention on clinical trial patients' financial burden. MATERIALS AND METHODS We developed an equity intervention to reimburse nonclinical expenses related to trials (e.g., travel and lodging). From July 2015 to July 2017, we surveyed intervention and comparison patients matched by age, sex, cancer type, specific trial, and trial phase. We longitudinally assessed financial burden (e.g., trial-related travel and lodging cost concerns, financial wellbeing [FWB] with the COmprehensive Score for financial Toxicity [COST] measure) at baseline, day 45, and day 90. We used longitudinal models to assess intervention effects over time. RESULTS Among 260 participants, intervention patients were more likely than comparison patients to have incomes under $60,000 (52% vs. 24%, p < .001) and to report travel-related (41.0% vs. 6.8%, p < 0.001) and lodging-related (32.5% vs. 2.0%, p < .001) cost concerns at baseline. Intervention patients were more likely to report travel to appointments as their most significant financial concern (24.0% vs. 7.0%, p = .001), and they had worse FWB than comparison patients (COST score: 15.32 vs. 23.88, p < .001). Over time, intervention patients experienced greater improvements in their travel-related (-10.0% vs. +1.2%, p = .010) and lodging-related (-3.9% vs. +4.0%, p = .003) cost concerns. Improvements in patients reporting travel to appointments as their most significant financial concern and COST scores were not statistically significant. CONCLUSION Cancer clinical trial participants may experience substantial financial issues, and this equity intervention demonstrates encouraging results for addressing these patients' longitudinal financial burden. IMPLICATIONS FOR PRACTICE Clinical trials are critical for developing novel therapies for patients with cancer, yet financial barriers may discourage some patients from participating in cancer clinical trials. This study found that patients who received financial assistance from an equity intervention experienced significant improvements over time in their concerns about the cost of travel and lodging associated with clinical trials compared with comparison patients who did not receive financial assistance from the equity intervention. Among cancer clinical trial participants, an equity intervention shows potential for addressing patients' concerns regarding clinical trial-related travel and lodging expenses.
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Affiliation(s)
- Ryan D Nipp
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Emily Gorton
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Morgan Lichtenstein
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Salome Kuchukhidze
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Elyse Park
- Department of Psychiatry, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Bruce A Chabner
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Beverly Moy
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
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Kanya L, Sanghera S, Lewin A, Fox-Rushby J. The criterion validity of willingness to pay methods: A systematic review and meta-analysis of the evidence. Soc Sci Med 2019; 232:238-261. [PMID: 31108330 DOI: 10.1016/j.socscimed.2019.04.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 03/11/2019] [Accepted: 04/14/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND The contingent valuation (CV) method is used to estimate the willingness to pay (WTP) for services and products to inform cost benefit analyses (CBA). A long-standing criticism that stated WTP estimates may be poor indicators of actual WTP, calls into question their validity and the use of such estimates for welfare evaluation, especially in the health sector. Available evidence on the validity of CV studies so far is inconclusive. We systematically reviewed the literature to (1) synthesize the evidence on the criterion validity of WTP/willingness to accept (WTA), (2) undertake a meta-analysis, pooling evidence on the extent of variation between stated and actual WTP values and, (3) explore the reasons for the variation. METHODS Eight electronic databases were searched, along with citations and reference reviews. 50 papers detailing 159 comparisons were identified and reviewed using a standard proforma. Two reviewers each were involved in the paper selection, review and data extraction. Meta-analysis was conducted using random effects models for ratios of means and percentage differences separately. Meta-bias was investigated using funnel plots. RESULTS Hypothetical WTP was on average 3.2 times greater than actual WTP, with a range of 0.7-11.8 and 5.7 (0.0-13.6) for ratios of means and percentage differences respectively. However, key methodological differences between surveys of hypothetical and actual values were found. In the meta-analysis, high levels of heterogeneity existed. The overall effect size for mean summaries was 1.79 (1.56-2.04) and 2.37 (1.93-2.80) for percent summaries. Regression analyses identified mixed results on the influence of the different experimental protocols on the variation between stated and actual WTP values. Results indicating publication bias did not account for differences in study design. CONCLUSIONS The evidence on the criterion validity for CV studies is more mixed than authors are representing because substantial differences in study design between hypothetical and actual WTP/WTA surveys are not accounted for.
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Affiliation(s)
- Lucy Kanya
- Health Economics Research Group, Brunel University, Kingston Lane, Uxbridge, UB8 3PH, England, UK.
| | - Sabina Sanghera
- Health Economics Research Group, Brunel University, Kingston Lane, Uxbridge, UB8 3PH, England, UK; Bristol Medical School (Population Health Sciences), Bristol University, 1-5 Whiteladies Road, Bristol, England, UK.
| | - Alex Lewin
- Department of Mathematics and Statistics, Brunel University, Kingston Lane, Uxbridge, UB8 3PH, England, UK.
| | - Julia Fox-Rushby
- Health Economics Research Group, Brunel University, Kingston Lane, Uxbridge, UB8 3PH, England, UK.
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Abstract
INTRODUCTION The patient cost burden of oral anticancer medicines has been associated with prescription abandonment, delayed treatment initiation, and poorer health outcomes in the US. Since 2011, several small molecule tyrosine kinase inhibitors have been approved for the treatment of non-small cell lung cancer (NSCLC) patients with rearrangement of the anaplastic lymphoma kinase (ALK) gene. The objective of this study was to measure the impact of copay assistance on patient cost sharing and treatment patterns in patients prescribed oral ALK inhibitors (ALKi's). METHODS Patterns of claims approval/rejection and payment/reversal, out-of-pocket (OOP) costs, and treatment persistence were reported for patients identified in the IQVIA Formulary Impact Analyzer database from January 2013 to August 2017 linked to a medical claims database. The primary study cohorts were patients with copay assistance, including manufacturer's copay cards, other discount cards, or free-trial vouchers, on the index ALKi claim, and patients without copay assistance at any time during the follow-up period. RESULTS In total, 3,143 patients were included in analyses related to claim patterns, and 1,685 patients were included in analyses related to treatment persistence. Copay assistance decreased the OOP cost for the first approved ALKi by $1,930, on average. Patients with copay assistance picked up ALKi prescriptions from the pharmacy sooner than patients without copay assistance (2.6 days vs 25.7 days). In adjusted analyses, patients with copay assistance had 88.2% lower risk of abandoning their first approved prescription and 24.3% lower risk of discontinuing treatment with the first observed ALKi (all p < 0.001). CONCLUSION Copay assistance reduced the patient cost burden for ALKi's and was associated with patients picking up their ALKi prescriptions, beginning ALKi treatment sooner, and remaining on treatment.
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Affiliation(s)
| | - William Wong
- b Genentech Inc , South San Francisco , CA , USA
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Cohen RA, Boersma P. Strategies Used by Adults Aged 65 and Over to Reduce Their Prescription Drug Costs, 2016-2017. NCHS Data Brief 2019:1-8. [PMID: 31163016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In 2017, 86% of U.S. adults aged 65 and over reported being prescribed medication in the past 12 months (1). Most adults aged 65 and over have prescription drug coverage through either Medicare Part D or some source such as private health insurance, Medicaid, or Veterans Administration coverage (2). However, previous data indicate that some may still use strategies to reduce prescription drug costs, including not taking their medication as prescribed or asking their doctor for a lower-cost medication (3). This report examines the percentage of adults aged 65 and over who used these strategies to reduce their prescription drug costs in the past 12 months by selected characteristics.
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Drake C. What are consumers willing to pay for a broad network health plan?: Evidence from covered California. J Health Econ 2019; 65:63-77. [PMID: 30981153 DOI: 10.1016/j.jhealeco.2018.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 11/30/2018] [Accepted: 12/15/2018] [Indexed: 06/09/2023]
Abstract
Health Insurance Marketplaces have received considerable attention for their narrow network health plans. Yet, little is known about consumer tastes for network breadth and how they affect plan selection. I estimate demand for health plans in California's Marketplace, Covered California. Using 2017 individual enrollment data and provider network directories, I develop a geospatial measure of network breadth that reflects the physical locations of households and network providers. I find that households are sensitive to network breath in their plan choices. Mean willingness to pay for a broad network plan relative to a narrow network plan, defined as a two standard deviation, 17.44 percentage point increase in network breadth, is $45.83 in post-subsidy monthly premiums. Variation in WTP indicates a selection mechanism exists whereby older households sort into broader network plans. I also find that households are highly premium sensitive, which may be a result of plan standardization in Covered California.
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Affiliation(s)
- Coleman Drake
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, A664 Public Health, 130 DeSoto Street, 15261, Pittsburgh, PA, United States.
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Miao Y, Yuan X, Gu J, Zhang L, He R, Sandeep S, Wu J. Constructing a value-based healthcare system for hypertensive patients through changing payment mode: evidence from a comparative study in rural China. J Med Econ 2019; 22:245-251. [PMID: 30547700 DOI: 10.1080/13696998.2018.1558864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To construct a value-based healthcare system for rural Chinese hypertensive patients through an increasing outpatient care reimbursement ratio. METHODS This comparative study sampled two similar counties, Dangyang County and Zhijiang County, in Hubei Province of China, as the intervention group and the control group, respectively. The Social Health Insurance Fund of the intervention group budgeted 600 yuan per capita per year to insured patients with third stage hypertension to cover their outpatient expenditures, while the outpatient expenditures of the control group were not covered by its Social Health Insurance Fund. The inpatient expenditure reimbursement policies in both groups were not adjusted during the study. Value improvement in this study was defined as reduction in medical costs and improvement in health outcomes within the pilot healthcare system. A propensity score matching model combined with a difference-in-differences model was used to estimate the changes in medical costs and health outcomes. RESULTS In total, 1,673 pairs of patients were enrolled into statistical analysis after the propensity score matching. The intervention increased per capita annual outpatient expenditure by 81.2 (+31.8%) yuan (p > .05), but decreased the per capita annual inpatient expenditure and total medical expenditure by 475.4 (-40.7%) yuan and 394.2 (-27.7%) yuan, respectively (p < .05). Accordingly, the per capita annual total medical expenditure reimbursement decreased by 192.3 (-28.5%) yuan (p < .05), and the per capita annual total out-of-pocket expenditure by 201.9 (-29.9%) yuan (p < .05). The diastolic blood pressure of the intervention group decreased significantly by 2.9 mmHg (p < .05), but no significant change was found in systolic blood pressure and prevalence of hypertension complications (p > .05). CONCLUSION Increasing the outpatient expenditures, the reimbursement ratio was beneficial to the value of the healthcare system for hypertensive patients. Outpatient care for patients with chronic diseases should be prioritized for rural China and healthcare settings with inadequate health insurance funds.
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Affiliation(s)
- Yudong Miao
- a Department of General Medicine of Henan Provincial People's Hospital , Zhengzhou , China
- b School of Health Policy and Management , Nanjing Medical University , Nanjing , China
| | - Xiangdong Yuan
- c Guangdong General Hospital , Guangdong Academy of Medical Sciences , Guangzhou , China
| | - Jianqin Gu
- a Department of General Medicine of Henan Provincial People's Hospital , Zhengzhou , China
| | - Liang Zhang
- d School of Medicine and Health Management , Tongji Medical College, Huazhong University of Science & Technology , Wuhan , China
| | - Ruibo He
- d School of Medicine and Health Management , Tongji Medical College, Huazhong University of Science & Technology , Wuhan , China
| | - Sandeep Sandeep
- d School of Medicine and Health Management , Tongji Medical College, Huazhong University of Science & Technology , Wuhan , China
| | - Jian Wu
- e College of Public Health , Zhengzhou University , Zhengzhou , China
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Gildner TE, Liebert MA, Capistrant BD, D’Este C, Snodgrass JJ, Kowal P. Perceived Income Adequacy and Well-being Among Older Adults in Six Low- and Middle-Income Countries. J Gerontol B Psychol Sci Soc Sci 2019; 74:516-525. [PMID: 27852739 PMCID: PMC7179842 DOI: 10.1093/geronb/gbw145] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/12/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Perceived income adequacy is positively associated with self-rated health (SRH) and quality of life (QOL) among adults in higher-income countries. Additionally, older individuals often report higher levels of income adequacy. However, it is unclear if these associations, documented primarily in high-income countries, are also evident across economically and culturally distinctive low- and middle-income countries. METHODS Data were drawn from the World Health Organization's Study on global AGEing and adult health (SAGE), a study of adults aged 50 years or older in China, Ghana, India, Mexico, the Russian Federation, and South Africa. Smaller samples of younger adults (18-49 years) were included for comparison purposes. Participants reported income adequacy, SRH, and QOL. Associations between age and income adequacy and between income adequacy and SRH/QOL were examined using country-specific logistic regression analysis. RESULTS Older adults in China and Russia were more likely to report better income adequacy than their 18- to 49-year-old counterparts; however, the opposite was observed in Ghana and India. SRH and QOL improved as income adequacy increased in all countries. DISCUSSION As expected, income adequacy was correlated with SRH and QOL. However, the relationship between age and income adequacy varied cross-culturally, potentially due to differences in familial and governmental financial support.
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Affiliation(s)
| | | | | | - Catherine D’Este
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, College of Medicine, Biology and Environment, Canberra, Australia
| | | | - Paul Kowal
- Department of Anthropology, University of Oregon, Eugene
- World Health Organization, Geneva, Switzerland
- University of Newcastle Research Centre for Generational Health and Ageing, Newcastle, New South Wales, Australia
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Miljeteig I, Defaye FB, Wakim P, Desalegn DN, Berhane Y, Norheim OF, Danis M. Financial risk protection at the bedside: How Ethiopian physicians try to minimize out-of-pocket health expenditures. PLoS One 2019; 14:e0212129. [PMID: 30753215 PMCID: PMC6372229 DOI: 10.1371/journal.pone.0212129] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/27/2019] [Indexed: 11/18/2022] Open
Abstract
Background Out-of-pocket health expenditures can pose major financial risks, create access-barriers and drive patients and families into poverty. Little is known about physicians’ role in financial protection of patients and families at the bedside in low-income settings and how they perceive their roles and duties when treating patients in a health care system requiring high out-of-pocket costs. Objective Assess physicians’ concerns regarding financial welfare of patients and their families and analyze physicians’ experiences in reducing catastrophic health expenditures for patients in Ethiopia. Method A national survey was conducted among physicians at 49 public hospitals in six regions in Ethiopia. Descriptive statistics were used. Results Totally 587 physicians responded (response rate 91%) and 565 filled the inclusion criteria. Health care costs driving people into financial crisis and poverty were witnessed by 82% of respondants, and 88% reported that costs for the patient are important when deciding to use or not use an intervention. Several strategies to save costs for patients were used: 37–79% of physicians were doing this daily or weekly through limiting prescription of drugs, limiting radiologic studies, ultrasound and lab tests, providing second best treatments, and avoiding admission or initiating early discharge. Overall, 75% of the physicians reported that ongoing and future costs to patients influenced their decisions to a greater extent than concerns for preserving hospital resources. Conclusion In Ethiopia, a low-income country aiming to move towards universal health coverage, physicians view themselves as both stewards of public resources, patient advocates and financial protectors of patients and their families. Their high concern for family welfare should be acknowledged and the economic and ethical implications of this practice must be further explored.
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Affiliation(s)
- Ingrid Miljeteig
- Research Group in Global Health Priorities, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Research and Development, Helse Bergen Health Trust, Bergen, Norway
- * E-mail:
| | - Frehiwot Berhane Defaye
- Research Group in Global Health Priorities, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Centre for Medical Ethics and Priority Setting, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Paul Wakim
- Biostatistics and Clinical Epidemiology Service, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Dawit Neema Desalegn
- Research Group in Global Health Priorities, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Centre for Medical Ethics and Priority Setting, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Ole Frithjof Norheim
- Research Group in Global Health Priorities, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Marion Danis
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, United States of America
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Bobinac A. Mitigating hypothetical bias in willingness to pay studies: post-estimation uncertainty and anchoring on irrelevant information. Eur J Health Econ 2019; 20:75-82. [PMID: 29796781 DOI: 10.1007/s10198-018-0983-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 05/03/2018] [Indexed: 06/08/2023]
Abstract
One possible source of hypothetical bias in willingness to pay (WTP) estimates is response uncertainty, referring to subject's uncertainty about the value of the good under assessment. It has been argued that uncertainty can be measured using the post-valuation 'certainty question' that asks: 'How certain are you about your stated WTP?' and marks the degree of certainty on a quantitative or a qualitative scale. Research has shown that the self-reported certainty evaluations can help mitigate hypothetical bias and obtain increasingly accurate WTP estimates. These study reports present a simple test of reliability of post-valuation certainty assessment and then looks at the empirical evidence for clues regarding the general usefulness of certainty adjustment in mitigating hypothetical bias in WTP studies. We find that the post-estimation uncertainty scores are malleable, i.e., significantly correlated with entirely irrelevant information. We conclude that more robust evidence could justify the routine inclusion of certainty evaluation in WTP studies although in the meantime the interpretation of certainty-adjusted WTP values should be approached cautiously.
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Affiliation(s)
- Ana Bobinac
- Medical Faculty, University of Rijeka, B. Branchetta 12, 51000, Rijeka, Croatia.
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Ku YC, Chou YJ, Lee MC, Pu C. Effects of National Health Insurance on household out-of-pocket expenditure structure. Soc Sci Med 2018; 222:1-10. [PMID: 30579140 DOI: 10.1016/j.socscimed.2018.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/06/2018] [Accepted: 12/07/2018] [Indexed: 11/19/2022]
Abstract
Achieving universal health insurance coverage is a major objective for many countries. Taiwan implemented its National Health Insurance (NHI) program with universal coverage in 1995. This study investigates whether the NHI program affects the level and structures of out-of-pocket (OOP) health expenditures. We used data from the Taiwan Survey of Family Income and Expenditure released by the Directorate-General of Budget, Accounting and Statistics. We identified a case and a control group and then employed coarsened exact matching to match the two groups using several available variables. We then conducted a difference-in-difference analysis and determined that there was a statistically significant negative effect on OOP expenditure that was attributable to NHI (a reduction of 2.11 percentage points in total household expenditure). The largest reductions were found in health care services (-1.63%) and pharmaceuticals (-0.45%). We found a statistically significant positive effect on purchases of private insurance related to health care, which was attributable to NHI (an increase of 0.96 percentage points in household budget share). In addition, we discovered that the NHI program had a greater impact on households of a lower socioeconomic status compared with higher socioeconomic status households. The structure of OOP payments in the post-NHI period remained similar to that of the pre-NHI period in the full sample but varied slightly depending on the educational level of the head of the household.
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Affiliation(s)
- Yu-Chun Ku
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Miaw-Chwen Lee
- Department of Social Welfare, Advanced Institute of Manufacturing with High-tech Innovations, and Center for Innovative Research on Aging Society, National Chung Cheng University, Cha-Yi, Taiwan
| | - Christy Pu
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
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Abstract
BACKGROUND Recent health policy efforts have sought to promote universal health coverage (UHC) as a means of providing affordable access to health services to populations. However, insurance schemes are heterogeneous, and some schemes may not provide necessary services to those covered. We explored the prevalence and determinants of ineffective insurance across 42 lower and middle income countries (LMICs) from the 2002-2004 World Health Survey. METHODS Respondents were defined as having ineffective health insurance if they reported being insured and: were forced to borrow or sell personal items to pay for health services; had an untreated chronic condition; or had recently delivered a child outside of a skilled health facility (women only). RESULTS Among the insured, 13% had ineffective insurance, which was most commonly due to having to borrow or sell to pay for health care. The likelihood of ineffective insurance was lowest in upper-middle income countries and higher in other lower-middle and low-income countries. Ineffective insurance also decreased with family wealth and was higher among rural residents. CONCLUSIONS Our findings suggest that a high proportion of insurance in LMICs is ineffective, particularly among those who need it most, and that attention should be paid to effectiveness when defining health insurance in policy conversations about UHC.
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Affiliation(s)
- Abdulrahman M El-Sayed
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Daniel Vail
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Margaret E Kruk
- Department of Global Health & Population, TH Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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Xu J, Wang J, King M, Liu R, Yu F, Xing J, Su L, Lu M. Rural-urban disparities in the utilization of mental health inpatient services in China: the role of health insurance. Int J Health Econ Manag 2018; 18:377-393. [PMID: 29589249 PMCID: PMC6223725 DOI: 10.1007/s10754-018-9238-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 03/17/2018] [Indexed: 05/28/2023]
Abstract
Reducing rural-urban disparities in health and health care has been a key policy goal for the Chinese government. With mental health becoming an increasingly significant public health issue in China, empirical evidence of disparities in the use of mental health services can guide steps to reduce them. We conducted this study to inform China's on-going health-care reform through examining how health insurance might reduce rural-urban disparities in the utilization of mental health inpatient services in China. This retrospective study used 10 years (2005-2014) of hospital electronic health records from the Shandong Center for Mental Health and the DaiZhuang Psychiatric Hospital, two major psychiatric hospitals in Shandong Province. Health insurance was measured using types of health insurance and the actual reimbursement ratio (RR). Utilization of mental health inpatient services was measured by hospitalization cost, length of stay (LOS), and frequency of hospitalization. We examined rural-urban disparities in the use of mental health services, as well as the role of health insurance in reducing such disparities. Hospitalization costs, LOS, and frequency of hospitalization were all found to be lower among rural than among urban inpatients. Having health insurance and benefiting from a relatively high RR were found to be significantly associated with a greater utilization of inpatient services, among both urban and rural residents. In addition, an increase in the RR was found to be significantly associated with an increase in the use of mental health services among rural patients. Consistent with the existing literature, our study suggests that increasing insurance schemes' reimbursement levels could lead to substantial increases in the use of mental health inpatient services among rural patients, and a reduction in rural-urban disparities in service utilization. In order to promote mental health care and reduce rural-urban disparities in its utilization in China, improving rural health insurance coverage (e.g., reducing the coinsurance rate) would be a powerful policy instrument.
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Affiliation(s)
- Junfang Xu
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Jian Wang
- Center for Health Economic Experiments and Public Policy, Department of Social Medicine and Administration, School of Public Health, Shandong University, No. 44 Wen Hua Xi Road, Jinan, Shandong, China.
| | - Madeleine King
- School of Public Policy and Management, Tsinghua University, Beijing, China
| | - Ruiyun Liu
- Shandong Center for Mental Health, Jinan, Shandong, China
| | - Fenghua Yu
- Shandong Health and Family Planning Commission, Jinan, Shandong, China
| | - Jinshui Xing
- Shandong Center for Mental Health, Jinan, Shandong, China
| | - Lei Su
- Shandong Center for Mental Health, Jinan, Shandong, China
| | - Mingshan Lu
- Department of Economics, University of Calgary, Calgary, Canada
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Naqvi AA, Naqvi SBS, Zehra F, Verma AK, Usmani S, Badar S, Ahmad R, Ahmad N. Estimation of the Direct Cost of Poliomyelitis Rehabilitation Treatment to Pakistani Patients: A 53-Year Retrospective Study. Appl Health Econ Health Policy 2018; 16:871-888. [PMID: 30128833 DOI: 10.1007/s40258-018-0422-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Pakistan is one of the last few countries in which poliomyelitis is endemic. Evidence indicates that out-of-pocket expenditures are a barrier to polio rehabilitation treatment, yet there are no reported figures related to the financial burden of this disease on patients in a recently polio-endemic country. OBJECTIVE This study investigated direct costs attributed to rehabilitation treatment of poliomyelitis among Pakistani patients and reported its duration along with the socioeconomic status of poliomyelitis survivors. CONCLUSION The cost of poliomyelitis rehabilitation in Pakistan is high; it has an economic effect on the lives of patients and their families. Despite good education, polio survivors in Pakistan appear to have low socioeconomic status, lower chances of employment and marriage, as well as fewer children. Further research is recommended to explore the burden of disease on society, i.e., indirect costs and suffering.
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Affiliation(s)
- Atta Abbas Naqvi
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Saudi Arabia.
| | | | - Fatima Zehra
- Applied Economics Research Centre, University of Karachi, Karachi, 75270, Pakistan
| | - Ashutosh Kumar Verma
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, 11800, Penang, Malaysia
| | - Saman Usmani
- Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University, Karachi, 75510, Pakistan
| | - Sehrish Badar
- Faculty of Pharmacy, Hamdard University, Madinatul Hikmah, Karachi, 74600, Pakistan
| | - Rizwan Ahmad
- Natural Products and Alternative Medicines, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Saudi Arabia
| | - Niyaz Ahmad
- Department of Pharmaceutics, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Saudi Arabia
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Oraro T, Wyss K. How does membership in local savings groups influence the determinants of national health insurance demand? A cross-sectional study in Kisumu, Kenya. Int J Equity Health 2018; 17:170. [PMID: 30458792 PMCID: PMC6247627 DOI: 10.1186/s12939-018-0889-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 11/09/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Rotating savings and credit associations (ROSCAs) are highly active in many sub-Saharan African countries, serving as an important gateway for coping with financial risk. In light of the Kenya's National Hospital Insurance Fund's (NHIF's) strategy of targeting ROSCAs for membership enrolment, this study sought to estimate how ROSCA membership influences the determinants of voluntary health insurance enrolment. METHODS A cross-sectional survey of 444 households was carried out in Kisumu City between July and August 2016. A structured questionnaire was administered on health insurance membership, household attributes, headship characteristics and health-seeking behaviour. We assessed the influence of ROSCA membership on the associations between NHIF enrolment and the explanatory variables using univariate logistic regression. RESULTS The study found that education was associated with NHIF demand regardless of ROSCA membership. Both ROSCA and non-ROSCA households with high socioeconomic status showed stronger health insurance demand compared with poorer households; there was, however, no evidence that the strength of this association was influenced by ROSCA status (p-value = 0.47). Participants who were self-employed were significantly less likely to enrol into the NHIF if they did not belong to a ROSCA (interaction test p-value = 0.03). NHIF enrolment was found to be lower among female-headed households. There was a borderline effect of ROSCA membership on this association, with a lower odds ratio amongst non-ROSCA members (p-value = 0.09): the low treatment numbers amongst the insured infers that ROSCA membership may play a role on the association between gender and NHIF demand. CONCLUSIONS Our findings suggest that ROSCA membership may play a role in increasing health insurance demand amongst some traditionally under-represented groups such as women and the self-employed. However, the strategy of targeting ROSCAs to increase national health insurance enrolment may yield exiguous results, given that ROSCA membership is itself influenced by several non-observable factors - such as time-availability and self-selection. It is therefore important to anchor outreach to ROSCAs within a broader, multi-pronged approach that targets households within their social, economic and political realities.
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Affiliation(s)
- Tessa Oraro
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Department of Epidemiology and Public Health, Health Systems Support Unit, Swiss Tropical and Public Health Institute, P.O. Box 4002, Basel, Switzerland
| | - Kaspar Wyss
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Glied SA, Jackson A. How Would Americans' Out-of-Pocket Costs Change If Insurance Plans Were Allowed to Exclude Coverage for Preexisting Conditions? Issue Brief (Commonw Fund) 2018; 2018:1-9. [PMID: 30387577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
ISSUE A current Republican legislative proposal would permit insurers to offer plans that exclude coverage of treatment for preexisting health conditions, even while the bill would maintain the Affordable Care Act’s rule prohibiting denial of coverage to people with a preexisting condition. GOAL Estimate patients’ out-of-pocket costs for five common preexisting conditions if the bill were to become law and assess any additional impact on out-of-pocket expenditures if spending on care for preexisting conditions no longer counted against plan deductibles. METHODS Analysis of 2014–2016 Medical Expenditure Panel Survey data for the privately insured adult population under age 65; and the proposed Ensuring Coverage for Patients with Pre-Existing Conditions Act (S. 3388). FINDINGS AND CONCLUSION If preexisting conditions were excluded from coverage, nearly all people with these conditions would see increased out-of-pocket costs. Average out-of-pocket costs for those with cancer or diabetes would triple, while costs for arthritis, asthma, and hypertension care would rise by 27 percent to 39 percent. Some individuals would see much larger increases: for example, 10 percent of diabetes patients could expect to incur over $9,200 annually in out-of-pocket costs. Many with preexisting conditions also would spend more on conditions that are not excluded, since out-of-pocket spending on their preexisting conditions would no longer count toward the deductible and out-of-pocket maximum.
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Affiliation(s)
- Sherry A Glied
- Robert F. Wagner Graduate School of Public Service, New York University
| | - Adlan Jackson
- Robert F. Wagner Graduate School of Public Service, New York University
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Skalicky AM, Rentz AM, Liu Z, Said Q, Nakagawa JA, Frost MD, Wheless JW, Dunn DW. Economic burden, work, and school productivity in individuals with tuberous sclerosis and their families. J Med Econ 2018; 21:953-959. [PMID: 29890870 DOI: 10.1080/13696998.2018.1487447] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
AIMS Tuberous sclerosis complex (TSC) is a multi-organ autosomal-dominant, genetic disorder with incomplete penetrance. The multiple manifestations of TSC and impacts to numerous organ systems represent significant disease, healthcare, and treatment burden. The economic and employment burden of the disease on individuals and their families is poorly understood. This study assessed the cost of illness and work and school productivity burden associated with TSC in a cross-sectional web-survey sample. MATERIALS AND METHODS Eligible TSC individuals and caregivers were invited through the Tuberous Sclerosis Alliance advocacy group to complete a web-based survey about illness characteristics, treatment, disease burden, direct and indirect healthcare costs, work and school impairment. RESULTS Data from 609 TSC adults or caregiver respondents with no cognitive impairments were analyzed. TSC adults (>18 years of age) had significantly higher direct out-of-pocket costs for ER visits, expenses for medical tests and procedures, alternative treatments, medications and lifetime cost of surgeries compared to TSC pediatric individuals. Both TSC adults and TSC caregivers reported work and school absenteeism and presenteeism; however, adults reported significantly higher absenteeism and presenteeism and overall activity impairment due to TSC, as might be expected, compared to TSC caregivers. TSC adults had significantly higher absenteeism and presenteeism rates compared to adults with moderate-to-severe plaque psoriasis and muscular sclerosis. CONCLUSIONS TSC results in considerable direct out-of-pocket medical costs and impairment to work productivity, especially for adults. Future studies should include the comparator group and examine direct cost burden in the US using electronic medical records and insurance databases.
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Affiliation(s)
| | | | - Zhimei Liu
- b Novartis Oncology , East Hanover , NJ , USA
| | - Qayyim Said
- b Novartis Oncology , East Hanover , NJ , USA
| | | | | | - James W Wheless
- e Le Bonheur Children's Hospital and the University of Tennessee, University of Tennessee Health Science Center , Memphis , TN , USA
| | - David W Dunn
- f Riley Hospital for Children , Indianapolis , IN , USA
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Yazdany J, Dudley RA, Lin GA, Chen R, Tseng CW. Out-of-Pocket Costs for Infliximab and Its Biosimilar for Rheumatoid Arthritis Under Medicare Part D. JAMA 2018; 320:931-933. [PMID: 30193264 PMCID: PMC6142992 DOI: 10.1001/jama.2018.7316] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/10/2018] [Indexed: 01/07/2023]
Affiliation(s)
- Jinoos Yazdany
- Division of Rheumatology, University of California, San Francisco
| | - R. Adams Dudley
- Center for Healthcare Value, University of California, San Francisco
| | - Grace A. Lin
- Center for Healthcare Value, University of California, San Francisco
| | - Randi Chen
- Pacific Health Research and Education Institute, Honolulu, Hawaii
| | - Chien-Wen Tseng
- Department of Family Practice and Community Health, University of Hawaii, Honolulu
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48
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Aregbeshola BS, Khan SM. Out-of-Pocket Payments, Catastrophic Health Expenditure and Poverty Among Households in Nigeria 2010. Int J Health Policy Manag 2018; 7:798-806. [PMID: 30316228 PMCID: PMC6186489 DOI: 10.15171/ijhpm.2018.19] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 02/21/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is high reliance on out-of-pocket (OOP) health payments as a means of financing health system in Nigeria. OOP health payments can make households face catastrophe and become impoverished. The study aims to examine the financial burden of OOP health payments among households in Nigeria. METHODS Secondary data from the Harmonized Nigeria Living Standard Survey (HNLSS) of 2009/2010 was utilized to assess the catastrophic and impoverishing effects of OOP health payments on households in Nigeria. Data analysis was carried out using ADePT 6.0 and STATA 12. RESULTS We found that a total of 16.4% of households incurred catastrophic health payments at 10% threshold of total consumption expenditure while 13.7% of households incurred catastrophic health payments at 40% threshold of nonfood expenditure. Using the $1.25 a day poverty line, poverty headcount was 97.9% gross of health payments. OOP health payments led to a 0.8% rise in poverty headcount and this means that about 1.3 million Nigerians are being pushed below the poverty line. Better-off households were more likely to incur catastrophic health payments than poor households. CONCLUSION Our study shows the urgency with which policy makers need to increase public healthcare funding and provide social health protection plan against informal OOP health payments in order to provide financial risk protection which is currently absent among high percentage of households in Nigeria.
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Affiliation(s)
- Bolaji Samson Aregbeshola
- Department of Community Health & Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Samina Mohsin Khan
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Gustafsson-Wright E, Popławska G, Tanović Z, van der Gaag J. The impact of subsidized private health insurance and health facility upgrades on healthcare utilization and spending in rural Nigeria. Int J Health Econ Manag 2018; 18:221-276. [PMID: 29222608 DOI: 10.1007/s10754-017-9231-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 10/04/2017] [Indexed: 06/07/2023]
Abstract
This paper analyzes the quantitative impact of an intervention that provides subsidized low-cost private health insurance together with health facility upgrades in Nigeria. The evaluation, which measures impact on healthcare utilization and spending, is based on a quasi-experimental design and utilizes three population-based household surveys over a 4-year period. After 4 years, the intervention increased healthcare use by 25.2 percentage points in the treatment area overall and by 17.7 percentage points among the insured. Utilization of modern healthcare facilities increased after 4 years by 20.4 percentage points in the treatment area and by 18.4 percentage points among the insured due to the intervention. After 2 years of program implementation, the intervention reduced healthcare spending by 51% compared with baseline, while after 4 years, spending resumed to pre-intervention levels.
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Affiliation(s)
| | - Gosia Popławska
- Department of Primary Health Care, Center for Health Service Economics and Organisation, University of Oxford, Oxford, UK
| | - Zlata Tanović
- Vrije University (VU), Amsterdam, The Netherlands
- Amsterdam Institute for International Development, Amsterdam, The Netherlands
| | - Jacques van der Gaag
- Brookings Institution, Washington, DC, USA
- Department of Economics and Business, University of Amsterdam, Amsterdam, The Netherlands
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50
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Pallegedara A. Impacts of chronic non-communicable diseases on households' out-of-pocket healthcare expenditures in Sri Lanka. Int J Health Econ Manag 2018; 18:301-319. [PMID: 29322278 DOI: 10.1007/s10754-018-9235-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/03/2018] [Indexed: 06/07/2023]
Abstract
This article examines the effects of chronic non-communicable diseases (NCDs) on households' out-of-pocket health expenditures in Sri Lanka. We explore the disease specific impacts on out-of-pocket health care expenses from chronic NCDs such as heart diseases, hypertension, cancer, diabetics and asthma. We use nationwide cross-sectional household income and expenditure survey 2012/2013 data compiled by the department of census and statistics of Sri Lanka. Employing propensity score matching method to account for selectivity bias, we find that chronic NCD affected households appear to spend significantly higher out-of-pocket health care expenditures and encounter grater economic burden than matched control group despite having universal public health care policy in Sri Lanka. The results also suggest that out-of-pocket expenses on medicines and other pharmaceutical products as well as expenses on medical laboratory tests and other ancillary services are particularly higher for households with chronic NCD patients. The findings underline the importance of protecting households against the financial burden due to NCDs.
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Affiliation(s)
- Asankha Pallegedara
- Department of Industrial Management, Faculty of Applied Sciences, Wayamba University of Sri Lanka, Kuliyapitiya, 60200, Sri Lanka.
- Chair of Development Economics, Faculty of Business Administration and Economics, University of Passau, Innstrasse 29, 94032, Passau, Germany.
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