Assessing the incidence of catastrophic health expenditure and impoverishment from out-of-pocket payments and their determinants in Bangladesh: evidence from the nationwide Household Income and Expenditure Survey 2016

Ahmed, Sayem; Ahmed, Minhajuddin; Hasan, Md. Zahid; Mehdi, Gazi Golam; Islam, Ziaul; Rehnberg, Clas; Niessen, Louis; Khan, Jahangir

doi:10.1093/inthealth/ihab015

Cited by 38 publications

(45 citation statements)

References 48 publications

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“…For example, surveys show that the per capita medical expenses for diabetes patients aged 65 years and above were 2551.97 yuan, which is higher than the average for the whole population [ 36 ]. Moreover, our findings are consistent with Sayem Ahmed et al, who reported that CHE are higher when an older person is in the household [ 37 ]. Although China’s current medical insurance policy has focused on the cost of outpatient drug that are urgently needed by the sick population, it has not focused on vulnerable people.…”

Section: Discussionsupporting

confidence: 92%

Multi-dimensional vulnerability analysis on catastrophic health expenditure among middle-aged and older adults with chronic diseases in China

Miao

Shi

Tian

et al. 2022

BMC Med Res Methodol

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Objective Middle-aged and older adults are more likely to suffer from chronic diseases because of their particular health characteristics, which lead to a high incidence of catastrophic health expenditure (CHE). This study plans to analyse the different factors affecting CHE in middle-aged and older adults with chronic diseases, target the vulnerable characteristics, and suggest groups that medical insurance policies should pay more attention to. Methods The data used in this study came from the 2018 China Health and Retirement Longitudinal Study (CHARLS) database. The method of calculating the CHE was adopted from the World Health Organization (WHO). The logistic regression was used to determine the family characteristics of chronic disease in middle-aged and older adults with a high probability of incurring CHE. Results The incidence of CHE in middle-aged and older adults with chronic disease was highest in sub-poverty level families (26.20%) was lowest in wealthier level families (20.07%). Households with malignant tumours had the highest CHE incidence under any circumstances, especially if the householder had been using inpatient service in the past year. Among the comparison of CHE incidence in different types of medical insurance, the Urban and Rural Residents’ Basic Medical Insurance (URRBMI) was the highest (27.46%). The incidence of CHE was 2.73 times (95% CI 2.30–3.24) and 2.16 times (95% CI 1.81–2.57) higher among people who had used inpatient services in the past year or outpatient services in the past month than those who had not used them. Conclusions Relatively wealthy economic conditions cannot significantly reduce the financial burden of chronic diseases in middle-aged and older adults. For this particular group with multiple vulnerabilities, such as physical and social vulnerability, the high demand and utilization of health services are the main reasons for the high incidence of CHE. After achieving the goal of lowering the threshold of universal access to health services, the medical insurance system in the next stage should focus on multiple vulnerable groups and strengthen the financial protection for middle-aged and older adults with chronic diseases, especially for patients with malignant tumours.

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Section: Discussionsupporting

confidence: 92%

Multi-dimensional vulnerability analysis on catastrophic health expenditure among middle-aged and older adults with chronic diseases in China

Miao

Shi

Tian

et al. 2022

BMC Med Res Methodol

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“…Similar evidence (14 percent in the national level and16 percent in the rural level) was found in another study [ 24 ]. The other study found a higher catastrophic healthcare expenditure (24.6 percent in the national level) [ 38 ]. In rural India, two different studies found about 34 percent and 15 percent households faced catastrophic healthcare expenditure [ 13 , 55 ].…”

Section: Discussionmentioning

confidence: 99%

“…A number of studies also concentrated in assessing the impoverishment impact of OOP payments for healthcare in Bangladesh context [ 14 , 24 , 26 , 36 – 38 ]. Hamid et al (2014) mainly focused on disease-specific impoverishment in the rural areas [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…(2017), and Molla and Chi (2020) explored the overall national impoverishment impact of OOP payments providing more emphasis on catastrophic healthcare expenditures [ 24 , 37 ]. Based on HIES 2016 data, Sayem et al ., 2021 made rural-urban as well as regional comparisons of impoverishment impact of OOP outlays for healthcare at the divisional level and found geographical location as one of the important factors of impoverishment [ 38 ]. Moreover, several studies examined the level of OOP payments and/or catastrophic healthcare expenditures [ 39 – 42 ].…”

Section: Introductionmentioning

confidence: 99%

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Impoverishment impact of out-of-pocket payments for healthcare in rural Bangladesh: Do the regions facing different climate change risks matter?

Begum

Hamid

2021

PLoS ONE

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Introduction Out-of-pocket (OOP) payments for healthcare severely affect the current consumption, future health and earnings capacity of poor/underprivileged households and hence it is crucial for priority setting. This study assesses the variation in overall as well as disease-specific impoverishment impact of OOP payments between the regions experiencing different climate change risks, defined as high disaster-prone (HDP) areas and low-disaster-prone (LDP) areas, in Bangladesh. Materials and methods This paper estimated three poverty measures, such as poverty headcount, poverty intensity and normalized poverty gap for all ailments, catastrophic events, diseases types (communicable, non-communicable (NCDs), and accident and injury), illness conditions (acute and chronic) and hospitalization using 3,791 randomly selected rural households (1,203 from HDP and 2,588 from LDP areas) across the regions. Cost of basic need approach was used for estimating poverty line expenditure. Results About 13 percent households annually fall into poverty due to OOP outlays for healthcare. Despite having significantly (p-value≤0.01) less OOP payments (HDP areas: BDT 5,117; LDP areas: BDT5,811) the impoverishment impact of OOP payments for healthcare in HDP areas (16.5%) has substantially higher than LDP areas (11.3%). Population in HDP areas, especially char (river island; 19.55 percent) and haor (water submerged; 16.80 percent) are more susceptible to any level of OOP payments due to low level of earnings. Catastrophic healthcare expenditure (61.79%) and NCDs (14.29 percent) are exacerbating the poverty level in Bangladesh. Both absolute and relative average poverty gap are more widen in HDP than LDP areas due to catastrophic OOP outlays for healthcare. Conclusion The impoverishment effect due to OOP payments for healthcare in both HDP and LDP areas are high, especially for NCDs and catastrophic healthcare expenditure. However, the situation is bit worse in HDP areas. Preventing the escalation of NCDs as well as catastrophic expenditure and hence reducing the level of impoverishment thereof call for restricting tobacco use, increasing physical activity, encouraging to intake healthy diets, ensuring food safety, controlling air pollution, and improving mental health. Moreover, government should give more emphasis, especially in the HDP areas, on making community clinics more functional through providing screening equipment and training to the Community Health Care Providers for early detection of NCDs, and ensuring availability of medicine all the time. Note that other than community clinics, there is little option for providing healthcare in HDP areas due to poor functionality of public facilities as well as lack of private facilities in HDP areas.

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“…This is consistent with previous studies that have shown that the place where healthcare is sought when ill is strongly associated with vulnerability to poverty due to OOP payments (Aregbeshola & Khan, 2017). Another study in Bangladesh also suggested that the use of private health facilities, including drug stores is associated with OOP payments and impoverishment (Ahmed et al, 2021). Ahmed et al ( 2021) explained that DOI: https://doi.org.10.47740/603.UDSIJD6i households that sought healthcare from private health facilities had a 9.88 higher odds of facing catastrophic health expenditure and impoverishment relative to those who sought care from public health facilities.…”

Section: Discussionmentioning

confidence: 99%

Out-of-Pocket Healthcare Payments and Impoverishment Among Migrant Adolescent Female Head Porters in Ghana: A Cross Sectional Study

Alatinga¹,

Kanmiki²,

Abiiro³

2022

UDSIJD

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Direct out-of-pocket (OOP) payments for healthcare can have devastating effects on vulnerable populations leading to impoverishments. Ghana’s National Health Insurance Scheme (NHIS) aims to remove financial hardships associated with seeking healthcare. However, there are concerns that vulnerable sections of the population still face healthcare-related financial hardships. This paper examines the impoverishing effects of OOP healthcare payments and the determinants of impoverishment due to OOP healthcare payments among migrant adolescent female head porters aged 10-19 years in Ghana. A quantitative cross-sectional survey was administered to a sample of 336 respondents who reported ill and sought healthcare within the last 12 months, January-December 2015, prior to the survey in 2016. Impoverishment due to OOP payment was assessed by computing the net income after payment for health care using the World Bank’s poverty line of income of $1.90 a day converted to 2015 purchasing power parity (PPP) equivalence for Ghana. The results illustrate that poverty incidence increased from 23 percent before OOP payment to 76 percent post OOP payment for healthcare. In a multivariate analysis, primary education [AOR=0.32, 95%CI=0.15-0.68]; Mamprusi (AOR=0.41, 95%CI=0.19-0.87) and other ethnic groups [AOR=0.33, 95%CI=0.14-0.75] compared to Dagomba; >1year in head portage (AOR=0.46; 0.23 - 0.95); drug store (AOR=0.43, 95%CI=0.19 - 0.96) and home treatment [AOR=0.20, 95%CI=0.05-0.85] were significantly associated with lower odds, whilst never registering for (AOR=4.05; 95%=1.82 - 9.03) or no valid NHIS card (2.29; 95%CI=1.08 - 4.83), Kumasi city [AOR=5.14; 95% CI:2.45-10.77] and severity of illness[AOR=2.86, CI 1.49-5.45] were associated with higher odds, of impoverishment due to OOP payment.. We recommend that the Ministries of Gender, Children and Social Protection and Health should collaborate to enrol adolescent female head porters onto the NHIS in order to increase their financial risk protection. Government should also put in place policy interventions including skills training and livelihood programmes to increase income levels, and improve the poverty situation of adolescent girl head porters. Key Words: Impoverishment, out-of-pocket healthcare payments, adolescent girls, migrants, Ghana

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Assessing the incidence of catastrophic health expenditure and impoverishment from out-of-pocket payments and their determinants in Bangladesh: evidence from the nationwide Household Income and Expenditure Survey 2016

Cited by 38 publications

References 48 publications

Multi-dimensional vulnerability analysis on catastrophic health expenditure among middle-aged and older adults with chronic diseases in China

Multi-dimensional vulnerability analysis on catastrophic health expenditure among middle-aged and older adults with chronic diseases in China

Impoverishment impact of out-of-pocket payments for healthcare in rural Bangladesh: Do the regions facing different climate change risks matter?

Out-of-Pocket Healthcare Payments and Impoverishment Among Migrant Adolescent Female Head Porters in Ghana: A Cross Sectional Study

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