Catastrophic health expenditure on acute coronary events in Asia: a prospective study

Abstract

ObjectiveTo estimate out-of-pocket costs and the incidence of catastrophic health expenditure in people admitted to hospital with acute coronary syndromes in Asia.MethodsParticipants were enrolled between June 2011 and May 2012 into this observational study in China, India, Malaysia, Republic of Korea, Singapore, Thailand and Viet Nam. Sites were required to enrol a minimum of 10 consecutive participants who had been hospitalized for an acute coronary syndrome. Catastrophic health expenditure was defined as out-of-pocket costs of initial hospitalization > 30% of annual baseline household income, and it was assessed six weeks after discharge. We assessed associations between health expenditure and age, sex, diagnosis of the index coronary event and health insurance status of the participant, using logistic regression models.FindingsOf 12 922 participants, 9370 (73%) had complete data on expenditure. The mean out-of-pocket cost was 3237 United States dollars. Catastrophic health expenditure was reported by 66% (1984/3007) of those without insurance versus 52% (3296/6366) of those with health insurance (P < 0.05). The occurrence of catastrophic expenditure ranged from 80% (1055/1327) in uninsured and 56% (3212/5692) of insured participants in China, to 0% (0/41) in Malaysia.ConclusionLarge variation exists across Asia in catastrophic health expenditure resulting from hospitalization for acute coronary syndromes. While insurance offers some protection, substantial numbers of people with health insurance still incur financial catastrophe.

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“…Out of pocket payment for accessing healthcare is a barrier to even basic health services. It has been established that out of pocket health expenditures condemn low income households into financial catastrophe (Ji et al, 2017;Jan et al, 2016;WHO, 2014). Consequently, such households find themselves trapped in the vicious circle of poverty due to the inability to work because of poor health.…”

“…Low cost health insurance to low income households is one innovative method of financing healthcare, avoiding catastrophic out of pocket expenditures and increasing health access (Ji et al, 2017;Bhageerathy et al, 2017;Jan et al, 2016;GoZ, 2010). Health insurance allows risk pooling and provides financial protection when need for healthcare utilisation actually arises.…”

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