Coping with healthcare costs for chronic illness in low-income and middle-income countries: a systematic literature review

Murphy, Adrianna; McGowan, Catherine R.; McKee, Martin; Suhrcke, Marc; Hanson, Kara

doi:10.1136/bmjgh-2019-001475

Cited by 48 publications

(38 citation statements)

References 61 publications

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“…Several studies in especially in low-income and middle-income countries found that households and patients adopt different strategies in the face of health expenditures. [31][32][33] The findings in the study showed that 94% of primary caregivers were highly burdened. The findings are supported by Chua et al 34 who reported a ZBI mean total score of 17.81 indicating high burden among more than half of informal caregivers in Singapore.…”

Section: Discussionmentioning

confidence: 82%

Costs, burden and quality of life associated with informal caregiving for children with Lymphoma attending a tertiary hospital in Ghana

Dawson

Aryeetey

Agyemang

et al. 2020

International Journal of Care Coordination

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Introduction Primary family caregivers provide substantial support in the management of lymphoma, potentially affecting their quality of life and increasing household health care costs. Our aim was thus to determine the economic costs and quality of life of primary caregivers of children with lymphoma. Methods This cross-sectional study involved primary informal caregivers of children with lymphoma attending the pediatric cancer unit at Komfo Anokye Teaching Hospital. The study adopted a cost-of-illness approach to estimate the direct costs (medical and non- medical) incurred and indirect cost (productive losses) to caregivers over the one-month period preceding the data collection. Zarit Burden Interview was used to determine caregiver burden and EUROHIS-QoL tool was used to determine the quality of life of primary caregivers. Results The average cost of managing lymphoma in children was estimated to be US$440.32, 97% of which were direct costs. On average, caregiver burden was 26.3 on the scale of 0 to 48. About 94% of caregivers reported high burden, with more males reporting high burden. Overall, average quality of life among caregivers was 2.20 on the 1 to 5 range. Approximately 85% of respondents reported low quality of life, with females reporting lower quality of life than males. Discussion This study shows that lymphoma is associated with substantial cost and increased burden, and affects quality of life of family caregivers. Future studies can explore the impact of social protection interventions (in the form of health insurance) to reduce the household economic burden of managing lymphoma in children.

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Section: Discussionmentioning

confidence: 82%

Costs, burden and quality of life associated with informal caregiving for children with Lymphoma attending a tertiary hospital in Ghana

Dawson

Aryeetey

Agyemang

et al. 2020

International Journal of Care Coordination

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“…Assessing monetary poverty is often an unreliable and inaccurate measure of well-being in low-income countries [42]. Further, measuring spending alone does not capture the long-term detrimental impact of difficult coping strategies including borrowing money with high interest rates, removing children from school, reducing expenses on food and education, or quitting work to give care [43]. Traditional spending measures may underestimate the impact on families as they adjust spending in response to medical financial shocks [14,15].…”

Section: Discussionmentioning

confidence: 99%

High Poverty and Hardship Financing Among Patients with Noncommunicable Diseases in Rural Haiti

Kwan

Yan

Isaac³

et al. 2020

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Background: Poverty is a major barrier to healthcare access in low-income countries. The degree of equitable access for noncommunicable disease (NCD) patients is not known in rural Haiti. Objectives: We evaluated the poverty distribution among patients receiving care in an NCD clinic in rural Haiti compared with the community and assessed associations of poverty with sex and distance from the health facility. Methods: We performed a cross-sectional study of patients with NCDs attending a public-sector health center in rural Haiti 2013-2016, and compared poverty among patients with poverty among a weighted community sample from the Haiti 2012 Demographic and Health Survey. We adapted the multidimensional poverty index: people deprived ≥44% of indicators are among the poorest billion people worldwide. We assessed hardship financing: borrowing money or selling belongings to pay for healthcare. We examined the association between facility distance and poverty adjusted for age and sex using linear regression. Results: Of 379 adults, 72% were women and the mean age was 52.5 years. 17.7% had hypertension, 19.3% had diabetes, 3.1% had heart failure, and 33.8% had multiple conditions. Among patients with available data, 197/296 (66.6%) experienced hardship financing. The proportions of people who are among the poorest billion people for women and men were similar (23.3% vs. 20.3%, p > 0.05). Fewer of the clinic patients were among the poorest billion people compared with the community (22.4% vs. 63.1%, p < 0.001). Patients who were most poor were more likely to live closer to the clinic (p = 0.002). Conclusion: Among patients with NCD conditions in rural Haiti, poverty and hardship financing are highly prevalent. However, clinic patients were less poor compared with the community population. These data suggest barriers to care access particularly affect the poorest. Socioeconomic data must be collected at health facilities and during community-level surveillance studies to monitor equitable healthcare access. Highlights:• Poverty and hardship financing are highly prevalent among NCD patients in rural Haiti.• Patients attending clinic are less poor than expected from the community. • People travelling farther to clinic are less poor. • Socioeconomic data should be collected to monitor healthcare access equity.

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“…In Equation (1 ), we capture the effects of financial inclusion on financial hardship in healthcare coverage by looking at the individuals’ probability of borrowing for medical purposes. Based on literature regarding how individuals cope with health shocks, 32 , 46 , 47 we hypothesise that, if an individual borrows for medical purposes, they are more likely to have financial hardships that can lead to catastrophic health expenditure. Included in the matrix are the variables we control for, largely motivated by the literature, which are age groups, education and income quintiles.…”

Section: Methodsmentioning

confidence: 99%

<p>Effects of Financial Inclusion on Access to Emergency Funds for Healthcare in the Kingdom of Saudi Arabia</p>

Al-Hanawi

Chirwa

Kamninga

et al. 2020

JMDH

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Background: Having access to convenient and quality healthcare at all times is not only a human right but also a goal that many countries strive to achieve for their population. However, access to healthcare might face blocks in the presence of financial exclusions. Saudi Arabia has, over the years, continued to pursue policy and system reforms to enhance its population's access to financial inclusion, as well as proper health coverage to improve health outcomes. This study seeks to estimate the effects of financial inclusion on the financial hardships in accessing healthcare in Saudi Arabia. Methods: This study uses a nationally representative survey conducted with 1009 adults, using the 2017 World Bank Global Findex Study data. The study estimates the conditional probability of coming up with emergency funds and the conditional probability of borrowing for medical purposes to understand access to healthcare. A composite value is created for financial inclusion using several variables for individuals' interactions with financial institutions, such as access to financial services and loans. Results: The results revealed that financially included individuals have a higher conditional probability of both borrowing for medical purposes and coming up with emergency funds, compared to those who are financially excluded. Additionally, the study showed that individuals in low-income brackets are more likely to be financially excluded and have a reduced chance of coming up with emergency funds and borrowing for medical purposes. Conclusion: These findings indicate that there is need for authorities to roll out a financial inclusion drive that will not only incentivise the financially excluded population to become included but that will also aim at promoting various financial products so that those who are already financially included have a wide range from which they can choose.

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Coping with healthcare costs for chronic illness in low-income and middle-income countries: a systematic literature review

Cited by 48 publications

References 61 publications

Costs, burden and quality of life associated with informal caregiving for children with Lymphoma attending a tertiary hospital in Ghana

Costs, burden and quality of life associated with informal caregiving for children with Lymphoma attending a tertiary hospital in Ghana

High Poverty and Hardship Financing Among Patients with Noncommunicable Diseases in Rural Haiti

<p>Effects of Financial Inclusion on Access to Emergency Funds for Healthcare in the Kingdom of Saudi Arabia</p>

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