Household catastrophic health expenditure and its effective factors: a case of Iran

Ravangard, Ramin; Jalali, Faride Sadat; Bayati, Mohsen; Palmer, Andrew J.; Jafari, Abdosaleh; Bastani, Peivand

doi:10.1186/s12962-021-00315-2

Cited by 19 publications

(19 citation statements)

References 27 publications

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“…In a study by Ravangard et al evaluated household catastrophic health expenditure and its effective factors from Iran showed that 16.48% of studied households had faced CHEs. The higher ones facing CHEs were observed in the households living in rented houses, households with disabled members and households with children under 5 years old (7). In our study, we found that parents of patients with amino acid metabolism disorders with dietary treatment had signi cantly higher CHEs than those who had other types of IEM.…”

Section: Discussionsupporting

confidence: 45%

Out-of-pocket health expenditures in patients living with Inborn Errors of Metabolism

Gündüz¹,

Güdek

Kasapkara

2023

Preprint

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Aim: Implementation of newborn screening (NBS) programs for inborn errors of metabolism have advanced the diagnosis and management of affected infants and undoubtedly improved their outcomes. We aimed to determine out-of-pocket health expenditures of patients with inborn errors of metabolism during follow-up and treatment process and to determine the economic burden on the families. Materials and Methods: A total of 232 patients who voluntarily accepted to participate in the study and regularly followed up in the Department of Pediatric Metabolism with the diagnosis of Inborn Errors of Metabolism between April 2022 and July 2022 were included. Questionnaires were asked about the demographic characteristics of patients, use of health services, follow-up, treatment procedures, frequency of controls and health expenditures. Results: The average out-of-pocket expenditure of the households in the last month was 1039,22±1030,08 (minimum:20, maximum:5000) Turkish Liras (TL). When we consider the catastrophic health expenditure rate as the expenditure exceeding 40% of the household income; we found that 9.9% (23 people) of parents included in the study made catastrophic health expenditures. The rate of catastrophic expenditure of patients with diagnosis of Amino Acid Metabolism Disorders was found to be higher than the patients with diagnosis of Vitamin and Cofactor Metabolism Disorders. Similarly, Patients with the diagnosis of Lysosomal Storage Diseases had more expenditures than patients with the diagnosis of Vitamin and Cofactor Metabolism Disorders. When we compared the rate of catastrophic health expenditure of the patients with Urea Cycle Disorders and the patients with the diagnosis of patients with Vitamin and Cofactor Metabolism Disorders, the former had more expenditure than the latter (p<0.05). There was no significant difference between other disease groups in terms of catastrophic expenditure. The rate of catastrophic expenditures of the households living as large family type were higher than the families living as nuclear family type (p<0.01). A statistically significant difference was found between the rates of catastrophic expenditures of the families living in Ankara and those who admitted from other provinces for follow-up and treatment (p<0.001). However, there was no difference between the rates of catastrophic expenditure of the patients who received any treatment and those who were followed up without treatment (p>0.05). Conclusion: Due to the high rate of consanguineous marriages in our country, the development of newborn screening programs, the increase in awareness about metabolic diseases and the improvement in diagnostic methods; the frequency of metabolic diseases is increasing, and mortality and morbidity rates are significantly reduced with early diagnosis and treatment opportunities. It is necessary to carry out more comprehensive studies in order to determine and prevent the socioeconomic effects of out-of-pocket health expenditures of patients living with Inborn Errors of Metabolism.

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Section: Discussionsupporting

confidence: 45%

Out-of-pocket health expenditures in patients living with Inborn Errors of Metabolism

Gündüz¹,

Güdek

Kasapkara

2023

Preprint

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“…This review also reported that households with more children under 5 years were at risk of incurring CHE. A cross-sectional study carried out in Iran also reported that households with is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) children under 5 had a greater risk of encountering financial burden due to health spending [71]. Both studies support the idea that children under 5 are prone to childhood illnesses and injuries and as such will require more healthcare services.…”

Section: Determinants Of Che and Impoverishment Due To Health Spendingmentioning

confidence: 83%

Do National Health Insurance Schemes Guarantee Financial Risk Protection in the drive towards Universal Health Coverage in West Africa? A Systematic Review of Observational Studies

Odonkor

Koranteng

Appiah-Danquah

et al. 2022

Preprint

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Background To facilitate the drive towards Universal Health Coverage (UHC) several countries in the West African subregion have over the last two decades adopted the system of National Health Insurance (NHI) to finance their health services. However, most of these countries continue to face challenges safeguarding the insured population against catastrophic health expenditure (CHE) and impoverishment due to health spending. The aim of this study is to describe the extent of financial risk protection among households enrolled under NHI schemes in West Africa and summarize potential learnings. Methods We conducted a systematic review of observational studies in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published in English between 2005 and 2022 were searched for using keywords, synonyms and MeSH terms related to NHI, financial risk protection and UHC in all West African countries on the following electronic databases: PubMed/Medline, Web of Science and CINAHL via EBSCOhost and Embase via Ovid and Google Scholar. The quality of included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. Two independent reviewers assessed the studies for inclusion, extracted data and conducted quality assessment. We present the findings of the narrative synthesis consisting of thematic synthesis for qualitative data and a Synthesis Without Meta-analysis (SWiM) for quantitative data. The study protocol was published in PROSPERO under the ID CRD42022338574 on 28th June 2022. Results Of the 1,279 articles initially identified, nine were eligible for inclusion. These were cross-sectional studies (n=8) and retrospective cohort study (n=1) published between 2011 and 2021 in Ghana (n=8) and Nigeria (n=1). Two-thirds of the included studies reported that enrollment into the NHI showed a positive (protective) effect on CHE at different thresholds and one study showed a protective effect of NHI on impoverishment due to health spending. However, almost all of the included studies (n=8) reported that a proportion of insured households still encountered CHE with one-third of them reporting more than 50% of insured households incurring CHE. Key determinants of CHE and impoverishment due to health spending reported consisted of income, employment and educational status of household members as well as household size, household health profile, gender of household head and distance of household from health facility. Discussion Households insured under NHI schemes in some West African countries (Ghana and Nigeria) are better protected against CHE and impoverishment due to health spending compared to uninsured households as evidenced in other studies. However, insured households continue to incur CHE and impoverishment due to health expenditure resulting from gaps identified in the current design of NHI schemes in these West African countries. Conclusion To protect insured households from the financial burden due to health spending and advance the drive towards UHC in West Africa, governments should consider investing more into research on NHI, implementing nationwide compulsory NHI programmes and establishing a multinational West African collaboration to co-design a sustainable contextspecific NHI system based on solidarity, equity and fairness in financial contribution.

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“…Nevertheless, to fight against health expenditures costs, WHO emphasize the use of healthcare insurance [ 25 ]. The idea of universal healthcare coverage is a working promise in developed countries but the opposite is true in developing countries [ 8 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

The Effects of Sickle Cell Disease on the Quality of Life: A Focus on the Untold Experiences of Parents in Tanzania

Kilonzi

Mwakawanga

Felician

et al. 2022

IJERPH

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Tanzania is among the top five countries with a high burden of sickle cell disease (SCD) in the world. Even though the effects of SCD on quality of life have been documented in other countries including Nigeria and the United States of America, few are known from Tanzania. Therefore, this study focused on evaluating the effects of SCD on the quality of life among children living with SCD and their parents. The study employed a qualitative approach to interview purposively selected parents of children who have lived with SCD and have used hydroxyurea (HU) for more than 3 years. The in-depth interviews were conducted with 11 parents of children with SCD at the Muhimbili University of Health and Allied Sciences (MUHAS) in Dar-es-salaam, Tanzania. A semi-structured interview guide was used. Interviews were audio-recorded, transcribed, and thematically analyzed. Three themes were generated including psycho-social effects: family conflicts and divorce, limited access to education, stress and fear; financial effects: Employment limitation, reduced efficiency and productivity, loss of job and lack of self-keeping expenses; and physical effects: physical disability and dependence, and burden of the frequent crisis. Children living with SCD and their parents suffer psycho-social, financial, and physical impacts of the disease. Appropriate interventions should be introduced to minimize the observed effects as ways of improving the quality of life of the individuals living with SCD and their caregivers.

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Household catastrophic health expenditure and its effective factors: a case of Iran

Cited by 19 publications

References 27 publications

Out-of-pocket health expenditures in patients living with Inborn Errors of Metabolism

Out-of-pocket health expenditures in patients living with Inborn Errors of Metabolism

Do National Health Insurance Schemes Guarantee Financial Risk Protection in the drive towards Universal Health Coverage in West Africa? A Systematic Review of Observational Studies

The Effects of Sickle Cell Disease on the Quality of Life: A Focus on the Untold Experiences of Parents in Tanzania

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