Measuring incidence of catastrophic out-of-pocket health expenditure: with application to India

Pal, Rama

doi:10.1007/s10754-012-9103-4

Cited by 72 publications

(75 citation statements)

References 23 publications

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“…CHEs refer to high levels of healthcare expenditures that affect a household’s standard of living by causing the household to sacrifice other basic expenditures to pay for health costs [4]. CHEs can be defined as health payments that exceed a fixed threshold share of household income or total expenditures in a given period, usually one year [5].…”

Section: Introductionmentioning

confidence: 99%

Does the new cooperative medical scheme reduce inequality in catastrophic health expenditure in rural China?

Guo

Iversen

et al. 2016

BMC Health Serv Res

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BackgroundIn 2003, the New Cooperative Medical Scheme (NCMS) was introduced in China to re-establish health insurance for the country’s vast rural population. In addition, the coverage of NCMS has been expanding after the new health care reform launched in 2009. This study aims to examine whether the NCMS and its recent expansion have reached the goal of reducing the risk and inequality of catastrophic health spending for rural residents in China.MethodsWe conducted a face-to-face household survey in three counties of the Shandong province in 2009 and 2012. Using this unique panel data, we examined the changes in the incidence and intensity of catastrophic health expenditures (CHEs) before and after NCMS reimbursement. We used concentration index (CI) and decomposition method to study the changes in inequality in CHEs.ResultsWe found that NCMS reimbursement played a role of reducing both the incidence and intensity of CHEs, and that this impact was stronger after the new health care reform was launched. After reimbursement, the concentration indices for CHEs were 0.073 and 0.021 in 2009 and 2012, indicating that the rich had a greater tendency to incur CHEs and there existed less inequality in the incidence of CHEs after reimbursement in 2012 compared with 2009. The decomposition analysis results suggested that changes in CHE inequality between 2009 and 2012 were attributed to changes in economic status and household size rather than reimbursement levels.ConclusionsOur results indicated that inequality was shrinking from 2009 to 2012, which could be a result of fewer rich people having CHEs in 2012 compared with 2009. The impact of NCMS in alleviating the financial burden of rural residents was still limited, especially among the poor. Health care reform policies in China that aim to reduce CHEs must continue to place an emphasis on improving reimbursement, cost containment, and reducing income inequalities.

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Section: Introductionmentioning

confidence: 99%

Does the new cooperative medical scheme reduce inequality in catastrophic health expenditure in rural China?

Guo

Iversen

et al. 2016

BMC Health Serv Res

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“…The variable of female household head increased the possibility of facing CHE in 2 studies (23,30) and decreased it in another (18). Therefore, it seems more appropriate to consider this variable as interacting with other variables such as education or place of residence (city or village) (33).…”

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confidence: 99%

The Prevalence and Determinants of Catastrophic Health Expenditures in Iran: A Systematic Review and Meta-Analysis

et al. 2017

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Objective: In this systematic review, we aimed at estimating the pooled prevalence of catastrophic health expenditures (CHE) in Iran and identifying and summarizing the determinants of CHE among Iranian households. Methods:We comprehensively searched the literature on November 2016 in PubMed, Scopus, Web of Science, the Cochrane Library, and 3 Persian databases. We also obtained the literature through colleague communications. Two review authors independently selected studies, extracted data, and evaluated them. We performed meta-analysis of prevalence of CHE and subgroup meta-analyses to assess the influence of data source and scope of research. Moreover, we categorized the determinants of CHE in Ian.Results: In this review, 16 studies met the inclusion criteria, and of them, 2 presented the results of multiple surveys. Results of 27 cross-sectional studies were used to estimate the pooled prevalence of CHE in Iran during 1995 and 2015, which was found to be 3.91% (95% confidence interval, CI: -3.26-11.07). Subgroup meta-analyses based on data source revealed that the highest prevalence estimate of facing CHE was associated with author-made questionnaires, and the lowest to the statistical Centre of Iran (SCI) questionnaire. Also, meta-regression showed that the difference in sample size and year of study did not have any significant effect on the prevalence of CHE. Some of the variables such as use of inpatient, outpatient, and dentistry services, education, place of residence, and household income, which were considered as determinants of CHE in Iran, increased the possibility of facing CHE. Conclusions:Decrease in CHE to less than 1%, which was the objective of the 2 of Iran's five-year development plans in 2007 and 2015, was not met. This percentage may need to be reconsidered according to the pooled estimate of CHE. Also, the factors revealed to be the determinants of an increase in the probability of facing CHE could indicate the need for health care services and socioeconomic variables that lower one's capacity to pay for health services.

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“…Two measures of financial protection were applied: first, the proportion of HHs that borrowed with interest to pay healthcare costs, because borrowing-with-interest is a strong indicator of the risk of falling into indigent status1415161718; and second, the effect of insurance on economic mobility ( i.e . the measurement of the capacity of a participant in a system to improve (or reduce) his/her economic status)19 measured by consumption spending on non-health items.…”

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confidence: 99%

Impact of community-based health insurance in rural India on self-medication & financial protection of the insured

Dror¹,

Chakraborty²,

Majumdar³

et al. 2016

Indian Journal of Medical Research

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Background & objectives:The evidence-base of the impact of community-based health insurance (CBHI) on access to healthcare and financial protection in India is weak. We investigated the impact of CBHI in rural Uttar Pradesh and Bihar States of India on insured households’ self-medication and financial position.Methods:Data originated from (i) household surveys, and (ii) the Management Information System of each CBHI. Study design was “staggered implementation” cluster randomized controlled trial with enrollment of one-third of the treatment group in each of the years 2011, 2012 and 2013. Around 40-50 per cent of the households that were offered to enroll joined. The benefits-packages covered outpatient care in all three locations and in-patient care in two locations. To overcome self-selection enrollment bias, we constructed comparable control and treatment groups using Kernel Propensity Score Matching (K-PSM). To quantify impact, both difference-in-difference (DiD), and conditional-DiD (combined K-PSM with DiD) were used to assess robustness of results.Results:Post-intervention (2013), self-medication was less practiced by insured HHs. Fewer insured households than uninsured households reported borrowing to finance care for non-hospitalization events. Being insured for two years also improved the HH's location along the income distribution, namely insured HHs were more likely to experience income quintile-upgrade in one location, and less likely to experience a quintile-downgrade in two locations.Interpretation & conclusions:The realized benefits of insurance included better access to healthcare, reduced financial risks and improved economic mobility, suggesting that in our context health insurance creates welfare gains. These findings have implications for theoretical, ethical, policy and practice considerations.

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Measuring incidence of catastrophic out-of-pocket health expenditure: with application to India

Cited by 72 publications

References 23 publications

Does the new cooperative medical scheme reduce inequality in catastrophic health expenditure in rural China?

Does the new cooperative medical scheme reduce inequality in catastrophic health expenditure in rural China?

The Prevalence and Determinants of Catastrophic Health Expenditures in Iran: A Systematic Review and Meta-Analysis

Impact of community-based health insurance in rural India on self-medication & financial protection of the insured

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