Progress on catastrophic health spending in 133 countries: a retrospective observational study

Wagstaff, Adam; Flores, Gabriela; Hsu, Justine; Smitz, Marc-François; Chepynoga, Kateryna; Buisman, Leander R.; Wilgenburg, Kim van; Eozenou, Patrick

doi:10.1016/s2214-109x(17)30429-1

Cited by 440 publications

(539 citation statements)

References 29 publications

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“…In Benin, it has been reported that 75% to 80% of households directly pay medical fees, and 76% of health spending is spent on pharmaceuticals and other medical goods [36]. This can cause households to incur catastrophic expenditures, which in turn can push them into poverty [37]. As this study shows that only very few caregivers declared to possess health insurance, obviously the financial expenditures increase with the number of persons in a family without health insurance, and could explain why the size of the household is associated with the practice of home treatment.…”

Section: Discussionmentioning

confidence: 99%

Home treatment and use of informal market of pharmaceutical drugs for the management of paediatric malaria in Cotonou, Benin

Apetoh

Tilly

Baxerres

et al. 2018

Malar J

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BackgroundMalaria is the main cause of hospital admissions in Benin and a leading cause of death in childhood. Beside consultations, various studies have underlined the management of the disease through home treatment. The medicines used can be purchased in informal market of pharmaceutical drugs (IMPD) without prescription or any involvement of healthcare professional. Pharmaceutical drugs are sold by informal private vendors, who operate at any time in the immediate environment of the patients. The present study was conducted in Cotonou to study the health-seeking behaviour of caregivers to treat malaria in children under 12 years old. Factors associated with malaria home treatment and drugs purchase in IMPD were studied.MethodsA cross-sectional study was carried out among 340 children’s caregivers who were interviewed about their socio-demographic characteristics and their care-seeking behaviour during the most recent episode of malaria in their children under 12. Medicines used and purchase place were also collected. Multivariate logistic regression model was used to determine factors associated with malaria home treatment and drug purchase in IMPD.ResultsBeyond all the 340 caregivers, 116 (34%) consulted healthcare professional, 224 (66%) home treat the children, among whom 207 (61%) gave pharmaceutical drugs and 17 (5%) gave traditional remedies to children. Malaria home treatment was associated with family size, health insurance (OR = 0.396, 95% CI 0.169–0.928), and wealth quintiles where home treatment was less used by the richest (OR = 0.199, 95% CI 0.0676–0.522) compared to those in the poorest quintile. The caregivers age group 30–39 years was associated to the use of IMPD (OR = 0.383, 95% CI 0.152–0.964), the most economically wealthy people were less likely to use IMPD (wealth quintile richest: OR = 0.239, 95% CI 0.064–0.887; wealth quintile fourth OR = 0.271, 95% CI 0.100–0.735) compared to those in the poorest quintile. All caregivers who benefited from health insurance did not use IMPD.ConclusionThis study highlights the link between worse economic conditions and accessibility to medical care as one of the main factors of malaria home treatment and drug purchase in IMPD, even if those two phenomena need to be understood apart.Electronic supplementary materialThe online version of this article (10.1186/s12936-018-2504-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Home treatment and use of informal market of pharmaceutical drugs for the management of paediatric malaria in Cotonou, Benin

Apetoh

Tilly

Baxerres

et al. 2018

Malar J

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“…Income was estimated by asking detailed questions about income categories, including patient income, income for household members, welfare payments, and government assistance. As a measure of financial risk protection, we compared total direct costs incurred against annual household income and total direct costs excluding transport costs and defined costs as catastrophic if they exceeded 10% of household income …”

Section: Methodsmentioning

confidence: 99%

Patient costs of hypertension care in public health care facilities in Kenya

Oyando

Njoroge

Nguhiu

et al. 2019

Health Planning & Management

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Summary Background Hypertension in low‐ and middle‐income countries, including Kenya, is of economic importance due to its increasing prevalence and its potential to present an economic burden to households. In this study, we examined the patient costs associated with obtaining care for hypertension in public health care facilities in Kenya. Methods We conducted a cross‐sectional study among adult respondents above 18 years of age, with at least 6 months of treatment in two counties. A total of 212 patients seeking hypertension care at five public facilities were interviewed, and information on care seeking and the associated costs was obtained. We computed both annual direct and indirect costs borne by these patients. Results Overall, the mean annual direct cost to patients was US$ 304.8 (95% CI, 235.7‐374.0). Medicines (mean annual cost, US$ 168.9; 95% CI, 132.5‐205.4), transport (mean annual cost, US$ 126.7; 95% CI, 77.6‐175.9), and user charges (mean annual cost, US$ 57.7; 95% CI, 43.7‐71.6) were the highest direct cost categories. Overall mean annual indirect cost was US$ 171.7 (95% CI, 152.8‐190.5). The incidence of catastrophic health care costs was 43.3% (95% CI, 36.8‐50.2) and increased to 59.0% (95% CI, 52.2‐65.4) when transport costs were included. Conclusions Hypertensive patients incur substantial direct and indirect costs. High rates of catastrophic costs illustrate the urgency of improving financial risk protection for these patients and strengthening primary care to ensure affordability of hypertension care.

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“…A retrospective observational study in 133 countries illustrated that CHE whose threshold supposed to be 10% rose from 9.7% to 11.7% in just 5 years’ time from 2005 to 2010 5. Another study on CHE conducted in 59 countries found that as the proportion of household health expenditure to total health expenditure increased by 1%, the incidence of CHE would correspondingly increase by 2.2% 6.…”

Section: Introductionmentioning

confidence: 99%

How great is current curative expenditure and catastrophic health expenditure among patients with cancer in China? A research based on “System of Health Account 2011”

et al. 2018

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In recent years, the incidence and mortality of cancer have witnessed a dramatic increase. Cancer has already caused severe economic burdens on society, especially in developing countries and has become a major public health concern. This study evaluates the medical economic burden, including total current curative expenditure (CCE) and catastrophic health expenditure (CHE) on cancer in Liaoning Province, China. A total of 252 medical institutions were investigated with multistage stratified cluster random sampling. We established a standardized database of 3 532 517 samples. “System of Health Account 2011”, a new internationally recognized accounting system, was established to analyze the CCE on six most common cancers. CHE were estimated from the extracted 1344 patients with cancer, which performed a cross‐sectional study. The association of individual and contextual factors with CHE was evaluated using logistic regression models. CCE for all the patients with the six types of cancer was 2801.38 million CNY in Liaoning Province, the highest of which was lung cancer. The incidence of CHE was 42.78%, while the threshold was 40%. The average and relative distance were 10.41% and 24.32%, respectively. Influencing factors were length of stay, type of health insurance, location of household, etc. Our findings highlight the need to address medical economic burden in the cancer population. Households with the cancer are more likely to incur CHE. Financial intervention to prevent it should target on poor households. We provide suggestions in aspects of health insurance and health service management to reduce CHE.

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Progress on catastrophic health spending in 133 countries: a retrospective observational study

Abstract: Rockefeller Foundation, Ministry of Health of Japan, UK Department for International Development (DFID).

Cited by 440 publications

References 29 publications

Home treatment and use of informal market of pharmaceutical drugs for the management of paediatric malaria in Cotonou, Benin

Home treatment and use of informal market of pharmaceutical drugs for the management of paediatric malaria in Cotonou, Benin

Patient costs of hypertension care in public health care facilities in Kenya

How great is current curative expenditure and catastrophic health expenditure among patients with cancer in China? A research based on “System of Health Account 2011”

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