The economic impact of the insured patients with severe chronic and acute illnesses: a qualitative approach

Aji, Budi; Yamamoto, Shelby; Sauerborn, Rainer

doi:10.3402/gha.v7.22526

Cited by 11 publications

(19 citation statements)

References 18 publications

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“…At the structural level, we recognized three issues: health insurance services for NCD patients [88], the need for a better collaboration between health and registration sectors [61], and the need to address the double burden of NCDs and infectious diseases such as tuberculosis and diabetes [25], which might be aggravated by smoking [39]. …”

Section: Resultsmentioning

confidence: 99%

How is Indonesia coping with its epidemic of chronic noncommunicable diseases? A systematic review with meta-analysis

et al. 2017

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BackgroundChronic noncommunicable diseases (NCDs) have emerged as a huge global health problem in low- and middle-income countries. The magnitude of the rise of NCDs is particularly visible in Southeast Asia where limited resources have been used to address this rising epidemic, as in the case of Indonesia. Robust evidence to measure growing NCD-related burdens at national and local levels and to aid national discussion on social determinants of health and intra-country inequalities is needed. The aim of this review is (i) to illustrate the burden of risk factors, morbidity, disability, and mortality related to NCDs; (ii) to identify existing policy and community interventions, including disease prevention and management strategies; and (iii) to investigate how and why an inequitable distribution of this burden can be explained in terms of the social determinants of health.MethodsOur review followed the PRISMA guidelines for identifying, screening, and checking the eligibility and quality of relevant literature. We systematically searched electronic databases and gray literature for English- and Indonesian-language studies published between Jan 1, 2000 and October 1, 2015. We synthesized included studies in the form of a narrative synthesis and where possible meta-analyzed their data.ResultsOn the basis of deductive qualitative content analysis, 130 included citations were grouped into seven topic areas: risk factors; morbidity; disability; mortality; disease management; interventions and prevention; and social determinants of health. A quantitative synthesis meta-analyzed a subset of studies related to the risk factors smoking, obesity, and hypertension.ConclusionsOur findings echo the urgent need to expand routine risk factor surveillance and outcome monitoring and to integrate these into one national health information system. There is a stringent necessity to reorient and enhance health system responses to offer effective, realistic, and affordable ways to prevent and control NCDs through cost-effective interventions and a more structured approach to the delivery of high-quality primary care and equitable prevention and treatment strategies. Research on social determinants of health and policy-relevant research need to be expanded and strengthened to the extent that a reduction of the total NCD burden and inequalities therein should be treated as related and mutually reinforcing priorities.

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Section: Resultsmentioning

confidence: 99%

How is Indonesia coping with its epidemic of chronic noncommunicable diseases? A systematic review with meta-analysis

et al. 2017

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“…Evidence shows, the financial capacity of households to maintain their basic needs is jeopardized due to CHE [ 7 ]. Households incurring CHE are likely to compromise their children’s education [ 8 ], sell assets [ 9 ], and pushed into poverty [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Cumulative incidence, distribution, and determinants of catastrophic health expenditure in Nepal: results from the living standards survey

Ghimire

Ayer

Kondo

2018

Int J Equity Health

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BackgroundNepal has committed to the global community to achieve universal health coverage by 2030. Nevertheless, Nepal still has a high proportion of out-of-pocket health payment and a limited risk-pooling mechanism. Out-of-pocket payment for the healthcare services could result in catastrophic health expenditure (CHE). Evidence is required to effectively channel the efforts to lower those expenses in order to achieve universal health coverage. However, little is known about CHE and its determinants in a broad national context in Nepal. Therefore, this study was conducted to explore the cumulative incidence, distribution, and determinants of CHE in Nepal.MethodsData were obtained from the nationally representative survey, the Nepal Living Standards Survey-third undertaken in 2010/11. Information from 5988 households was used for the analyses. Households were classified as having CHE when their out-of-pocket health payment was greater than or equal to 40% of their capacity to pay. Remaining households were classified as not having CHE. Logistic regression analyses were used to identify determinants of CHE.ResultsBased on household-weighted sample, the cumulative incidence of CHE was 10.3% per month in Nepal. This incidence was concentrated in the far-western region and households in the poorer expenditure quartiles. Multivariable logistic regression revealed that households were more likely to face CHE if they; consisted of chronically ill member(s), have a higher burden of acute illness and injuries, have elderly (≥60 years) member(s), belonged to the poor expenditure quartile, and were located in the far-western region. In contrast, households were less likely to incur CHE when their household head was educated. Having children (≤5 years) in households did not significantly affect catastrophic health expenditure.ConclusionsThis study identified a high cumulative incidence of CHE. CHE was disproportionately concentrated in the poor households and households located in the far-western region. Policy-makers should focus on prioritizing households vulnerable to CHE. Interventions to reduce economic burden of out-of-pocket healthcare payment are imperative to lower incidences of CHE among those households. Improving literacy rate might also be useful in order to lower CHE and facilitate universal health coverage.Electronic supplementary materialThe online version of this article (10.1186/s12939-018-0736-x) contains supplementary material, which is available to authorized users.

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“…Other public hospitals in Indonesia have different policies for upgrading class wards. The consequence of the upgrading leads to a higher out-of-pocket expenditures and becomes a barrier, particularly for the poor in accessing health services (Aji, De Allegri, Souares, & Sauerborn, 2013;Aji et al, 2014). The no-class wards policy at Wates Hospital might be able to be a relevant intervention to tackle this issue.…”

Section: Discussionmentioning

confidence: 99%

Hospital with No-class Wards Policy: An Effort to Create the Right to Access to Quality Health Care for the Poor

Aji

Sumawan

2019

Journal of Health Management

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The purpose of the present study was to explore the experience of the patients and hospital behaviour after the implementation of the no-class wards policy and its possible impact on the poor and non-poor patients provision and quality of care. This case study was conducted at Wates Hospital and purposeful sampling was used to yield participants. This study employed in-depth interviews with health care users district health care stakeholders, and focus group discussions with hospital healthcare professionals. The no-class wards policy had clearly demonstrated on improving the right to access to quality health care for the poor. The policy had been effectively reducing the experiences of patients on discriminatory treatment and improving quality of services. The policy also had an impact on increasing hospital utilization significantly among public insurance beneficiaries for both the poor and non-poor patients which supports the success of the implementation of the universal health coverage. Moreover, the policy had improved the assurance of quality of services. Future research needs to expand on our work to compare the implementation of no-class wards policy in other hospitals in different regions in Indonesia considering different local context such as local political issues, public expectations and other technical issues.

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The economic impact of the insured patients with severe chronic and acute illnesses: a qualitative approach

Cited by 11 publications

References 18 publications

How is Indonesia coping with its epidemic of chronic noncommunicable diseases? A systematic review with meta-analysis

How is Indonesia coping with its epidemic of chronic noncommunicable diseases? A systematic review with meta-analysis

Cumulative incidence, distribution, and determinants of catastrophic health expenditure in Nepal: results from the living standards survey

Hospital with No-class Wards Policy: An Effort to Create the Right to Access to Quality Health Care for the Poor

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