What Policy Approaches Were Effective in Reducing Catastrophic Health Expenditure? A Systematic Review of Studies from Multiple Countries

Jung, Hyunwoo; Lee, Kwang-Soo

doi:10.1007/s40258-022-00727-y

Cited by 7 publications

(9 citation statements)

References 62 publications

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“…It measures the ratio of OOP medical expenses to the ability to pay (more accurately, it subtracts a certain threshold from the ratio). Jung and Lee [13] confirmed that CHE incidence in most countries does not significantly fluctuate in the time series, whereas the intensity is flexible. Furthermore, they reviewed four studies that employed difference-in-difference (DID) analysis to evaluate the healthcare system's newly launched coverage expansion plan in different countries and confirmed that only one study found a significant decrease in CHE.…”

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confidence: 88%

“…However, recent studies have pointed out the significant inherent limitations of the indicator. Jung and Lee [13] conducted a systematic review of CHE, reviewing the time series trends of reported incidence and intensity of CHE in 34 countries. Intensity is a paired indicator with incidence [2], although it has not been used as much as incidence in previous studies.…”

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confidence: 99%

“…In fact, many studies in Korea that assessed the effect of the benefit expansion policy of National Health Insurance (NHI) using the DID test concluded that there was a statistically significant effect on medical expenditure but no effect on CHE incidence [14][15][16][17][18]. Consequently, Jung and Lee [13] argued that incidence has an inherent limitation-it does not change and cannot sensitively reflect the policy effect. Additionally, they proposed intensity as an alternative indicator.…”

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confidence: 99%

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Which indicator should be used? A comparison between the incidence and intensity of catastrophic health expenditure: using difference-in-difference analysis

Koo

Jung

2022

Health Econ Rev

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Background Catastrophic health expenditure (CHE) represents out-of-pocket payment as a share of household income. Most previous studies have focused on incidence aspects when assessing health policy effects. However, because CHE incidence is a binary variable, the effect of the health policy could not accurately be evaluated. On the contrary, the intensity of CHE is a continuous variable that can yield completely different results from previous studies. This study reassesses the coverage expansion plan for four serious diseases using the intensity of CHE in Korea. Methods We used the Korea Health Panel Study from 2013 to 2015 to conduct the analysis. The study population is households with chronic diseases patients. We divided the population into two groups: the policy beneficiary group, i.e., households with a patient of any of the four serious diseases, and the non-beneficiary group. A difference-in-difference model was employed to compare the variation in the intensity and incidence of CHE between the two groups. We defined the incidence of CHE as when the ratio of out-of-pocket medical expenses to household income is more than a threshold of 10%, and the intensity of CHE is the height of the ratio subtracting the threshold 10%. Results The increased rate of CHE intensity in households with four serious diseases was lower than that in households with other chronic diseases. The interaction term, which represents the effect of the policy, has a significant impact on the intensity but not on the incidence of CHE. Conclusions CHE indicators should be applied differently according to the purpose of policy evaluation. The incidence of CHE should be used as the final achievement indicator, and the intensity of CHE should be used as the process indicator. Furthermore, because CHE has an inherent characteristic that is measured by the ratio of household income to medical expenses, to lower this, a differential out-of-pocket maximum policy for each income class is more appropriate than a policy for strengthening the coverage for specific diseases.

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confidence: 88%

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confidence: 99%

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confidence: 99%

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Which indicator should be used? A comparison between the incidence and intensity of catastrophic health expenditure: using difference-in-difference analysis

Koo

Jung

2022

Health Econ Rev

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“…However, we consider these results to be biased because the incidence rates do not change significantly. Studies that have analyzed the effects of policy on the four major diseases using OOP expenses or NHI benefits as a dependent variable tend to report that there is a policy effect [30,33]; however, studies that adopt CHE incidence as a dependent variable tend to report no effect at all [34,35]. In this regard, Jung and Lee [26] confirmed that the positive gap can be viewed more accurately than the incidence approach when considering policy effects.…”

Section: Private Health Insurance Coverage (O3mentioning

confidence: 99%

How public and private health insurance coverage mitigates catastrophic health expenditures in Republic of Korea

Jung

Kwon

Noh

2022

BMC Health Serv Res

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Background The private health insurance (PHI) market in Republic of Korea has instituted indemnity insurance plans that provide partial reimbursements for some medical services or costs that are not covered by the National Health Insurance (NHI). To date, no study has estimated the extent to which PHI coverage lowers the economic burden of households’ access to health care. The current study aims to evaluate the design of Korea’s PHI system in terms of coverage using a catastrophic health expenditure (CHE) indicator and compare it with NHI. Methods This study determined the difference between the number of households that were subscribed to PHI and those that received reimbursements from PHI. Additionally, it compared the effects of reduced CHE by NHI benefits with PHI reimbursements. Furthermore, it compared PHI reimbursements based on income class. Finally, it analyzed the contribution of NHI and PHI to CHE reduction through a two-part model with hierarchical regression. Results The results indicated that of the 5644 households examined, 3769 subscribed to PHI, but only 246 households received reimbursements. Notably, NHI reduced CHE incidence by 15.17%, whereas PHI only reduced CHE by 1.22%. The NHI scheme indicated reduced inequality as it provided more benefits to the low-income class for their used medical services, whereas PHI paid more reimbursements to the high-income class. Accordingly, NHI coverage has protected households from CHE and improved equality to some extent; however, PHI coverage has had a relatively low effect on relieving CHE and has increased inequality. Conclusions The indemnity health insurance plans of PHI companies in Korea only cover partial medical costs or services, and so, most patients do not receive reimbursements. Thus, Korea’s PHI system needs to improve to provide benefits to patients more generously and alleviate their financial burden.

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“…On the basis of calculating catastrophic health expenditure, different scholars have put forward different policy suggestions (Jung and Lee, 2022 [ 28 ]; Pak, 2021 [ 29 ]). First of all, some scholars believe that the fundamental source of health problems, such as environmental pollution, should be solved (Dimitris et al, 2020 [ 30 ]; Reza et al 2019 [ 31 ]; Xu et al 2022 [ 32 ]).…”

Section: Introductionmentioning

confidence: 99%

Does Elderly Chronic Disease Hinder the Sustainability of Borderline Poor Families’ Wellbeing: An Investigation From Catastrophic Health Expenditure in China

Xu¹,

Yang²

2022

Int J Public Health

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Objectives: Health and health expenditure caused by elderly chronic diseases are a global problem. As China has just lifted itself out of poverty in 2020, the sustainable development of Borderline Poor Families’ Wellbeing faces severe challenges. Therefore, it is of great practical significance to explore the impact of elderly chronic diseases on the catastrophic health expenditure of Borderline Poor Families.Methods: Based on screening 8086 effective samples from China Health and Retirement Longitudinal Study (CHARLS) database and calculating catastrophic health expenditure, this paper uses two-part model and logit regression to discuss the impact of elderly chronic diseases on the sustainable development of Borderline Poor Families’ Wellbeing.Results: The results showed that stroke, cancer, and liver disease caused the most catastrophic health expenditures and had the greatest impact on the Borderline Poor Families’ Wellbeing.Conclusion: Therefore, in order to ensure the sustainable development of Borderline Poor Families’ Wellbeing, the government should strengthen the publicity of pre-prevention and post-healthcare of chronic diseases such as stroke, and combine pre-prevention policy with post-guarantee policy.

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What Policy Approaches Were Effective in Reducing Catastrophic Health Expenditure? A Systematic Review of Studies from Multiple Countries

Cited by 7 publications

References 62 publications

Which indicator should be used? A comparison between the incidence and intensity of catastrophic health expenditure: using difference-in-difference analysis

Which indicator should be used? A comparison between the incidence and intensity of catastrophic health expenditure: using difference-in-difference analysis

How public and private health insurance coverage mitigates catastrophic health expenditures in Republic of Korea

Does Elderly Chronic Disease Hinder the Sustainability of Borderline Poor Families’ Wellbeing: An Investigation From Catastrophic Health Expenditure in China

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