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Kafle S, Adhikari SR, Kallestrup P, Neupane D, Enemark U. Catastrophic and impoverishing impacts of health expenditures: a focus on non-communicable diseases in Pokhara Metropolitan City, Nepal. BMC Public Health 2025; 25:1283. [PMID: 40186202 PMCID: PMC11971764 DOI: 10.1186/s12889-025-22418-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 03/20/2025] [Indexed: 04/07/2025] Open
Abstract
BACKGROUND Ensuring equitable access to Universal Health Coverage (UHC) is crucial, particularly in low-resource settings like Nepal, where high out-of-pocket expenditure (OOPE) poses a significant barrier to the utilization of healthcare services. This study examined the catastrophic and impoverishing impact of household-level healthcare expenditures, focusing on whether households with NCDs have a higher likelihood of incurring CHE and experiencing impoverishment. METHODS We conducted this study in Pokhara Metropolitan City, Nepal, involving 1,276 households. Catastrophic Health Expenditure (CHE) was defined when OOPE was 10% or more of the household's total expenditure, while impoverishment was measured using the poverty headcount ratio, poverty gap, and squared poverty gap. We used a poverty line of NPR 7,674 (approximately USD 230 in Purchasing Power Parity) per capita per month, as set by the National Statistics Office for the Gandaki urban area in 2024. Total monthly household consumption was the sum of food and non-food expenditures, including healthcare expenditures. Health expenditure was calculated based on self-reported data validated by pertinent documents. Household weight was used in the data analysis. RESULTS Out of 1276 households, 853 (66.8%) reported illness in the past month, and 125 households suffered from CHE. This corresponds to 9.8% of all sampled and 14.6% of households that experienced illness. Out of those 125 households, 82 faced CHE due to NCDs, representing 6.4% of all sampled and 9.6% of households experiencing illness. Most health expenditures were primarily due to medication (60%) and curative care (17.3%) in NCD conditions. The poverty rate increased by 1.17%points, from 9.4% to 10.6%, over the past month due to healthcare costs, leading to a 12.3% increase in people living in poverty, with 1.02%points attributed to NCDs. The poverty gap rose from 1.5% to 1.9%, and the squared poverty gap increased from 0.003 to 0.005. Households with more than two members affected by NCDs had 3 times higher odds of experiencing CHE (AOR 3.02, 95% CI 2.59-3.51). Those with a household member/s suffering from heart disease had twice the odds of facing CHE (AOR 2.41, 95% CI 2.22-2.62). Households with diabetic members had 1.13 times higher odds of experiencing CHE (AOR = 1.13, 95% CI: 1.05-1.21). Households in the lowest quintile had twice the odds of incurring CHE than those in the highest quintile (AOR 1.93, 95% CI 1.75-2.15). CONCLUSION NCDs and their associated costs are significant contributors to CHE and impoverishment. As Nepal moves towards UHC, policymakers need to accord the highest priority to enhancing financial protection mechanisms by subsidizing healthcare costs, particularly for medicines and curative care related to NCDs. Furthermore, addressing economic inequalities through targeted support for low-income and marginalized households will mitigate CHE and prevent impoverishment.
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Affiliation(s)
- Simrin Kafle
- Department of Public Health, Aarhus University, Aarhus, Denmark.
| | | | - Per Kallestrup
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Dinesh Neupane
- Dinesh Neupane, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Ulrika Enemark
- Department of Public Health, Aarhus University, Aarhus, Denmark
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Assari S, Zare H. Weaker Effects of Educational Attainment on Chronic Medical Conditions in American Indian Alaska Native, Black, and Latino Adults: National Health Interview Survey 2023. OPEN JOURNAL OF MEDICAL SCIENCES 2025; 5:1150. [PMID: 39931521 PMCID: PMC11808385 DOI: 10.31586/ojms.2025.1150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2025]
Abstract
Background Chronic medical conditions are major drivers of healthcare spending, morbidity, and mortality in the United States, as well as critical indicators of health disparities. The disproportionately high rates of chronic medical conditions among Black, Latino, and American Indian and Alaska Native adults compared to non-Latino Whites highlight the urgent need to examine the factors contributing to these disparities. While higher socioeconomic status is generally associated with better health outcomes, this benefit may be diminished for racialized and minoritized populations. Objective This study investigates the protective effects of educational attainment and income-to-poverty ratio on the prevalence of chronic medical conditions and examines whether these effects vary across racial and ethnic groups, specifically among Black, Latino, and American Indian and Alaska Native adults compared to non-Latino White adults. Methods Using data from the 2023 National Health Interview Survey (NHIS), this cross-sectional study analyzed the association between educational attainment and chronic medical conditions across racial and ethnic groups. Logistic regression models were employed to assess whether the strength of the relationship between education and chronic medical conditions differed by racial/ethnic group, controlling for key demographic and socioeconomic covariates. Sample size was 29,373 which was reflective of 256,566,689 US population. Results Consistent with the theory of Minorities' Diminished Returns, findings showed that the protective effects of higher educational attainment on chronic medical conditions were significantly weaker for Black, Latino, and American Indian and Alaska Native adults than for their non-Latino White counterparts. Even among individuals with higher education, Black, Latino, and American Indian and Alaska Native adults faced elevated risks of chronic medical conditions. Conclusion While educational attainment generally reduces the prevalence of chronic medical conditions, this protective effect is moderated by racial and ethnic background. Structural barriers limit the health benefits of educational attainment. This underscores the need for policies that address structural inequities-such as low- quality education and occupational segregation-that constrain the protective health effects of educational attainment for minoritized groups.
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Affiliation(s)
- Shervin Assari
- Department of Internal Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
- Department of Urban Public Health, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
- Marginalized-Related Diminished Returns (MDRs) Research Center, Los Angeles, CA, USA
| | - Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- School of Business, University of Maryland Global Campus (UMGC), Adelphi, MD, USA
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Suvirya S, Tripathi S, Shukla M, Verma P, Kar SK, Sachan S. Out-of-pocket and catastrophic health expenditure among patients of sexually transmitted infections at a tertiary care center: A cross-sectional study. Indian J Sex Transm Dis AIDS 2024; 45:25-30. [PMID: 38989093 PMCID: PMC11233049 DOI: 10.4103/ijstd.ijstd_56_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/09/2023] [Accepted: 10/09/2023] [Indexed: 07/12/2024] Open
Abstract
Context Economic burden imposed by sexually transmitted infections (STIs) is substantial in low-middle-income countries like India, in spite of the fact that national programs for controlling STIs are operational. Aims The aim of this study was to estimate the out-of-pocket expenses and catastrophic health expenditure (CHE) incurred by patients of STIs and analyze expenditure pattern in relation to various clinical and sociodemographic characteristics. Settings and Design This was a hospital-based cross-sectional study among patients attending Suraksha Clinic. Subject and Methods The study was conducted among patients aged ≥18 years. Data were collected regarding various direct and indirect expenses incurred, after adjusting any reimbursement or waive off. Total costs exceeding 10% of annual household income were considered catastrophic. Stepwise regression analysis was used to analyze predictors, and P < 0.05 was considered statistically significant. Results Out of 157 patients, most were suffering from herpetic ulcers (27.4%). The median and interquartile range (IQR) for total OOPE of STI management was ₹1950 (IQR 1035-5725). Direct expenditure constituted major expenses with a median of ₹1850 (IQR 787.50-5385.0). The cost of STI management was catastrophic in 15.2% of cases. Lower socioeconomic status, longer traveling distance, overnight stay as a part of seeking treatment at Suraksha Clinic, previous history of other than allopathic treatment, and quack consultation were found to be independent predictors of CHE. Conclusions Despite free diagnostic and treatment services to STI patients under the National AIDS Control Programme, many incurred considerable costs and catastrophic expenditure toward STI care. Better outreach of health services is required to maximize STI control and lower financial morbidity.
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Affiliation(s)
- Swastika Suvirya
- Department of Dermatology, Venereology and Leprosy, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Srishti Tripathi
- Department of Dermatology, Venereology and Leprosy, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | - Mukesh Shukla
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, India
| | - Parul Verma
- Department of Dermatology, Venereology and Leprosy, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Sujita Kumar Kar
- Department of Psychiatry, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Sonal Sachan
- Department of Dermatology, Venereology and Leprosy, Hind Institute of Medical Sciences, Barabanki, Uttar Pradesh, India
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Zin CS, Ab Rahman NS, Mohamed Nazar NI, Kurdi A, Godman B. Trends in the Cost of Medicines, Consultation Fees and Clinic Visits in Malaysia's Private Primary Healthcare System: Employer Health Insurance Coverage. J Multidiscip Healthc 2023; 16:1683-1697. [PMID: 37350986 PMCID: PMC10284298 DOI: 10.2147/jmdh.s403589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/08/2023] [Indexed: 06/24/2023] Open
Abstract
Objective To examine trends in the cost of medicines, consultation fees and clinic visits among the employees covered by the employer health insurance in Malaysia's private primary healthcare system in Malaysia. Designs Retrospective cross-sectional study. Setting PMCare claims database from January 2016 to August 2019. Participants A total of 83,556 outpatient clinic visits involving 10,150 IIUM employees of the International Islamic University Malaysia (IIUM) to private general practitioners (GPs). During the study period, IIUM adopts the incentive structure of capping coverage at Ringgit Malaysia (RM) 45/outpatient visit (USD 10.58) to cover for consultation fees and medicine costs. Main Outcome Measures The monthly percentage change in the number of clinic visits, medicine costs, consultation fees and total costs between January 2016 and August 2019. A simple linear regression using Stata v15.1 was also performed to measure the association between the characteristics of the prescribed medicines and medicine charges. Results The number of clinic visits per patient increased by 17% from January 2016 to August 2019, with consultation fees increasing by 113.9% and total costs by 7.9% per clinic visit per patient. Conversely, the cost of medicines and the number of medicines prescribed per clinic visit per patient decreased by 39.7% and 6.3%, respectively. Conclusion Within the incentive structure of capping the total amount of coverage per clinic visit, medicine costs were reduced by decreasing the number of medicines prescribed, to offset the increased consultation fees. This may create perverse incentives that affect medicine use with negative consequences for the health system and health insurers.
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Affiliation(s)
- Che Suraya Zin
- Big Data Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Norny Syafinaz Ab Rahman
- Big Data Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Nor Ilyani Mohamed Nazar
- Big Data Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Department of Pharmacology and Toxicology, College of Pharmacy, Hawler Medical University, Erbil, Kurdistan Region Government, Iraq
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
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Nimavat N, Hasan MM, Charmode S, Mandala G, Parmar GR, Bhangu R, Khan I, Singh S, Agrawal A, Shah A, Sachdeva V. COVID-19 pandemic effects on the distribution of healthcare services in India: A systematic review. World J Virol 2022; 11:186-197. [PMID: 36159611 PMCID: PMC9372784 DOI: 10.5501/wjv.v11.i4.186] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/19/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has brought fundamental changes to our problems and priorities, especially those related to the healthcare sector. India was one of the countries severely affected by the harsh consequences of the COVID-19 pandemic.
AIM To understand the challenges faced by the healthcare system during a pandemic.
METHODS The literature search for this review was conducted using PubMed, EMBASE, Scopus, Web of Science, and Google Scholar. We also used Reference Citation Analysis (RCA) to search and improve the results. We focused on the published scientific articles concerned with two major vital areas: (1) The Indian healthcare system; and (2) COVID-19 pandemic effects on the Indian healthcare system.
RESULTS The Indian healthcare system was suffering even before the pandemic. The pandemic has further stretched the healthcare services in India. The main obstacle in the healthcare system was to combat the rising number of communicable as well as noncommunicable diseases. Besides the pandemic measures, there was a diversion of focus of the already established healthcare services away from the chronic conditions and vaccinations. The disruption of the vaccination services may have more severe short and long-term consequences than the pandemic’s adverse effects.
CONCLUSION Severely restricted resources limited the interaction of the Indian healthcare system with the COVID-19 pandemic. Re-establishment of primary healthcare services, maternal and child health services, noncommunicable diseases programs, National Tuberculosis Elimination Program, etc. are important to prevent serious long-term consequences of this pandemic.
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Affiliation(s)
- Nirav Nimavat
- Department of Community Medicine, Dr. Kiran C Patel Medical College and Research Institute, Bharuch 392001, India
| | - Mohammad Mehedi Hasan
- Department of Biochemistry and Molecular Biology, Mawlana Bhashani Science and Technology University, Tangail 1902, Bangladesh
| | - Sundip Charmode
- Department of Anatomy, All India Institute of Medical Sciences, Rajkot 360006, Gujarat, India
| | - Gowthamm Mandala
- Independent Researcher, Centre Groove High School, Greenwood, IN 46143, United States
| | | | - Ranvir Bhangu
- Department of Medical, Caribbean Medical University, Des Plaines, IL 60018, United States
| | - Israr Khan
- Shifa International Hospital, Islamabad 999010, Pakistan
| | - Shruti Singh
- Department of Pharmacology, All India Institute of Medical Sciences, Patna 801507, India
| | - Amit Agrawal
- Department of Paediatrics, Gandhi Medical College, Bhopal 462001, India
| | - Ashish Shah
- Department of Pharmacy, Sumandeep Vidyapeeth, Vadodara 391760, India
| | - Vishi Sachdeva
- Department of Medical, Adesh Institute of Medical Sciences and Research, Bathinda 151009, India
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Understanding Household Catastrophic Health Expenditures and Fairness of Financing for Cancer Treatment: A Cross-Sectional Case Study in West of Iran. HEALTH SCOPE 2022. [DOI: 10.5812/jhealthscope-119827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: Direct out-of-pocket (OOP) and indirect healthcare payments can limit the household budget and cause several financial problems for the household. Objectives: This study aimed to measure the financial protection and determinants of catastrophic health expenditures (CHEs) for cancer treatment in Shahid Rahimi Hospital, Khorramabad, located in western Iran. Methods: This study was conducted on 220 households of cancer patients in Lorestan Province, Iran. The framework of data collection was based on the World Health Organization (WHO) Global Health Survey. Interviews were conducted with individuals who met the inclusion criteria of this study; they were selected using a simple random sampling method. Data were analyzed using Chi-square test in STATA. Results: The present results showed that the incidence of CHEs and the fair financial contribution index (FFCI) were 70% and 86%, respectively. There was a significant relationship between the household CHEs and variables, such as supplementary insurance coverage, household income status, educational level of the household head, household size, age of the household head, type of cancer, and type of cancer treatment. Conclusions: More financial protection should be provided for the families of cancer patients due to the high incidence of CHEs and unfair financing of cancer care services. Moreover, healthcare systems should consider supportive policies for cancer patients and their household members by increasing the insurance coverage and expanding service packages to reduce cancer treatment expenditures.
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Harish R, Suresh RS, Rameesa S, Laiveishiwo PM, Loktongbam PS, Prajitha KC, Valamparampil MJ. Health insurance coverage and its impact on out-of-pocket expenditures at a public sector hospital in Kerala, India. J Family Med Prim Care 2020; 9:4956-4961. [PMID: 33209828 PMCID: PMC7652147 DOI: 10.4103/jfmpc.jfmpc_665_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/10/2020] [Accepted: 06/18/2020] [Indexed: 11/04/2022] Open
Abstract
Background Health insurance coverage ensures protection from catastrophic health-care expenditure, especially to the underprivileged sections of society. Health insurance schemes such as Ayushman Bharat are coming up in addition to the existing schemes such as Rashtriya Swasthya Bima Yojana in India. The objectives are to find the health insurance coverage and its impact on out-of-pocket (OOP) expenditure for public sector tertiary health-care hospitalization. Methods A cross-sectional study was conducted at a tertiary care hospital in Kerala. Insurance coverage was assessed among patients seeking inpatient care in various medical and surgical departments. OOP expenses incurred for those receiving and not receiving insurance coverage were compared. In addition, factors influencing enrolment and availing of insurance schemes were determined. Results The coverage of health insurance was found to be 74%. Awareness campaigns and activities of local self-government (LSG) departments were the important reasons for enrolment and availing, respectively. Significantly lower OOP expenditures occurred in insured persons with regard to expenses incurred for treatment procedures (P = 0.019), investigations (P = 0.004), and medicines (P = 0.001). Among the enrolled patients, 45% expressed dissatisfaction regarding available services. Conclusion A quarter of patients still remain out of insurance coverage. All patients are incurring OOP expenditures, though the insured patients have significantly lower OOP expenses. The role of primary care providers and LSG is pivotal in creating awareness and ensuring enrolment. Availing services depend on the availability of resources at the respective institution. Improvements in enrolment and use of health insurance should ultimately result in improved patient satisfaction.
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Affiliation(s)
- Ravindran Harish
- Interns, Department of Community Medicine, Government Medical College,Thiruvananthapuram, Kerala, India
| | - Ranjana S Suresh
- Interns, Department of Community Medicine, Government Medical College,Thiruvananthapuram, Kerala, India
| | - S Rameesa
- Interns, Department of Community Medicine, Government Medical College,Thiruvananthapuram, Kerala, India
| | - P M Laiveishiwo
- Interns, Department of Community Medicine, Government Medical College,Thiruvananthapuram, Kerala, India
| | - Prosper Singh Loktongbam
- Interns, Department of Community Medicine, Government Medical College,Thiruvananthapuram, Kerala, India
| | - K C Prajitha
- Junior Resident, Department of Community Medicine, Government Medical College,Thiruvananthapuram, Kerala, India
| | - Mathew J Valamparampil
- PhD Student, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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