Explore the vast range of titles available.

Background: Financial risk protection against the cost of unforeseen healthcare has gained global attention in recent years. Although Ghana implemented a nationwide health insurance scheme with a goal of reducing financial barriers to accessing healthcare and addressing impoverishing effects of out-of-pocket (OOP) healthcare payments, there is a paucity of knowledge on the extent of financial catastrophe of such payments in Ghana. Thus, this paper assesses the catastrophic effect of OOP healthcare payments in Ghana. Methods: Ghana Living Standard Survey (GLSS 5) data collected in 2005/2006 are used in this study. Catastrophic effect of OOP healthcare payments is assessed using various thresholds of total household expenditure and non-food expenditure. Furthermore, four indices, namely the catastrophic payment headcount, catastrophic payment gap, weighted catastrophic payment headcount and weighted catastrophic payment gap, are defined and computed. Results: As at 2005/2006, it was estimated that 11.0% of households in Ghana spent over 5% of their total household expenditure on healthcare OOP. However, after adjusting for the concentration of such spending, it decreased to 10.9%. Also 10.7% of households spent more than 10% of their non-food consumption expenditure on OOP healthcare payments. Furthermore, about 2.6% of households are observed to have spent in excess of 20% of their total household income on healthcare OOP. With the exception of the 5% threshold of household expenditure, because the concentration indices of these expenditures are negative, the burden of such expenditures rests more on the poor. Conclusions: Significant levels of financial catastrophe existed in Ghana prior to the uptake of the national health insurance scheme. Poorer households were at a higher risk than the relatively well-off households. The results of this study present baseline assessment of the impact of Ghana's health insurance policy on catastrophic healthcare payments. Thus, there is a need for continuous monitoring of financial catastrophe in the system to ensure that households are adequately protected.

Background There is a global concern regarding how households could be protected from relatively large healthcare payments which are a major limitation to accessing healthcare. Such payments also endanger the welfare of households with the potential of moving households into extreme impoverishment. This paper examines the impoverishing effects of out-of-pocket (OOP) healthcare payments in Ghana prior to the introduction of Ghana’s national health insurance scheme. Methods Data come from the Ghana Living Standard Survey 5 (2005/2006). Two poverty lines ($1.25 and $2.50 per capita per day at the 2005 purchasing power parity) are used in assessing the impoverishing effects of OOP healthcare payments. We computed the poverty headcount, poverty gap, normalized poverty gap and normalized mean poverty gap indices using both poverty lines. We examine these indicators at a national level and disaggregated by urban/rural locations, across the three geographical zones, and across the ten administrative regions in Ghana. Also the Pen’s parade of “dwarfs and a few giants” is used to illustrate the decreasing welfare effects of OOP healthcare payments in Ghana. Results There was a high incidence and intensity of impoverishment due to OOP healthcare payments in Ghana. These payments contributed to a relative increase in poverty headcount by 9.4 and 3.8% using the $1.25/day and $2.5/day poverty lines, respectively. The relative poverty gap index was estimated at 42.7 and 10.5% respectively for the lower and upper poverty lines. Relative normalized mean poverty gap was estimated at 30.5 and 6.4%, respectively, for the lower and upper poverty lines. The percentage increase in poverty associated with OOP healthcare payments in Ghana is highest among households in the middle zone with an absolute increase estimated at 2.3% compared to the coastal and northern zones. Conclusion It is clear from the findings that without financial risk protection, households can be pushed into poverty due to OOP healthcare payments. Even relatively richer households are impoverished by OOP healthcare payments. This paper presents baseline indicators for evaluating the impact of Ghana’s national health insurance scheme on impoverishment due to OOP healthcare payments.

PurposeThe purpose of this paper is to decompose the inequities induced by the Nigerian health care financing sources and their effect on the income distribution. Inequities in health care financing sources are of immense policy concern particularly in developing countries such as Nigeria, where high-level income inequality exists, and the cost of medical care is generally financed out-of-pocket (OOP) due to limited access to health insurance.Design/methodology/approachThe Duclos et al. decomposition model provided the theoretical framework for the study. Data were obtained from two waves of the Nigeria General Household Survey (GHS) panel, 2012–13 and 2015–16. The analysis covered 3,999 households in 2012–13 and 4,051 households in 2015–16. Two measures of health care financing: OOP payment and health insurance contribution (HIC) were used. The ability to pay measure was household consumption expenditure.FindingsThe major inequity issue induced by the OOP payments was vertical inequity. HICs created the problems of vertical inequity, horizontal inequity and reranking among households. Overall both health care financing options were associated with the worsening of income inequality both at the national and sectorial levels in the country. The operations of the NHIS need to be improved to ensuring improved health care coverage for the poor.Originality/valueThis paper fulfills an identified need to determine the income redistributive effects (REs) of the social health insurance (SHI) contribution at the national, urban and rural locations overtime.

In Crisis of Abundance: Rethinking How We Pay for Health Care, economist Arnold Kling argues that the way we finance health care matches neither the needs of patients nor the way medicine is practiced. The availability of \"premium medicine,\" combined with patients who are insulated from costs, means Americans are not getting maximum value per dollar spent.

In Bangladesh, maternal mortality is estimated to be 320 per 100,000 live births, among the highest in the world, and most deliveries in rural areas occur at home. Women with obstetric complications fear to seek hospital care for various reasons; one of which is the tremendous cost. This paper shows how cost impedes rural, poor women's access to emergency obstetric care. The data are from a larger ethnographic study of childbirth practices in 2000–01 in Apurbabari village, the adjacent sub-district health complex and more distant tertiary hospitals at district level. Families had to spend what for them added up to a fortune for a caesarean section and other surgery, medicines, laboratory investigations, blood transfusion, food, travel and other expenses. Corruption in the form of demands for under-the-table payments to obtain these aspects of essential care is rife. Adequate resources should be allocated to the different health facilities, including for emergency obstetric treatment. Thana health complexes (sub-district hospitals) should be upgraded to provide comprehensive obstetric care. The system for prescribing drugs should be reformed and the causes of corruption investigated and addressed. Hospital care should not be allowed to further impoverish the poor. Addressing these issues will help to encourage rural, poor women to seek skilled delivery and post-partum care, particularly in emergency situations. Au Bangladesh, la mortalité maternelle est estimée à 320 pour 100 000 naissances vivantes, l'une des plus élevées du monde ; la plupart des accouchements dans les régions rurales se déroulent à domicile. Les femmes présentant des complications obstétriques craignent de demander des soins hospitaliers, pour plusieurs raisons dont leur coût exorbitant. L'article montre comment le coût empêche les femmes rurales pauvres d'accéder aux soins obstétrique d'urgence. Les données sont tirées d'une vaste étude ethnographique sur les pratiques obstétriques en 2000-2001 dans le village d'Apurbabari, le complexe de santé de sous-district adjacent et les hôpitaux tertiaires de district plus éloignés. Les familles doivent dépenser ce qui représente pour elles une fortune pour des césariennes et d'autres interventions, des médicaments, des analyses, des transfusions sanguines, des frais de voyage, d'alimentation et autres. La corruption, sous la forme de ≪ dessous de table ≫ exigés pour obtenir ces soins essentiels, est très répandue. Il convient d'allouer des ressources appropriées aux centres de santé, notamment pour un traitement obstétrique d'urgence. Les centres de santé de sous-district doivent être aménagés pour fournir des soins obstétriques complets. Il faut réformer le système de prescription des médicaments et les causes de la corruption doivent faire l'objet d'enquêtes et être éliminées. Les soins hospitaliers ne sauraient appauvrir encore les démunis. Ces mesures encourageront les femmes rurales pauvres à rechercher des soins qualifiés pendant et après l'accouchement, particulièrement dans des situations d'urgence. En Bangladesh, la tasa de mortalidad materna es de aproximadamente 320 por cada 100,000 nacidos vivos, una de las más altas del mundo. La mayorı́a de las mujeres en las zonas rurales dan a luz en su hogar. Aquéllas que presentan complicaciones obstétricas temen acudir al hospital por varias razones, entre ellas el alto costo. En este artı́culo se muestra cómo el costo impede el acceso de las mujeres pobres rurales a la atención obstétrica de emergencia. Los datos provienen de un amplio estudio etnográfico sobre la atención de partos en del perı́odo 2000-01 en el poblado de Apurbabari, en el establecimiento de salud del subdistrito cercano y en los hospitales distritales de tercer nivel de atención más distantes. Las familias gastaron una fortuna para cubrir las cesáreas y otros procedimientos quirúrgicos, medicamentos, exámenes de laboratorio, transfusiones sanguı́neas, alimentación, transporte y otros gastos. La corrupción o exigencias de pagos por debajo de la mesa para obtener estos aspectos básicos de la atención médica es la norma. Se deben distribuir los recursos adecuados a los establecimientos de salud, incluso el tratamiento obstétrico de emergencia. Asimismo, se deben actualizar los establecimientos de salud de los subdistritos para capacitarlos en la atención obstétrica integral. Debe reformarse el sistema de formulación de medicamentos y se deben investigar y eliminar las causas de la corrupción. El tratar estos aspectos ayudará a motivar a las mujeres pobres rurales a acudir a los prestadores calificados de atención obstétrica y posparto, particularmente en situaciones de urgencia.

Background The Egyptian healthcare system has multiple stakeholders, including a wide range of public and private healthcare providers and several financing agents. This study sheds light on the healthcare system’s financing mechanisms and the flow of funds in Egypt. It also explores the expected challenges facing the system with the upcoming changes. Methods We conducted a systematic review of relevant papers through the PubMed and Scopus search engines, in addition to searching gray literature through the ISPOR presentations database and the Google search engine. Articles related to Egypt’s healthcare system financing from 2009 to 2019 were chosen for full-text review. Data were aggregated to estimate budgets and financing routes. Results We analyzed the data of 56 out of 454 identified records. Governmental health expenditure represented approximately one-third of the total health expenditure (THE). Total health expenditure as a percent of gross domestic product (GDP) was almost stagnant in the last 12 years, with a median of 5.5%. The primary healthcare financing source is out-of-pocket (OOP) expenditure, representing more than 60% of THE, followed by government spending through the Ministry of Finance, around 37% of THE. The pharmaceutical expenditure as a percent of THE ranged from 26.0 to 37.0%. Conclusions Although THE as an absolute number is increasing, total health expenditure as a percentage of GDP is declining. The Egyptian healthcare market is based mainly on OOP expenditures and the next period anticipates a shift toward more public spending after Universal Health Insurance gets implemented.

Background: This research examined differences in the utilisation of healthcare services and financial burden between and within insured and uninsured older persons and their households under the social health insurance scheme in Vietnam. Methods: We used nationally representative data from the Vietnam Household Living Standard Survey (VHLSS) conducted in 2014. We applied the World Health Organization (WHO)’s financial indicators in healthcare to provide cross-tabulations and comparisons for insured and uninsured older persons along with their individual and household characteristics (such as age groups, gender, ethnicity, per-capita household expenditure quintiles, and place of residence). Results: We found that social health insurance was beneficial to the insured in comparison with the uninsured in terms of utilization of healthcare services and financial burden. However, between and within these two groups, more vulnerable groups (i.e., ethnic minorities and rural persons) had lower utilization rates and higher rates of catastrophic spending than the better groups (i.e., Kinh and urban persons). Conclusion: Given the rapidly ageing population under low middle-income status and the “double burden of diseases”, this paper suggested that Vietnam reform the healthcare system and social health insurance so as to provide more equitable utilisation and financial protection to all older persons, including improving the quality of healthcare at the grassroots level and reducing the burden on the provincial/central health level; improving human resources for the grassroots healthcare facilities; encroaching public–private partnerships (PPPs) in the healthcare service provision; and developing a nationwide family doctor network.

Objective Equity is a key issue in the utilization of health services. However, existing research have focused on the developed eastern regions of China, and fails to account for the equity of the level of health service utilization (out-of-pocket payments). This study aims to assess the equity of health service utilization. By analyzing socioeconomic disparities in access to medical services, we seek to identify key barriers and provide evidence for policymakers to improve equitable healthcare delivery in resource-limited settings. Mathods Taking the data of the 7th National Health Service Survey in Gansu Province as an example, based on Anderson model, the equity of health service utilization and its influencing factors were evaluated by using the centralized index and its decomposition method. On this basis, it screened out patients who had used outpatient or inpatient services from the survey subjects, and extracted their out-of-pocket payments incurred by using the above services. Recentered influence functions regression and its decomposition method were used to analyze the equity difference of health service utilization level between urban and rural residents, and the contributing factors were discussed. Result The centralized index of outpatient service utilization was 0.0422 and − 0.0268, and the centralized index of inpatient service utilization was 0.1462 and − 0.1294, respectively. The utilization of both outpatient and inpatient services tends to be high income residents in cities, while in rural areas, the lower the economic level of residents, the higher the utilization rate. Further analysis of the level of health service utilization showed that the Gini coefficients of out-of-pocket payments for urban and rural patients were 0.703 and 0.748, respectively, indicating a large inequality. Recentered influence functions regression and its decomposition results show that rural patients have greater inequality than urban patients in out-of-pocket payments for out-patient and in-patient care, and there is discrimination effect. Conclusion At present, there are still inequities in the utilization of health services in less developed areas of China, especially in the utilization of inpatient services, but the degree of inequity is reduced compared with previous studies. In terms of the fairness of health service utilization level, the inequality degree of rural residents is greater than that of urban residents, and there is a greater discrimination effect. This finding suggests that it needs to develop and implement health equity policies for rural residents to ensure that they are not discriminated against in their access to health services. Equity in the utilization of health services is also monitored and evaluated to ensure the effectiveness of the policies and equal treatment in their implementation.

Background The burden of chronic conditions is on the rise in India, necessitating long-term support from healthcare services. Healthcare, in India, is primarily financed through out-of-pocket payments by households. Considering scarce evidence available from India, our study investigates whether and how out-of-pocket payments for outpatient care affect individuals with chronic conditions. Methods A large census covering 9299 households was conducted in Bangalore, India. Of these, 3202 households that reported presence of chronic condition were further analysed. Data was collected using a structured household-level questionnaire. Out-of-pocket payments, catastrophic healthcare expenditure, and the resultant impoverishment were measured using a standard technique. Results The response rate for the census was 98.5%. Overall, 69.6% (95%CI=68.0-71.2) of households made out-of-pocket payments for outpatient care spending a median of 3.2% (95%CI=3.0-3.4) of their total income. Overall, 16% (95%CI=14.8-17.3) of households suffered financial catastrophe by spending more than 10% of household income on outpatient care. Occurrence and intensity of financial catastrophe were inequitably high among poor. Low household income, use of referral hospitals as place for consultation, and small household size were associated with a greater likelihood of incurring financial catastrophe. The out-of-pocket spending on chronic conditions doubled the number of people living below the poverty line in one month, with further deepening of their poverty. In order to cope, households borrowed money (4.2% instances), and sold or mortgaged their assets (0.4% instances). Conclusions This study provides evidence from India that the out-of-pocket payment for chronic conditions, even for outpatient care, pushes people into poverty. Our findings suggest that improving availability of affordable medications and diagnostics for chronic conditions, as well as strengthening the gate keeping function of the primary care services are important measures to enhance financial protection for urban poor. Our findings call for inclusion of outpatient care for chronic conditions in existing government-initiated health insurance schemes.

Background Equity in the distribution of health care resources and mitigating the risk of out-of-pocket (OOP) catastrophic healthcare expenditures (CHE) are the major objectives of the health system of a country. This study aims to measure equity in OOP payments for healthcare and the incidence of CHE among Iranian households over time. Methods This retrospective cross-sectional study utilized data extracted from the household income and expenditure survey (HIES) of Iran, collected by the Statistical Center of Iran. The analysis included a total of 174,341 households’ five yearly data of 6 years starting from 1991 to 2017. Kakwani progressivity index (KPI) was used to measure the equity in OOP payment for each year and examine the households’ incidence of CHE at 20%, 30%, and 40% of their capacities to pay (CTP). The trend series regression analysis was used to examine the trend in the KPI and the incidence of the CHE over time. Results The findings indicated that the households’ expenditure on health out of their monthly budgets for the years 1991 and 2017 were 2.1% and 10.1%, respectively. The KPI for the OOP payment was negative for all 6-year observations (1991 = − 0.680; 1996 = − 0.608; 2001 = − 0.554; 2006 = − 0.265; 2011 = − 0.225, and 2017 = − 0.207), indicating that the OOP payments for healthcare are regressive and more concentrated among the socioeconomically disadvantaged households. There was a statistically significant ( p = 0.003) increase in the KPI (i.e., decline in the regressivity) over time. The incidence of the CHE (1.12, 1.93, and 3.71%) in 1991 at the CTP levels of 20%, 30%, and 40% was lower than the incidence at the corresponding levels of CTP (5.26, 10.88, and 22.16) in 2017. The findings of the time-series regression indicated a statistically significant ( p < 0.05) increase in the incidence of the CHE at the 20%, 30%, and 40% levels of the households’ CTP. Conclusions The current study demonstrated that OOP payment as a source of healthcare funding in Iran is inequitable. While the use of interventions such as the prepaid and publicly funded programs may contribute to the reduction of CHE and improvement of equity in healthcare financing, further inequality analyses in the incidence of the CHE among households and its main determinants can contribute to evidence-informed planning to reduce the CHE in the context.