Study on the concentration, distribution, and persistence of health spending for the contributory scheme in Colombia.

Colombia is among the countries with the most robust financial protection against personal health spending in the world, with out-of-pocket spending ranking lowest across OECD countries. We investigate the evolution, distribution, and persistence of health spending by age group, sex, health care setting, health condition and geographic region for over 19 million users of Colombia's health system between 2013 and 2021 (contributory scheme). We use average patient-level expenditure data from the Health-Promoting Entities of the Ministry of Health and Social Protection. We applied multivariate statistical techniques such as multiple correspondence analysis, factor maps and correlations. For both sexes, average health expenditure increases gradually with age until 60 years, accelerating thereafter abruptly. Health conditions with the highest percentage of expenditure were those related to neoplasms, blood diseases, circulatory system, pregnancy, puerperium and perinatal period. We found that home-based care in Amazonía-Orinoquía is almost non-existent, and that outpatient care represents a high proportion in all age groups (over 65%) compared to the other regions. There is a strong persistence of expenditure from one year to the next (i.e. they can provide relevant information for prediction), especially in areas with a larger supply of health services such as Bogotá-Cundinamarca. To the authors' knowledge, this is the most comprehensive and detailed micro-analysis of health spending that has been developed for a Latin American country to date.

Oral Health Care Out-of-Pocket Costs and Financial Hardship: A Scoping Review.

The objective of this study is to characterize how financial hardship related to oral health care (OHC) out-of-pocket (OOP) spending has been conceptualized, defined, and measured in the literature and to identify evidence gaps in this area. This scoping review follows Arksey and O'Malley's framework and synthesizes financial hardship from OHC concepts, methodologies, and evidence gaps. We searched Ovid-Medline, Ovid-Embase, PubMed, Web of Science, Scopus, EconLit, Business Source Premier, and the Cochrane Library. Gray literature was sourced from institutional websites (World Health Organization, United Nations, World Bank Group, Organisation for Economic Co-operation and Development, and governmental health agencies) as well as ProQuest Dissertations and Thesis Global. We used defined inclusion and exclusion criteria to select studies published between 2000 and 2023. Of the 1,876 records, 65 met our criteria. The studies conceptualized financial hardship as catastrophic spending, impoverishment, negative coping strategies, bankruptcy, financial burden, food insecurity, and personal financial hardship experience. We found heterogeneity in defining OHC OOP payments and services. Also, financial hardship was frequently measured as catastrophic health expenditure using cross-sectional designs and national household spending surveys from high-income and to a lesser extent lower-middle-income countries. We identify and discuss challenges in terms of conceptualizing financial hardship, study designs, and measurement instruments in the OHC context. Some of the common evidence gaps identified include studying the causal relationship in financial hardship from OHC, assessing the financial hardship and unmet dental needs due to cost relationship, and distinguishing the effect between pain/discomfort and esthetic/cosmetic dental treatments on financial hardship. Financial hardship in OHC needs further exploration and the use of consistent definitions as well must distinguish between treatments alleviating pain/discomfort from esthetic/cosmetic treatments. Our study is relevant for policy makers and researchers aiming to monitor financial protection of OOP payments on OHC in the wake of universal health coverage for oral health.

Lifetime healthcare expenditures across socioeconomic groups.

BACKGROUND: A socioeconomic gradient affects healthcare expenditures and longevity in opposite directions as less affluent individuals have higher current healthcare expenditures but simultaneously enjoy shorter lives. Yet, it is unclear whether this cross-sectional healthcare expenditure gradient persists from a lifetime perspective. This paper analyzes lifetime healthcare expenditures across socioeconomic groups using detailed individual-level healthcare expenditure data for the entire Danish population. METHOD: Using full population healthcare expenditures from Danish registries, we estimate lifetime healthcare expenditures as age-specific mean healthcare expenditures times the probability of being alive at each age. Our data enables the estimation of lifetime healthcare expenditures by sex, socioeconomic status, and by various types of healthcare expenditure. RESULTS: Once we account for mortality differences and all types of healthcare expenditures, all socioeconomic groups spend an almost equal amount on healthcare throughout a lifetime. Lower socioeconomic groups incur the lowest lifetime hospital expenditures, whereas higher socioeconomic groups experience the highest lifetime expenditures on long-term care services. Our findings remain robust across various socioeconomic measures and alternative estimation methodologies. CONCLUSION: Improving the health status of lower socioeconomic groups to align with that of higher socioeconomic groups is costly but may ultimately reduce current healthcare expenditures. Enhanced health outcomes likely increase lifespan, leading to extended periods of healthcare consumption. However, since all socioeconomic groups tend to have similar lifetime healthcare expenditures, this prolonged consumption has limited impact on overall lifetime healthcare costs. Additionally, a significant benefit is the deferment of healthcare expenditures into the future. Overall, our results diminish concerns about socially inequitable utilization of healthcare resources while socioeconomic differences in health and longevity persist, even in a universal healthcare system.

Analysis of hospitalization expenditures and influencing factors for inpatients with chronic bronchitis based on SHA2011 in a central Province of China.

This study compared the hospitalization expenses of patients with chronic bronchitis in a central province (Province A) in China to estimate the direct medical cost of the family. Our data included hospitalization records of 30,341 patients with chronic bronchitis from five urban general hospitals in Province A. Using descriptive statistics and regression analysis, we explored the relevant factors affecting hospitalization expenses. Our study results have indicated that from 2016 to 2020, the medical expenditure of patients with chronic bronchitis increased annually, with an average annual growth rate of 22.65%. Among all kinds of expenses, the hospitalization expenses, drug cost, bed cost, test cost and other cost of UEMI (Urban Employee Medical Insurance) are higher than that of other types of medical insurance. The check-up fees of CMI (Commercial Insurance) are lower than that of other types of insurance. Between 2016 and 2019, the average medical expenses per patient with chronic bronchitis increased by 44%, which is the highest average medical expenses among patients aged 60-70. And the highest average medical expenditure emerged when the number of service days is between 5 and 10 days. The increase in expenditure could be attributed to the rapid development of medical technology and the increasing medical demand of the people. Overall, the results of our study implied a significant increase in medical expenses for patients with chronic bronchitis from 2015 to 2020, indicating that chronic bronchitis could bring heavy economic pressures to patients, their families and society.

Financial hardship of tuberculosis patients registered under National Tuberculosis Elimination Programme (NTEP) in rural India: A longitudinal study.

BACKGROUND: India shares a significant proportion of the Tuberculosis (TB) burden of the world. TB diagnosis, treatment, and success are complicated by the chronic nature of the disease as well as additional stressors including financial, psychological, and social hardships, adverse events associated with management, and poor compliance towards anti-tuberculosis medications. METHODS: This is a longitudinal study conducted in the Tuberculosis Units (TUs) of rural field practice areas of the Department of Community Medicine and Family Medicine in a tertiary care hospital in Odisha. 168 diagnosed TB patients from the TUs were enrolled after registration in NTEP and were followed up every month for 6 months or treatment completion. TB patient's cost estimate tool was used to collect data regarding the cost incurred by the patients before and during the diagnosis as well as in the post-diagnosis or treatment period. RESULTS AND CONCLUSION: Out-of-pocket expenditure was calculated as direct, indirect, and total cost in the pre and post-diagnostic phases of the disease. The median pre and post-diagnosis direct, indirect and total costs were ₹ 12,805, ₹ 16,960 and ₹ 31,192, respectively, with almost 62 % of participants spending more than 20 % of their annual income. In this study, 41 % of participants had to stop working for more than 60 days, and 53.1 % faced distress financing due to the disease. Through this study, we found that more than half of rural TB patients still visit private health facilities, and 20 % start anti-TB drugs by purchasing them from private pharmacies, which incur substantial out-of-pocket expenditure. Most participants faced catastrophic costs associated with hospitalisation, lower family income, and a delay in disease diagnosis.

The impact of long-term care insurance on healthcare utilization and expenditures among middle-aged and older Chinese adults: a quasi-experiment study.

BACKGROUND: Long-term care insurance (LTCI) is essential to alleviate the challenges of rapid aging. Research on LTCI in developing countries is limited and conclusions remain controversial. This study aims to empirically evaluate how the LTCI pilot in selected cities influences healthcare utilization and expenditures among middle-aged and older Chinese adults. METHODS: Data was from 2013, 2015, and 2018 China Health and Retirement Longitudinal Study. 167 LTCI and 8225 non-LTCI group participants were identified. Propensity score matching difference-in-difference method was used to evaluate the net effect of LTCI. The robustness of the findings was tested using a placebo test. RESULTS: In the pilot cities, around 17.8% of the population had LTCI coverage, with approximately 59.9% participating in urban employee medical insurance and 81.4% being urban residents. LTCI significantly reduced the monthly out-of-pocket outpatient expenditure by 313.764 yuan (P < 0.05), but had no significant effects on the inpatient utilization and expenditure. Further analysis of vulnerable subgroup revealed that LTCI decreased monthly outpatient visits frequency, total outpatient expenditure, and out-of-pocket outpatient expenditure by 0.523 times, 643.500 yuan, and 302.367 yuan, respectively (P < 0.05). Robustness tests confirmed the stability of these results. CONCLUSIONS: The LTCI coverage rate has remained low. While LTCI has contributed to reducing outpatient utilization and expenditure, its impact on controlling inpatient-related outcomes is limited. It is recommended to broaden LTCI coverage beyond existing participants to encompass more vulnerable populations, and improve awareness and quality of LTCI services to achieve a significant effect on inpatient care.

Reduced red and processed meat consumption is associated with lower diet costs in US households: a national analysis of protein substitutions.

OBJECTIVE: To examine the association between red and processed meat consumption and total food expenditures in US households and explore whether households could reduce food costs by substituting these meats with other protein sources such as poultry, seafood, eggs and plant proteins. DESIGN: Cross-sectional study using data from the National Household Food Acquisition and Purchase Survey (FoodAPS). Using adult male equivalents (AME) for standardisation, we categorised red and processed meat purchases into quintiles. We used generalised linear models to explore the association between red or processed meat consumption and food expenditures and the cost effect of substituting meat with other proteins. SETTING: United States. PARTICIPANTS: Data from 4739 households with valid acquisition information from FoodAPS, a stratified multistage probability sample of US households. RESULTS: Higher red and processed meat consumption were both significantly associated with higher total weekly food expenditures, particularly among households with low income. Substituting red or processed meat with poultry, eggs or plant proteins did not significantly affect overall food expenditures, whereas replacing meat with seafood, especially varieties high in n-3 fatty acids, led to increased costs. CONCLUSIONS: Reducing red and processed meat consumption could offer savings for households, particularly those with low income. Although substitutions with seafood high in n-3 could increase expenses, alternative protein sources like poultry and plant proteins may serve as cost-neutral replacements. Public health strategies should emphasise dietary shifts' economic, health and environmental benefits and aim to make nutritious yet affordable protein sources more accessible.

End-of-life emergency department use and healthcare expenditures among older adults: A nationally representative study.

BACKGROUND: Emergency department (ED) visits at end-of-life may cause financial strain and serve as a marker of inadequate access to community services and health care. We sought to examine end-of-life ED use, total healthcare spending, and out-of-pocket spending in a nationally representative sample. METHODS: Using Medicare Current Beneficiary Survey data, we conducted a pooled cross-sectional analysis of Medicare beneficiaries aged 65+ years with a date of death between July 1, 2015 and December 31, 2021. Our primary outcomes were ED visits, total healthcare spending, and out-of-pocket spending in the 7, 30, 90, and 180 days preceding death. We estimated a series of zero-inflated negative binomial models identifying patient characteristics associated with the primary outcomes. RESULTS: Among 3812 older adult decedents, 610 (16%), 1207 (31.7%), 1582 (41.5%), and 1787 (46.9%) Medicare beneficiaries had ED visits in the final 7, 30, 90, and 180 days, respectively, of life. For Medicare beneficiaries with at least one ED visit in the final 30 days of life, the median total and out-of-pocket costs were, respectively, $12,500 and $308, compared, respectively, with $278 and $94 for those without any ED visits (p < 0.001 for both comparisons). Having a diagnosis of dementia (odds ratio [OR] 0.71; 95% confidence interval [CI] 0.51-0.99; p = 0.04) and being on hospice status during the year of death (OR 0.56; 95% CI 0.48-0.66; p = <0.001) were associated with a decreased likelihood of having an ED visit. Having dementia was associated with a decreased likelihood of having any healthcare spending (OR 0.50; 95% CI 0.36-0.71; p = 0.001) and any out-of-pocket spending (OR 0.51; 95% CI 0.36-0.72; p = <0.001). CONCLUSIONS: One in three older adults visit the ED in the last month of life, and approximately one in two utilize ED services in the last half-year of life, with evidence of associated considerable total and out-of-pocket spending.

Storage practice and wastage of pharmaceuticals in Chinese urban-dwelling households: Description of urban-dwelling households.

At-home storage of medications could pose a threat to public health and the environment if not handled appropriately. Excessive storage also creates health care and economic burdens. This study investigated storage practices, waste, and their determinants in China. Data were collected by pharmacy staff of urban-dwelling households via online questionnaires. Descriptions at the household and medicine levels were conducted in Stata 16. Individual and family characteristics were associated with the presence of household medicine storage (84.6%, n = 5290), but storage location was poor. Expiration was the primary reason for discarding medicines. Respondents were inclined to buy medicines in pharmacies without prescription for storage purposes at out-of-pocket expenses, and 60.7% of medicines were purchased at out-of-pocket expenses, despite medical insurance coverage. Regarding wastage, 11.2% of medicines had expired and 38.2% were no longer needed. Purchasing for storage purposes was related to less waste due to expiration, while purchasing for treating acute diseases rather than chronic diseases was related to more waste, due to less for use. Accounting for 12.2% of all medications, antibiotics were associated with expiration and no further need for use. Source-control measures targeting health facilities, pharmacies, and residents are needed under the combined efforts of all relevant departments.

Hypertension-Associated Expenditures Among Privately Insured US Adults in 2021.

BACKGROUND: There are no recent estimates for hypertension-associated medical expenditures. This study aims to estimate hypertension-associated incremental medical expenditures among privately insured US adults. METHODS: We conducted a retrospective cohort study using IQVIA's Ambulatory Electronic Medical Records-US data set linked with PharMetrics Plus claims data. Among privately insured adults aged 18 to 64 years, hypertension was identified as having ≥1 diagnosis code or ≥2 blood pressure measurements of ≥140/90 mm Hg, or ≥1 antihypertensive medication in 2021. Annual total expenditures (in 2021 $US) were estimated using a generalized linear model with gamma distribution and log-link function adjusting for demographic characteristics and cooccurring conditions. Out-of-pocket expenditures were estimated using a 2-part model that included logistic and generalized linear model regression. Overlap propensity score weights from logistic regression were used to obtain a balanced sample on hypertension status. RESULTS: Among the 393 018 adults, 156 556 (40%) were identified with hypertension. Compared with individuals without hypertension, those with hypertension had $2926 (95% CI, $2681-$3170) higher total expenditures and $328 (95% CI, $300-$355) higher out-of-pocket expenditures. Adults with hypertension had higher total inpatient ($3272 [95% CI, $1458-$5086]) and outpatient ($2189 [95% CI, $2009-$2369]) expenditures when compared with those without hypertension. Hypertension-associated incremental total expenditures were higher for women ($3242 [95% CI, $2915-$3569]) than for men ($2521 [95% CI, $2139-$2904]). CONCLUSIONS: Among privately insured US adults, hypertension was associated with higher medical expenditures, including higher inpatient and out-of-pocket expenditures. These findings may help assess the economic value of interventions effective in preventing hypertension.

Loss of production and animal health costs in assessing economic burden of animal disease.

This article focuses on identifying the loss of production and costs (or lack thereof) associated with livestock health as well as animal disease externalities, with the intent to estimate economy-wide burden. It limits its scope to terrestrial livestock and aquaculture, wherein economic burden is predominately determined by market forces. Losses and costs are delineated into both direct losses and costs and indirect losses and costs, as well as ex post costs and ex ante costs. These costs include not only private expenditures but also public expenditures related to the prevention of, treatment of, and response to livestock disease. This distinction is important because a primary role of government is to mitigate externalities. The article then discusses market impacts and investments. Finally, it provides selected examples and illustrative observations and discusses future directions for research and application.

Cet article examine les pertes de production et les coûts associés (ou non) à la santé animale ainsi que les externalités liées aux maladies animales, dans le but d'estimer le fardeau pour l'ensemble de l'économie. L'examen se limite à la production d'animaux terrestres et aquatiques, secteurs où le fardeau économique est principalement déterminé par les forces du marché. Les pertes et les coûts sont répartis en pertes et coûts directs et indirects, ainsi qu'en coûts ex post et ex ante. Ces coûts comprennent non seulement les dépenses privées, mais aussi les dépenses publiques liées à la prévention, au traitement et aux réponses aux maladies des animaux d'élevage. Il s'agit d'une distinction importante car l'une des fonctions premières d'un gouvernement est d'atténuer les externalités. Les auteurs examinent ensuite les impacts sur les marchés et les investissements. Pour conclure, à partir d'exemples choisis et d'observations illustrant leur propos, les auteurs proposent des voies d'exploration pour la recherche et ses applications.

Este artículo se centra en determinar las pérdidas de producción y los costos (o la ausencia de ellos) asociados con las externalidades de la sanidad del ganado y las enfermedades animales, con el objetivo de estimar su impacto en toda la economía. El ámbito del artículo se limita a la ganadería terrestre y la acuicultura, donde el impacto económico está principalmente determinado por las fuerzas del mercado. Las pérdidas y los costos se clasifican en pérdidas y costos directos e indirectos, así como en costos ex post y ex ante. Dichos costos incluyen no solo los gastos privados, sino también los gastos públicos relacionados con la prevención y el tratamiento de las enfermedades del ganado y la respuesta ante estas, una distinción que es importante habida cuenta de que una de las principales funciones del gobierno es mitigar las externalidades. En el artículo se analizan a continuación las repercusiones en el mercado y las inversiones y, por último, se presentan algunos ejemplos y observaciones ilustrativas y se examinan las orientaciones futuras de la investigación y sus aplicaciones.

A methodological framework for attributing the burden of animal disease to specific causes.

The Global Burden of Animal Diseases provides an analytical framework to measure the overall health of various farmed animal populations, to estimate the farm-level burden of different diseases, incorporating production losses due to morbidity and mortality as well as health expenditure, and to identify the wider economic and human health impacts of animal disease. Attributing the burden of animal diseases to specific causes or groups of causes requires methodological choices, including the classification of diseases and the resulting health states that manifest in loss of production. The aim of this article is to address the key challenges in the process of estimating farm-level disease burden, including ambiguity in terminology, data availability and collation, and adjustments for comorbidity. Using infection with zoonotic Brucella spp. in small ruminants as an aetiological cause of disease and abortion as a sequela of multiple diseases, practical examples of the framework are provided. Cause-specific attribution of the burden of animal disease captures temporal and spatial trends, an understanding of which is essential for planning, monitoring and evaluating animal health programmes and disease interventions.

Le programme " Impact mondial des maladies animales " fournit un cadre analytique pour mesurer l'état de santé général de diverses populations d'animaux d'élevage, estimer la charge de morbidité associée à certaines maladies à l'échelle d'une exploitation, prendre en compte aussi bien les pertes de production dues à la morbidité et à la mortalité que les dépenses de santé, et mettre en lumière les effets plus larges des maladies animales sur l'économie et la santé humaine. Des choix méthodologiques doivent être faits pour attribuer l'impact des maladies animales à des facteurs spécifiques ou à des séries de facteurs, en classant les maladies et en définissant les profils sanitaires qui en résultent et qui induisent des pertes de production. L'objectif de cet article est d'aborder les principales difficultés rencontrées lors de l'estimation de la charge de morbidité à l'échelle des exploitations, en particulier celles relevant d'une terminologie ambiguë, de la disponibilité et modalités de collecte des données, et des ajustements à effectuer en cas de comorbidité. Les auteurs donnent des exemples concrets du cadre proposé, en prenant d'une part l'infection zoonotique par des Brucella spp. chez les petits ruminants comme cause étiologique de la maladie, et d'autre part les avortements comme séquelles de plusieurs maladies. L'attribution de l'impact des maladies animales à des facteurs spécifiques permet de saisir les tendances aussi bien dans le temps que dans l'espace, dont la connaissance se révèle indispensable pour assurer la planification, le suivi et l'évaluation des programmes de santé animale et des interventions liées aux maladies.

El impacto global de las enfermedades animales proporciona un marco analítico para medir la sanidad general de diversas poblaciones de animales de granja, estimar el impacto de las distintas enfermedades en las explotaciones, incorporando las pérdidas de producción debidas a la morbilidad y a la mortalidad, así como los gastos sanitarios, y determinar las repercusiones más amplias de las enfermedades animales en la economía y la salud humana. Para atribuir el impacto de las enfermedades animales a causas o grupos de causas específicos es necesario tomar decisiones metodológicas, incluida la clasificación de las enfermedades y de los estados sanitarios resultantes, que se traducen en pérdidas de producción. El objetivo de este artículo es abordar las principales dificultades que se plantean en el proceso de la estimación del impacto de las enfermedades en las explotaciones, entre ellas la ambigûedad terminológica, la disponibilidad y el cotejo de datos, y los ajustes por comorbilidad. Utilizando la infección zoonótica por Brucella spp. en pequeños rumiantes como causa etiológica de enfermedad y el aborto como secuela de múltiples enfermedades, se ofrecen ejemplos prácticos del marco. La atribución del impacto de las enfermedades animales a causas específicas permite captar tendencias temporales y espaciales cuya comprensión es esencial para planificar, supervisar y evaluar programas de sanidad animal e intervenciones relacionadas con enfermedades.

The effect of air pollution on defensive expenditures: Evidence from individual commercial health insurance in China.

To mitigate the substantial losses incurred by air pollution, individuals undertake defensive behaviors in the form of health insurance expenses. Leveraging data from the 2011-2017 China Household Finance Survey (CHFS) encompassing 3033 residents, we estimate the causal impact of air pollution on defensive expenditures. Our findings are as follows: (1) Air pollution exhibits a significantly favorable effect on individual commercial health insurance expenses, with a 1% increase in PM2.5 concentration correlating to an 11.02% rise in personal commercial health insurance expenditure. (2) Demographics such as younger individuals, married populations, lower educational attainment cohorts, and urban residents, displaying higher sensitivity to air pollution, tend to purchase more insurance coverage. (3) Risk perception emerges as a pivotal channel through which air pollution affects commercial health insurance expenditure. Our conclusions underscore the significance of risk perception in defensive expenditures, thereby optimizing individual risk mitigation strategies.

Effects of transparent online open procurement on prices, volumes, and costs of medicines: an interrupted time series study in Ningxia, China.

Objectives: To assess the effects of the transparent online open procurement arrangement on the prices, volumes, and costs of medicines in Ningxia, China. Methods: Data were extracted from the Ningxia pharmaceutical procurement platform, covering 16 months of purchase orders (December 2019 to March 2021) prior to the implementation of the transparent online open procurement policy and 20 months of purchase orders after the implementation of the policy (April 2021 to November 2022). Interrupted time series (ITS) analysis was performed to evaluate the effects of the transparent online open procurement policy on the prices, volumes, and total costs of the purchase orders. Results: After implementation of the transparent online open procurement policy, the average price of purchased medicines showed a declining trend by 0.012 Yuan per month, while the total volume of purchase orders declined at a rate by 1.741 million per month measured by the smallest formulation units and the total costs of the purchase orders decreased at a rate by 5.525 million Yuan per month. Conclusion: The transparent online open procurement policy resulted in reduced prices, lowered volumes, and lowered total costs of purchased orders of medicines.

Monitoring financial healthcare protection in Brazil: evolution, inequalities, and associated factors.

OBJECTIVES: Although catastrophic health spending is the main measure for assessing financial healthcare protection, it varies considerably in methodological and empirical terms, which hinders comparison between studies. The aim of this study was to measure the prevalence of catastrophic health spending in Brazil in 2003, 2009, and 2018, its associated factors, and disparities in prevalence distribution according to socioeconomic status. STUDY DESIGN: This was a time series study. METHODS: Data from the Household Budget Surveys were used. Prevalence of catastrophic health spending was measured as a percentage of the budget and ability to pay, considering thresholds of 10, 25, and 40%. It was determined whether household, family, and household head characteristics influence the likelihood of incurring catastrophic health spending. Households were stratified by income deciles, consumption, and wealth score. RESULTS: There was an increase in prevalence of catastrophic health spending between 2003 and 2009 in Brazil and a slight reduction in 2018. The wealth score showed more pronounced distributional effects between the poor and the rich, with the former being the most affected by catastrophic health spending. Consumption showed greater percentage variations in the prevalence of catastrophic health spending. The prevalence of catastrophic health spending was positively associated with the presence of older adults, age and female household head, rural area, receipt of government benefits, and some degree of food insecurity. CONCLUSIONS: The poorest families are most affected by catastrophic health spending in Brazil, requiring more effective and equitable policies to mitigate financial risk.

COVID-19 Relief Receipt and U.S. Household Food Expenditures.

Introduction: COVID-19 relief payments and programs may have contributed to the shift in food expenditures from food away from home to food at home during the pandemic. This shift has public health implications given the differences in the nutritional quality between food at home and food away from home. The objective of this study is to examine the association between COVID-19 relief and household food at home and food away from home expenditure shares. Economic Impact Payments, Pandemic-Electronic Benefits Transfer, Supplemental Nutrition Assistance Program, and charitable food receipt are considered. Methods: Food expenditure and COVID-19 relief data for 265,443 households were obtained from Phase 3.1 (April 28 to July 5, 2021) of the Household Pulse Survey. Poisson pseudo-maximum likelihood estimators were employed in 2023 to analyze the association between COVID-19 relief and household food at home and food away from home expenditure shares. Results: Pandemic-Electronic Benefits Transfer receipt was associated with households allocating 3% less of food expenditures to food at home and 9% more to food away from home. Supplemental Nutrition Assistance Program and charitable food receipt were associated with spending 8% and 3% more of food expenditures on food at home and 22% and 9% less on food away from home, respectively. Recent Economic Impact Payment receipt was associated with reduced food at home and increased food away from home expenditure shares among households with low-income and/or a Black respondent. Conclusions: Study results indicate that COVID-19 relief contributed to changing food expenditure patterns during the pandemic. Of note, Pandemic-Electronic Benefits Transfer and Economic Impact Payment receipt were associated with spending a greater share of food dollars on food away from home. Nutritional implications of COVID-19 relief warrant further investigation and should be carefully considered in the design of future nutrition assistance emergency relief.

Healthcare spending versus mortality in central nervous system cancer: Has anything changed?

Background: The financial implications of central nervous system (CNS) cancers are substantial, not only for the healthcare service and payers, but also for the patients who bear the brunt of direct, indirect, and intangible costs. This study sought to investigate the impact of healthcare spending on CNS cancer survival using recent US data. Methods: This study used public data from the Disease Expenditure Project 2016 and the Global Burden of Disease Study 2019. The primary outcome was the annual healthcare spending trend from 1996 and 2016 on CNS tumors adjusted for disease prevalence, alongside morbidity and mortality. Secondary outcomes included drivers of change in healthcare expenditures for CNS cancers. Subgroup analysis was performed stratified by age group, expenditure type, and care type provided. Results: There was a significant increase in total healthcare spending on CNS cancers from $2.72 billion (95% CI: $2.47B to $2.97B) in 1996 to $6.85 billion (95% CI: $5.98B to $7.57B) in 2016. Despite the spending increase, the mortality rate per 100 000 people increased, with 5.30 ±â€…0.47 in 1996 and 7.02 ±â€…0.47 in 2016, with an average of 5.78 ±â€…0.47 deaths per 100 000 over the period. The subgroups with the highest expenditure included patients aged 45 to 64, those with private insurance, and those receiving inpatient care. Conclusions: This study highlights a significant rise in healthcare costs for CNS cancers without corresponding improvements in mortality rate, indicating a mismatch of healthcare spending, contemporary advances, and patient outcomes as it relates to mortality.

Changes in the Epidemiological Landscape of Diabetes in South Korea: Trends in Prevalence, Incidence, and Healthcare Expenditures.

Diabetes is a serious public health concern that significantly contributes to the global burden of disease. In Korea, the prevalence of diabetes is 12.5% among individuals aged 19 and older, and 14.8% among individuals aged 30 and older as of 2022. The total number of people with diabetes among those aged 19 and older is estimated to be 5.4 million. The incidence of diabetes decreased from 8.1 per 1,000 persons in 2006 to 6.3 per 1,000 persons in 2014, before rising again to 7.5 per 1,000 persons in 2019. Meanwhile, the incidence of type 1 diabetes increased significantly, from 1.1 per 100,000 persons in 1995 to 4.8 per 100,000 persons in 2016, with the prevalence reaching 41.0 per 100,000 persons in 2017. Additionally, the prevalence of gestational diabetes saw a substantial rise from 4.1% in 2007 to 22.3% in 2023. These changes have resulted in increases in the total medical costs for diabetes, covering both outpatient and inpatient services. Therefore, effective diabetes prevention strategies are urgently needed.

The financial burden of noncommunicable diseases from out-of-pocket expenditure in sub-Saharan Africa: a scoping review.

The growing financial burden of noncommunicable diseases (NCDs) in sub-Saharan Africa (SSA) hinders the attainment of the sustainable development goals. However, there has been no updated synthesis of evidence in this regard. Therefore, our study summarizes the current evidence in the literature and identifies the gaps. We systematically search relevant databases (PubMed, Scopus, ProQuest) between 2015 and 2023, focusing on empirical studies on NCDs and their financial burden indicators, namely, catastrophic health expenditure (CHE), impoverishment, coping strategies, crowding-out effects and unmet needs for financial reasons (UNFRs) in SSA. We examined the distribution of the indicators, their magnitudes, methodological approaches and the depth of analysis. The 71 included studies mostly came from single-country (n = 64), facility-based (n = 52) research in low-income (n = 22), lower-middle-income (n = 47) and upper-middle-income (n = 10) countries in SSA. Approximately 50% of the countries lacked studies (n = 25), with 46% coming from West Africa. Cancer, cardiovascular disease (CVD) and diabetes were the most commonly studied NCDs, with cancer and CVD causing the most financial burden. The review revealed methodological deficiencies related to lack of depth, equity analysis and robustness. CHE was high (up to 95.2%) in lower-middle-income countries but low in low-income and upper-middle-income countries. UNFR was almost 100% in both low-income and lower-middle-income countries. The use of extreme coping strategies was most common in low-income countries. There are no studies on crowding-out effect and pandemic-related UNFR. This study underscores the importance of expanded research that refines the methodological estimation of the financial burden of NCDs in SSA for equity implications and policy recommendations.