Catastrophic health-care payments and multidimensional poverty: Are they related?

The negative impact of health-related out-of-pocket (OOP) payments is a well-known problem in low and middle-income countries (LMICs). Cross-sectional analysis reveals that households use different coping mechanisms to mitigate or overcome the effect of OOP payments, but little is known from a longitudinal perspective. We explore this link using panel data for Colombia, Mexico, India, Malawi, Nigeria, Uganda, and Tanzania. Using a fixed-effect model, we computed the association between multidimensional poverty (MP) and facing catastrophic health payments (CHP) using a capacity-to-pay approach. We estimated different heterogeneous effects, including variables such as area of residence, facing CHP, being poor in the first wave, and facing CHP in period two. While using cross-sectional data, we found that the association between CHP and MP is present for six of the seven countries; it is not the case for the time variation in most of them. The results provide evidence that OOP induce a long-term impact on MP only in Colombia, India and Nigeria. In the last two countries, the levels of poverty and CHP were the highest of all seven, and the association between both situations was found by using different poverty cutoffs and thresholds to define CHP.

Catastrophic expenditure due to out-of-pocket health payments and its determinants in Colombian households.

BACKGROUND: Out-of-pocket expenditure to pay for health services could result in financial catastrophe. The purpose of this study was to identify the incidence and determinants of catastrophic out-of-pocket payments for healthcare in Colombia. The underlying hypotheses are that low-income and non-insured population in Colombia, and households living in isolated and high level of rurality regions, are more likely to incur catastrophic healthcare expenses. METHODS: This study used data from the Quality of Life National Survey conducted in Colombia in 2011. The presence of catastrophic healthcare spending was calculated using the methodology proposed by the World Health Organization in 2005. Households were classified as having catastrophic health spending when their out-of-pocket health payments were over 20 % of their payment capacity. All other households were classified as not having catastrophic health spending. A probit model was estimated aimed at determining what factors influence the probability of catastrophic healthcare spending. RESULTS: Study findings show that 9.6 % of Colombian households had catastrophic expenditure. The incidence was higher in households in the Pacífica and Atlántica regions, extended and nuclear families, households with children or elderly adults, located in rural areas, and not insured under the healthcare system. The ratio of household members who work seems to reduce the risk of catastrophic healthcare spending, but the occurrence of any in-patient event increases it. So, there is no statistical evidence for rejecting the hypotheses under study. CONCLUSIONS: Results indicate the importance of establishing intervention mechanisms in order to improve equity in access and payment for health care, protect vulnerable groups against financial risk, and, consequently, reduce the incidence of catastrophic healthcare spending. For this, it is essential to achieve universal health coverage through standardized and improved health services packages for vulnerable age groups and implement healthcare campaigns for households in rural areas where the incidence of out-of-pocket payments is higher.

Comparación de la implementación del modelo de vigilancia de morbilidad materna extrema en doce instituciones de salud en Colombia, 2013. Estudio mixto: cualitativo y cuantitativo / Comparison of the implementation of the Extreme Maternal Morbidity Surveillance Model in 12 Health Institutions in Colombia, 2013. Mixed study: qualitative and quantitative

Comparar el nivel de implementación del Modelo de Vigilancia de la Morbilidad Materna Extrema (MVMME) y las principales barreras y facilitadores respecto de la implementación en dos grupos de instituciones prestadoras de servicios de salud (IPS) de Colombia.Materiales y métodos: estudio mixto, que emplea técnicas de información cuantitativa (instrumento semiestructurado) y cualitativa (entrevista a profundidad). Las IPS en las que se inició el modelo IPS piloto (IPSP) fueron comparadas con otro grupo de IPS que no participó en la inserción inicial del mismo, las que se denominarán IPS control (IPSC). Ambas fueron seleccionadas por conveniencia en conjunto con el Ministerio de Salud. El nivel de implementación se presenta como proporción por institución. La información se trianguló para complementar la información de los diferentes componentes de la implementación del MVMME.Resultados: hubo diferencias en la implementación según el grupo de IPS, en IPSP hubo mayor difusión de protocolos, detección, notificación, flujo de la información, análisis y toma de decisiones. En IPSC hubo más dificultades con la asignación de la causa principal, definir criterios de evitabilidad e identificar demoras. El volumen de profesionales, las horas promedio mes y los perfiles eran mayores en IPSP que en IPSC. El rango del nivel de implementación entre las IPSP varió entre el 73 y el 94 %; en el grupo de IPSC el rango estuvo entre 41 y 90 %. En las IPSP había mayor claridad sobre el papel del MVMME como herramienta para mejorar la calidad en la atención de las gestantes. En IPSC, si bien consideraban que el modelo ayudaba a mejorar la calidad, era interpretado como una sobrecarga de trabajo.Conclusiones: el mayor desarrollo en IPSP podría estar asociado a un mayor acompañamiento por parte del MS-UNFPA, y una mayor voluntad política e institucional para su implementación...

To compare the level of implementation of the Extreme Maternal Morbidity Surveillance Model (EMMSM). and the main barriers and facilitators to the implementation in two groups of Healthcare Service Providers (HSP) in Colombia.Materials and methods: Mixed study using quantitative (semi-structured tool) and qualitative (In-depth interview) information techniques. The healthcare service providers in which the pilot model was implemented (pHSP) were compared with another group of healthcare institutions that did not participate in the initial implementation, hereinafter called control HSP (cHSP). They were are all selected jointly with the Ministry of Health (MoH) based on convenience. The level of implementation is presented in terms of proportions for each healthcare institution. The information was crossed-referenced in order to supplement the data of the various components of the EMMSM implementation.Results: Differences in implementation were found for each IPS group. In the IPSP there was greater dissemination of the protocols, detection, notification, information flows and decision-making.In the IPSC group there were more difficulties in determining main causes, defining avoidability criteria, and identifying delays. The numbers of professional staff, mean monthly hours and profiles were higher among the IPSP when compared with the IPSC...

Determining factors of catastrophic health spending in Bogota, Colombia.

This study tests whether the low-income population in Bogota not insured under the General Social Security Health System is able to economically handle unexpected health problems or not. It used data from the Health Services Use and Expenditure Study conducted in Colombia in 2001, for which each household recorded its monthly out-of-pocket health expenditure during the year and the household income was measured as the sum of each member's contribution to the household. Payment capacity or available income and catastrophic health spending were based on the latest methodology proposed by the World Health Organization (WHO) in 2005. A probit model was adjusted to determine the factors that significantly influence the likelihood of a household having catastrophic health spending. The percentage of households with catastrophic health spending in Bogota was 4.9%; incidence was higher in low-income households where none of the members were affiliated to social security, where there had been an in-patient event, and where the heads of household were over 60 years of age. There is no statistical evidence for rejecting the hypothesis under study, which states that low-income households that have no health insurance are more likely to have catastrophic health spending than higher-income households with health insurance.

Una revisión de las formas de pago de los servicios de salud en el Distrito Capital / A review of the forms of payment for health services in the Capital District / A review of the forms of payment of the services of health in the Cardinal District

Este artículo es una presentación de la evaluación de las formas de pago a través de las cuales se reconocen los servicios prestados a la población pobre no afiliada en el Distrito Capital. Los resultados del presente trabajo se concentran principalmente en el análisis de una de las formas de pago, Pago Global Fijo prospectivo por actividad final, y tan sólo en dos de las actividades finales definidas por la Secretaría. Tales actividades son: la consulta de medicina general electiva y la consulta de medicina especializada electiva. Estas dos actividades representan, entre las dos, el 81,15% de las actividades finales realizadas por la red de hospitales y de ellas la atención médica general representa el 79,70%. El proceso metodológico para toda la evaluación desarrollo seis grande subprocesos: a) revisión bibliográfica, b) un marco conceptual y el diseño del plan de análisis, c) revisión de las especificaciones técnicas para la identificación de los registros de prestaciones de servicios de salud enviados, d) evaluación del sistema actual, e) construcción de escenarios de ajuste, y f) formulación de indicadores para el seguimiento de las formas de pago. A partir de los resultados se encontró que los actuales sistemas de pago del Fondo Financiero Distrital requiere ajustes que permitan un mejor manejo del riesgo financiero y la búsqueda de conciliación de los objetivos de política entre la Secretaría Distrital de Salud y los hospitales que prestan los servicios a la población pobre no cubierta con subsidios a demanda. Antes de pensar en migrar a otro sistema, se hace necesario entender que cada uno de los mecanismos genera diferentes incentivos los cuales se busca controlar a través del sistema de monitoreo y evaluación.

This article presents an evalution of the forms of pay that recognize services rendered to the poor population not housed in the capital district. The results of the present work are concentrated principlally in an analysis of one form of pay: Global fixed prospective pay for finished activities, and only in two of the finished activities as definined by the Secretary. Such work is: general elective medical consultations and specialized elective medical consultations and specialized elective medical consultation. These two activities represent, between the two, some 81.15% of the finished activites done by the network of hospitals, and of these the general medical attention represents 79.70%.This methodological process for a full evaluation creates six large subprocesses: a) bibliographic review, b) a conceptual framework and the design of a plan for analysis, c) review of the technical specifications for the identification of the registries for health services rendered, d) evaluation of the currents system, e) construction of adjustment scenarios, and f) formulation of indicators for the continuation of the forms of pay. From these results it was found that the current payment systems of the District Financial Fund require adjustments that permit better management of financial risk. The search must continue for the conciliationof political objectives between the District Health Secretary and the hospitals that serve the poor population not covered by necessary subsidies. Before thinking of moving to another system, it is necessary to understand that each one of the mechanisms generates different incentives which can be controled through the monitoring and evaluation systems.