Revisiting a decade of inequality in healthcare financial burden in Cambodia, 2009-19: trends, determinants and decomposition.

BACKGROUND: Out-of-pocket healthcare expenditure (OOPHE) without adequate social protection often translates to inequitable financial burden and utilization of services. Recent publications highlighted Cambodia's progress towards Universal Health Coverage (UHC) with reduced incidence of catastrophic health expenditure (CHE) and improvements in its distribution. However, departing from standard CHE measurement methods suggests a different storyline on trends and inequality in the country. OBJECTIVE: This study revisits the distribution and impact of OOPHE and its financial burden from 2009-19, employing alternative socio-economic and economic shock metrics. It also identifies determinants of the financial burden and evaluates inequality-contributing and -mitigating factors from 2014-19, including coping mechanisms, free healthcare, and OOPHE financing sources. METHODS: Data from the Cambodian Socio-Economic Surveys of 2009, 2014, and 2019 were utilized. An alternative measure to CHE is proposed: Excessive financial burden (EFB). A household was considered under EFB when its OOPHE surpassed 10% or 25% of total consumption, excluding healthcare costs. A polychoric wealth index was used to rank households and measure EFB inequality using the Erreygers Concentration Index. Inequality shifts from 2014-19 were decomposed using the Recentered Influence Function regression followed by the Oaxaca-Blinder method. Determinants of financial burden levels were assessed through zero-inflated ordered logit regression. RESULTS: Between 2009-19, EFB incidence increased from 10.95% to 17.92% at the 10% threshold, and from 4.41% to 7.29% at the 25% threshold. EFB was systematically concentrated among the poorest households, with inequality sharply rising over time, and nearly a quarter of the poorest households facing EFB at the 10% threshold. The main determinants of financial burden were geographic location, household size, age and education of household head, social health protection coverage, disease prevalence, hospitalization, and coping strategies. Urbanization, biased disease burdens, and preventive care were key in explaining the evolution of inequality. CONCLUSION: More efforts are needed to expand social protection, but monitoring those through standard measures such as CHE has masked inequality and the burden of the poor. The financial burden across the population has risen and become more unequal over the past decade despite expansion and improvements in social health protection schemes. Health Equity funds have, to some extent, mitigated inequality over time. However, their slow expansion and the reduced reliance on coping strategies to finance OOPHE could not outbalance inequality.

Health expenditure trajectory and gastric cancer incidence in the National Health Insurance Senior Cohort: a nested case-control study.

BACKGROUND: Gastric cancer is the fourth most common cancer and highly prevalent in South Korea. As one of the predictors of gastric cancer, we focused on health utilization patterns and expenditures, as the surrogate variables of health conditions. This nested case-control study aimed to identify the association between health expenditure trajectory and incidence of gastric cancer. METHODS: Data from the National Health Insurance Service Senior Cohort of South Korea were used. Individuals diagnosed with gastric cancer (N = 14,873) were matched to a non-diagnosed group (N = 44,619) in a 1:3 ratio using a nested case-control design. A latent class trajectory analysis was performed to identify the patterns of health expenditure among the matched participants. Furthermore, conditional logistic regression analysis was conducted to examine the relationship between healthcare expenditure trajectories and gastric cancer incidence. RESULTS: Seven distinct health expenditure trajectories for five years were identified; consistently lowest (13.8%), rapidly increasing (5.9%), gradually increasing (13.8%), consistently second-highest (21.4%), middle-low (18.8%), gradually decreasing (13.1%), and consistently highest (13.2%). Compared to the middle-low group, individuals in the rapidly increasing [odds ratio (OR) = 2.11, 95% confidence interval (CI); 1.94-2.30], consistently lowest (OR = 1.40, 95% CI; 1.30-1.51), and gradually increasing (OR = 1.26, 95% CI; 1.17-1.35) groups exhibited a higher risk of developing gastric cancer. CONCLUSIONS: Our findings suggest that health expenditure trajectories are predictors of gastric cancer. Potential risk groups can be identified by monitoring health expenditures.

Global Health Indicators and Child Mortality Trends: Insights from a Global Panel Data Analysis of 200 Countries.

The aim of this study was to explore how medical resources and vaccine coverage relate to infant mortality rate (IMR) and under-five mortality rate (U-5MR), which are both key national health indicators. This longitudinal study was based on panel data from the national level of 200 countries. Data from 1990 to 2021 were grouped into seven regions based on geographic and epidemiological similarities. Regarding correlation, the high-income region showed a different trend from that shown by other regions. Health expenditure was positively associated with IMR and U-5MR globally. Number of medical doctors per 1,000 people was negatively associated with IMR and U-5MR globally. Hepatitis type B (HBV) and measles, first dose (MCV) were negatively associated with IMR and HBV, MCV, and Bacillus Calmette-Guérin were negatively associated with U-5MR globally. In quadratic regression, the correlation between the number of doctors and mortality stabilizes or plateaus at approximately four individuals. Overall vaccine coverage was positively correlated with mortality up to a certain threshold, beyond which it became negatively correlated. A higher number of doctors was consistently associated with decreased mortality, regardless of location, while other factors varied by region. Our study findings highlight the importance of implementing global strategies that are specific to each region's characteristics to reduce IMR and U-5MR.

[Telephone surveys for the study of catastrophic costs due to tuberculosis in Colombia: a novel toolPesquisas telefônicas para um estudo de custos catastróficos da tuberculose na Colômbia: uma ferramenta inovadora]. / Encuestas telefónicas para el estudio de costos catastróficos por tuberculosis en Colombia: una herramienta innovadora.

The study of catastrophic costs incurred by people affected by tuberculosis (TB), conducted in Colombia during the COVID-19 pandemic, provided the opportunity to implement telephone surveys for data collection. This constitutes a methodological innovation regarding the standards established by the World Health Organization (WHO) which, for this type of study, usually rely on face-to-face surveys of patients attending health facilities. The study design, objectives, and methodology were adapted from the WHO publication Tuberculosis patient cost surveys: a handbook. A total of 1065 people affected by tuberculosis were selected as study participants and, by telephone, were administered a standard questionnaire adapted to the Colombian context. This allowed the collection of structured data on the direct and indirect costs faced by TB patients and their families. Greater than 80% completeness was achieved for all variables of interest, with an average survey duration of 40 minutes and a rejection rate of 8%. The described survey method to determine the baseline for further study of catastrophic costs in Colombia was novel because of its telephone-based format, which adheres to the information standards required to allow internationally comparable estimates. It is a useful means of generating standardized results in contexts in which the ability to conduct face-to-face surveys is limited.

O estudo dos custos catastróficos incorridos pelas pessoas afetadas pela tuberculose realizado na Colômbia durante a pandemia de COVID-19 representou uma oportunidade de implementar pesquisas telefônicas como forma de coleta de dados. Constitui-se uma inovação metodológica dos padrões estabelecidos pela Organização Mundial da Saúde (OMS), que, para esse tipo de estudo, geralmente se baseiam no uso de pesquisas presenciais com os pacientes que frequentam estabelecimentos de saúde. O delineamento, os objetivos e a metodologia do estudo foram adaptados do manual prático da OMS para a realização de pesquisas de custos da tuberculose. Um total de 1065 pessoas afetadas pela tuberculose foram selecionadas para participar do estudo. O questionário padrão, adaptado ao contexto colombiano, foi aplicado pelo telefone. Foi possível obter dados estruturados sobre os custos diretos e indiretos enfrentados pelos pacientes com tuberculose e suas famílias. Em geral, observou-se que todas as variáveis de coleta atingiram uma completude de mais de 80%, com um tempo médio de pesquisa de 40 minutos e uma taxa de recusa de 8%. A metodologia de pesquisa telefônica desenvolvida para determinar a linha de base do estudo de custos catastróficos na Colômbia foi inovadora devido ao formato telefônico, que mantém os padrões de informação necessários para permitir estimativas comparáveis internacionalmente e é uma forma útil de gerar resultados padronizados em circunstâncias em que há limitações para a realização de pesquisas presenciais.

The temporal and spatial interpretation of China's health financing: what do Chinese' government 'do' in new healthcare reform?

OBJECTIVE: The analysis of health expenditure and its structure takes on a critical significance in national health policy research, and the public welfare of national health undertakings can be manifested by the government's investment in health. In this study, the aim was to analyze total health care costs, the structure of health financing, and the government's investment in health, so as to provide a reference for China's health policy adjustment. METHODS: Description and cluster analysis were conducted using R language to analyze total health care costs and the structure of health financing of 31 regions in China between 1990 and 2020 to gain insights into the temporal and spatial changes total health care costs and the structure of health financing in China. The government's investment in health was analyzed using description and abundance heatmap to know the temporal and spatial changes of the government's health investment. RESULTS: The total health expenditure per capita reached 5112.3 yuan in 2020, and the total health expenditure accounted for 7.10% of GDP. The government health expenditure took up a significantly lower share of the total health expenditure in 1993-2006 (17.09% [16.30,17.88]), whereas it has been nearly 30% (29.56% [28.73,30.3]) over the past few years. As to 31 regions in China, the government health expenditure per total health expenditure reached 67.94% in Tibet, whereas a level of 27.866% (25.629-30.103) were maintained in other regions. Beijing and Shanghai have achieved over 50.00% of social health expenditure per total health expenditure in recent five years, it was significantly higher than other regions. The per capita government expenditure as a fraction of GDP of Tibet (6.842%) was the highest region in 2011-2019, while Jiangsu (only 0.937%) was the lowest region. CONCLUSIONS: Sustainable increases in total health expenditure as a percent of GDP take on a critical significance to adequate health financing. Equity in health financing has been insufficient in China, and spatial and temporal differences of China's health financing structure are significant. The region' governments should adjust policy based on typical regions to weaken the differences.

Variations in out-of-pocket spending and factors influencing catastrophic health expenditure of households with patients suffering from chronic conditions in four districts in Sri Lanka.

INTRODUCTION: Healthcare financing systems, dependent on out-of-pocket expenditure(OOPE), impose a heavy burden on those who use the services regularly, such as patients suffering from chronic diseases. High OOPE for health services leads to decreased utilization of the services and/or catastrophic health expenditure, which would significantly impede the achievement of Universal Health coverage. OBJECTIVE: We aimed to determine variations in OOPE and factors associated with Catastrophic Health Expenditure (CHE) of households with patients suffering from non-communicable diseases(NCDs) in four districts. METHODS: A survey was conducted among 2344 adult patients having selected NCD/s. Multi-stage stratified cluster sampling selected respondents from 4 districts representing urban, rural, semi-urban, and estate. Data was collected using a validated interviewer-administered questionnaire. Logistic regression identified the predictors of CHE(> 40%). Significance was considered as 0.05. RESULTS: Common NCDs were hypertension(29.1%), diabetes(26.8.0%), hyperlipidaemia(9.8%) and asthma(8.2%). Only 13% reported complications associated with NCDs. Fifty-six percent(N = 1304) were on regular clinic follow-up, and majority utilized western-medical government hospitals(N = 916,70.2%). There were 252 hospital admissions for chronic-disease management in the past 12 months. Majority(86%) were admitted to government sector hospitals. Most patients incurred nearly SLR 3000 per clinic visit and SLR 3300 per hospital admission. CHE was beyond 40% for 13.5% of the hospital admissions and 6.1% of the regular clinic follow-up. Patients admitted to private sector hospitals had 2.61 times higher CHE than those admitted to government sector hospitals. CONCLUSIONS: Patients with NCDs incurred high OOPE and faced CHE during healthcare seeking in Sri Lanka. The prevalence of NCDs and complications were high among the participants. Patients with chronic conditions incur high OOPE for a single clinic visit and a hospital admission. Patients incur high OOPE on direct medical costs, and district-wise variations were observed. The proportion with more than 40% CHE on monthly clinic care was high. Patients being followed up in the government sector are more likely to have CHE when obtaining healthcare and are more likely to face barriers in obtaining needed health services. The services rendered to patients with chronic conditions warrant a more integrative approach to reduce the burden of costs and related complications.

Global structures, practices, and tools for provision of hemodialysis.

BACKGROUND: Hemodialysis (HD) is the most commonly utilized modality for kidney replacement therapy worldwide. This study assesses the organizational structures, availability, accessibility, affordability and quality of HD care worldwide. METHODS: This cross-sectional study relied on desk research data as well as survey data from stakeholders (clinicians, policymakers and patient advocates) from countries affiliated with the International Society of Nephrology from July to September 2022. RESULTS: Overall, 167 countries or jurisdictions participated in the survey. In-center HD was available in 98% of countries with a median global prevalence of 322.7 [interquartile range (IQR) 76.3-648.8] per million population (pmp), ranging from 12.2 (IQR 3.9-103.0) pmp in Africa to 1575 (IQR 282.2-2106.8) pmp in North and East Asia. Overall, home HD was available in 30% of countries, mostly in countries of Western Europe (82%). In 74% of countries, more than half of people with kidney failure were able to access HD. HD centers increased with increasing country income levels from 0.31 pmp in low-income countries to 9.31 pmp in high-income countries. Overall, the annual cost of in-center HD was US$19 380.3 (IQR 11 817.6-38 005.4), and was highest in North America and the Caribbean (US$39 825.9) and lowest in South Asia (US$4310.2). In 19% of countries, HD services could not be accessed by children. CONCLUSIONS: This study shows significant variations that have remained consistent over the years in availability, access and affordability of HD across countries with severe limitations in lower-resourced countries.

Burden assessment of antimicrobial use and resistance in livestock in data-scarce contexts.

Misuse and overuse of antimicrobials in livestock production are identified as drivers for antimicrobial resistance (AMR). To improve decision-making concerning livestock health, it is important to understand the impact of AMR in livestock and aquaculture, within and beyond farm level, as well as expenditure on antimicrobial use (AMU). Such understanding provides grounds for systematic disease prioritisation and establishes a baseline for understanding the value of different strategies to mitigate animal health problems and for the monitoring and evaluation of the impact of those strategies. Yet limited data availability and quality surrounding AMU and AMR create barriers to furthering the knowledge of such impact. These data constraints are also more prevalent in contexts that lack the necessary resources to develop and maintain systematic and centralised data collection and collation systems. Even in regions with robust AMU and AMR monitoring systems in place, data limitations remain, such that the expenditure on antimicrobials and impacts of AMR remain unclear. Additionally, the current research funding strategies have been less focused on primary data collection, adding further barriers to filling the data void and reducing the global AMU/AMR knowledge gap. To work around the data scarcity and leverage previous and ongoing research efforts, it is vital to gain comprehensive knowledge of the people, projects and research consortia dedicated to the topic of AMU/AMR.

Les utilisations incorrecte et excessive d'agents antimicrobiens dans la production animale figurent parmi les facteurs connus de développement de résistances aux agents antimicrobiens (RAM). Pour améliorer la prise de décision relative à la santé des cheptels, il est essentiel de comprendre l'impact de la RAM chez les animaux d'élevage terrestres et aquatiques, aussi bien au niveau des élevages qu'au-delà, et de pouvoir quantifier les dépenses consacrées à l'utilisation d'agents antimicrobiens (UAM). Cette compréhension apporte les éléments d'information pour la priorisation systématique des maladies et établit un cadre de référence pour comprendre la valeur respective des différentes stratégies d'atténuation des problèmes de santé animale et pour assurer le suivi et l'évaluation d'impact de ces stratégies. Cependant, la disponibilité et la qualité limitées des données relatives à l'UAM et à la RAM font obstacle à une connaissance plus poussée de cet impact. Ces contraintes liées aux données sont plus répandues dans les contextes dépourvus des ressources nécessaires pour élaborer et entretenir des systèmes de collecte de données systématiques et centralisés. Même dans les régions où des systèmes robustes de suivi de l'UAM et de la RAM sont en place, le problème de l'insuffisance de données reste posé de sorte que la réalité des coûts induits par les agents antimicrobiens et l'impact de la RAM demeurent incertains. De plus, les stratégies actuelles de financement de la recherche ont été moins axées sur la collecte de données primaires, ce qui ajoute des obstacles supplémentaires pour l'obtention des données manquantes et compromet les efforts visant à réduire les écarts de connaissances sur l'UAM et la RAM à l'échelle mondiale. Afin de remédier à la pénurie de données et de mettre à profit les recherches antérieures et en cours, il est indispensable de savoir quels sont les acteurs, les projets et les consortiums de recherche qui travaillent sur l'UAM et la RAM.

El uso incorrecto y excesivo de antimicrobianos en la producción ganadera se considera un impulsor de la resistencia a los antimicrobianos (RAM). Para mejorar la toma de decisiones relativas a la sanidad del ganado, es importante comprender el impacto de la RAM en la ganadería y la acuicultura, a nivel de las granjas y más allá, así como el coste con el uso de antimicrobianos (UAM). Tal comprensión permite una priorización sistemática de enfermedades y establece una línea base para comprender el valor de las distintas estrategias destinadas a mitigar los problemas de sanidad animal, así como para supervisar y evaluar el impacto de esas estrategias. Sin embargo, la limitada disponibilidad y calidad de los datos en torno al UAM y a la RAM crean barreras que impiden ampliar la comprensión de dicho impacto. Estas limitaciones de datos también son más frecuentes en contextos que carecen de los recursos necesarios para desarrollar y mantener sistemas sistemáticos y centralizados de recopilación y cotejo de datos. Incluso en las regiones que cuentan con sistemas sólidos de seguimiento del UAM y la RAM, los datos siguen siendo limitados, de modo que los costes con antimicrobianos y las repercusiones de la resistencia a estos siguen sin estar claros. Además, las actuales estrategias de financiación de la investigación se han centrado menos en la recopilación de datos primarios, lo que añade más obstáculos a la hora de llenar el vacío de datos y reducir la brecha mundial de conocimientos sobre el UAM y la RAM. Para superar la escasez de datos y aprovechar las iniciativas de investigación previas y en curso, es fundamental adquirir un conocimiento detallado de las personas, los proyectos y los consorcios de investigación dedicados al tema del uso de antimicrobianos y la resistencia a estos.

Financial literacy, social security, and healthcare cost anxiety in China.

This study examines the impact of financial literacy and social security on healthcare cost anxiety in China using data from the 2021 Global Financial Inclusion database. Employing an ordered logit model and its marginal effects, we analyse how these factors influence varying levels of healthcare cost anxiety (worried, somewhat worried, and not worried at all) across total, female-headed and male-headed households. Financial literacy and social security both demonstrate significant negative effects on healthcare cost anxiety across all household types. It implied that individuals who save for old age and those with social security coverage are less likely to experience high levels of healthcare cost anxiety. The ordered logit results show consistent negative coefficients for financial literacy and social security across all household categories. Marginal effects analysis further illustrates how these factors affect the probability of falling into each category of healthcare cost anxiety. These findings underscore the importance of promoting financial literacy and expanding social security coverage as potential strategies to alleviate healthcare cost anxiety in China.

Cette étude examine l'impact de la littératie financière et de la sécurité sociale sur l'anxiété liée aux coûts des soins de santé en Chine à l'aide des données de la base de données mondiale sur l'inclusion financière 2021. En utilisant un modèle logit ordonné et ses effets marginaux, nous analysons comment ces facteurs influencent différents niveaux d'anxiété liée aux coûts de santé (inquiet, quelque peu inquiet et pas du tout inquiet) dans l'ensemble des ménages dirigés par une femme ou un homme. La littératie financière et la sécurité sociale démontrent toutes deux des effets négatifs significatifs sur l'anxiété liée aux coûts des soins de santé dans tous les types de ménages. Cela implique que les personnes qui épargnent pour leur vieillesse et celles qui bénéficient d'une couverture de sécurité sociale sont moins susceptibles de ressentir des niveaux élevés d'anxiété liée aux coûts des soins de santé. Les résultats du logit ordonné montrent des coefficients négatifs cohérents pour la culture financière et la sécurité sociale dans toutes les catégories de ménages. L'analyse des effets marginaux illustre en outre comment ces facteurs affectent la probabilité d'appartenir à chaque catégorie d'anxiété liée aux coûts des soins de santé. Ces résultats soulignent l'importance de promouvoir la culture financière et d'élargir la couverture de sécurité sociale en tant que stratégies potentielles pour atténuer l'anxiété liée aux coûts des soins de santé en Chine.

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.

Study on the impact of air pollution on residents' health expenditures in Guangdong, Hong Kong, and Macao Greater Bay Area.

The Guangdong, Hong Kong, and Macao Greater Bay Area (GHMA) has experienced economic development and rapid growth of transportation infrastructure in recent years. However, the economic advancement is also accompanied by serious atmospheric pollution, which threatens the health of the residents, thus, it is of great significance to explore the impact of atmospheric pollution on the health expenditures of residents in the GHMA. The article establishes a spatial econometric model to study the impact of atmospheric pollution on residents' health expenditure in the GHMA based on panel data from 2014 to 2021, using nine prefectures in the GHMA as research objects. The results show that: (1) Atmospheric pollution in the GHMA has an obvious spatial agglomeration phenomenon and spatial spillover effect, and the impact of atmospheric pollution on the health of the residents is still very serious; (2) PM2.5 emissions are positively and significantly related to the actual health care cost per person, and the rise in air pollution is the main reason for the rise in public health spending; (3) Other factors also have different impacts on residents' health expenditures. Based on the above research, the article puts forward corresponding policy recommendations.

The Economic Burden of Childhood Ocular Morbidity in Bangladesh.

INTRODUCTION: Childhood eye morbidity is a great public health problem, especially in low-income countries. This study aimed to determine the economic burden of childhood ocular morbidity on attending tertiary hospitals in Bangladesh. This study also assessed the catastrophic health expenditure (CHE) for childhood ocular morbidity in Bangladesh. METHODS: A cross-sectional mixed method was used for this study from April to October 2023 at two tertiary hospitals in Bangladesh, one government-funded and one private. Face-to-face interviews using a semi-structured quantitative questionnaire with the caregivers/parents and in-depth interviews (IDIs) were conducted among the same respondents of these two hospitals, and a workshop was conducted with the stakeholders during the study period. RESULTS: This was the first study in Bangladesh to determine the cost of pediatric ocular morbidity. Among 335 patients, the total median direct cost at a single time was 3740 ± 18,285 BDT (34 ± 166.2 USD) at the government hospital and 7300 ± 40,630 BDT (66.36 ± 369.36 USD) at the private hospital. The disease-specific median overall cost from diagnosis of the disease was 65,000 BDT (591 USD) for squint, 50,000 BDT (454.54 USD) for cataract, and 30,000 BDT (272.72 USD) for eye injury. Almost 90% of the caregivers/parents faced CHE due to different pediatric ocular morbidity. CONCLUSIONS: These cost estimates can be used as an initial basis for financial decisions that aim to enhance access to care, management, and follow-up of children with ocular morbidity. These cost estimates also offer helpful information for organizational and financial sustainability initiatives. Policymakers can consider serious immediate interventions for securing ocular health services in Bangladesh and prevent families from CHE.

Catastrophic health expenditure of inpatients in emerging economies: evidence from the Indian subcontinent.

BACKGROUND: Catastrophic health expenditures condensed the vital concern of households struggling with notable financial burdens emanating from elevated out-of-pocket healthcare expenditures. In this regard, this study investigated the nature and magnitude of inpatient healthcare expenditure in India. It also explored the incidence and determinants of inpatient catastrophic health expenditure. METHODOLOGY: The study used the micro-level data collected in the 75th Round of the National Sample Survey on 93 925 households in India. Descriptive statistics were used to examine the nature, magnitude and incidence of inpatient healthcare expenditure. The heteroscedastic probit model was applied to explore the determinants of inpatient catastrophic healthcare expenditure. RESULTS: The major part of inpatient healthcare expenditure was composed of bed charges and expenditure on medicines. Moreover, results suggested that Indian households spent 11% of their monthly consumption expenditure on inpatient healthcare and 28% of households were grappling with the complexity of financial burden due to elevated inpatient healthcare. Further, the study explored that bigger households and households having no latrine facilities and no proper waste disposal plans were more vulnerable to facing financial burdens in inpatient healthcare activity. Finally, the result of this study also ensure that households having toilets and safe drinking water facilities reduce the chance of facing catastrophic inpatient health expenditures. CONCLUSIONS: A significant portion of monthly consumption expenditure was spent on inpatient healthcare of households in India. It was also conveyed that inpatient healthcare expenditure was a severe burden for almost one fourth of households in India. Finally, it also clarified the influence of socio-economic conditions and sanitation status of households as having a strong bearing on their inpatient healthcare.

The out-of-pocket cost of living with obesity: Results from a survey in Spain, South Korea, Brazil, India, Italy, and Japan.

Objectives: In many countries, obesity treatments are not fully reimbursed by healthcare systems. People living with obesity (PwO) often pay out-of-pocket (OOP) for pharmacological and non-pharmacological interventions, placing them in a position of financial risk to manage their condition. This study sought to understand the OOP expenditures and non-financial costs incurred by PwO to manage weight. Methods: A 25-min cross-sectional online survey was conducted with PwO between ages 18-60 in Italy, Japan, India, Brazil, Spain and South Korea. Respondents were recruited using proprietary vendor panels and non-probability sampling. N = 600 participants completed the survey (n = 100 per country). Results: The mean annual OOP expenditure related to weight loss/management was $7,351, accounting for nearly 17% of annual household income. Costs generally increased by BMI. Half or more of the respondents agreed that obesity affected multiple aspects of their lives (outside activities, running a household, social life, work, family life, traveling). 46% agreed that obesity limited their job prospects. Conclusion: PwO spend a notable amount of their income paying OOP expenditures related to managing their weight. Quantifying the individual economic burden of living with obesity can inform the understanding of the resources required and policy changes needed to treat obesity as a disease.

Pakistan's path to universal health coverage: national and regional insights.

BACKGROUND: Universal Health Coverage (UHC) is a common health policy objective outlined in the Sustainable Development Goals. With provincial governments taking the initiative, Pakistan has implemented and extended UHC program amid a complex public health landscape. In this context, we assess Pakistan's progress toward achieving UHC at the national and subnational level. METHODS: We use data from the Demographic and Health Surveys and the Household Integrated Economic Survey to construct a UHC index at the national and subnational level for 2007, 2013, and 2018. Furthermore, we use Concentration Index (CI) and CI decomposition methodologies to assess the primary drivers of inequality in accessing medical services. Logistic regression and Sartori's two-step model are applied to examine the key determinants of catastrophic health expenditure (CHE). RESULTS: Our analysis underscores Pakistan's steady progress toward UHC, while revealing significant provincial disparities in UHC progress. Provinces with lower poverty rate achieve higher UHC index, which highlights the synergy of poverty alleviation and UHC expansion. Among the examined indicators, child immunization remains a key weakness that one third of the children are not fully vaccinated and one sixth of these not-fully-vaccinated children have never received any vaccination. Socioeconomic status emerges as a main contributor to disparities in accessing medical services, albeit with a declining trend over time. Household socioeconomic status is negatively correlated with CHE incidence, indicating that wealthier households are less susceptible to CHE. For individuals experiencing CHE, medicine expenditure takes the highest share of their health spending, registering a staggering 70% in 2018. CONCLUSION: Pakistan's progress toward UHC aligns closely with its economic development trajectory and policy efforts in expanding UHC program. However, economic underdevelopment and provincial disparities persist as significant hurdles on Pakistan's journey toward UHC. We suggest continued efforts in UHC program expansion with a focus on policy consistency and fiscal support, combined with targeted interventions to alleviate poverty in the underdeveloped provinces.

Assessing the accuracy of self-reported health expenditure data: Evidence from two public surveys in China.

This paper utilizes Benford's law, the distribution that the first significant digit of numbers in certain datasets should follow, to assess the accuracy of self-reported health expenditure data known for measurement errors. We provide both simulation and real data evidence supporting the validity assumption that genuine health expenditure data conform to Benford's law. We then conduct a Benford analysis of health expenditure variables from two widely utilized public datasets, the China Health and Nutrition Survey and the China Family Panel Studies. Our findings show that health expenditure data in both datasets exhibit inconsistencies with Benford's law, with the former dataset tending to be less prone to reporting errors. These results remain robust while accounting for variations in survey design, recall periods, and sample sizes. Moreover, we demonstrate that data accuracy improves with a shorter time interval between hospitalization and interviews, when the data is self-reported as opposed to proxy responses, and at the household level. We find no compelling evidence that enumerators' assessments of respondents' credibility or urgency to end interviews are indicative of data accuracy. This paper contributes to literature by introducing an easy-to-implement analytical framework for scrutinizing and comparing the reporting accuracy of health expenditure data.

Catastrophic out-of-pocket payments related to non-communicable disease multimorbidity and associated factors, evidence from a public referral hospital in Addis Ababa Ethiopia.

BACKGROUND: In low and middle-income countries (LMICs), non-communicable diseases (NCDs) are on the rise and have become a significant cause of mortality. Unfortunately, accessing affordable healthcare services can prove to be challenging for individuals who are unable to bear the expenses out of their pockets. For NCDs, the treatment costs are already high, and being multimorbid further amplifies the economic burden on patients and their families. The present study seeks to bridge the gap in knowledge regarding the financial risks that come with NCD multimorbidity. It accomplishes this by examining the catastrophic out-of-pocket (OOP) expenditure levels and the factors that contribute to it at Tikur Anbesa Specialized Hospital, Addis Ababa, Ethiopia. METHODS: A facility-based cross-sectional study was conducted at Tikur Anbesa Specialized Hospital between May 18 and July 22, 2020 and 392 multimorbid patients participated. The study participants were selected from the hospital's four NCD clinics using systematic random sampling. Patients' direct medical and non-medical out-of-pocket (OOP) expenditures were recorded, and the catastrophic OOP health expenditure for NCD care was estimated using various thresholds as cutoff points (5%, 10%, 15%, 20%, 25%, and 40% of both total household consumption expenditure and non-food expenditure). The collected data was entered into Epi Data version 3.1 and analyzed using STATA V 14. Descriptive statistics were utilized to present the study's findings, while logistic regression was used to examine the associations between variables. RESULTS: A study was conducted on a sample of 392 patients who exhibited a range of socio-demographic and economic backgrounds. The annual out-of-pocket spending for the treatment of non-communicable disease multimorbidity was found to be $499.7 (95% CI: $440.9, $558.6) per patient. The majority of these expenses were allocated towards medical costs such as medication, diagnosis, and hospital beds. It was found that as the threshold for spending increased from 5 to 40% of total household consumption expenditure, the percentage of households facing catastrophic health expenditures (CHE) decreased from 77.55 to 10.46%. Similarly, the proportion of CHE as a percentage of non-food household expenditure decreased from 91.84 to 28.32% as the threshold increased from 5 to 40%. The study also revealed that patients who traveled to Addis Ababa for healthcare services (AOR = 7.45, 95% CI: 3.41-16.27), who were not enrolled in an insurance scheme (AOR = 4.97, 95% CI: 2.37, 10.4), who had more non-communicable diseases (AOR = 2.05, 95% CI: 1.40, 3.01), or who had more outpatient visits (AOR = 1.46, 95%CI: 1.31, 1.63) had a higher likelihood of incurring catastrophic out-of-pocket health expenditures at the 40% threshold. CONCLUSION AND RECOMMENDATION: This study has revealed that patients with multiple non-communicable diseases (NCDs) frequently face substantial out-of-pocket health expenditures (CHE) due to both medical and non-medical costs. Various factors, including absence from an insurance scheme, medical follow-ups necessitating travel to Addis Ababa, multiple NCDs and outpatient visits, and utilization of both public and private facilities, increase the likelihood of incurring CHE. To mitigate the incidence of CHE for individuals with NCD multimorbidity, an integrated NCD care service delivery approach, access to affordable medications and diagnostic services in public facilities, expanded insurance coverage, and fee waiver or service exemption systems should be explored.

Health-led growth hypothesis and health financing systems: an econometric synthesis for OECD countries.

Introduction: This study investigates the Health-Led Growth Hypothesis (HLGH) within OECD countries, examining how health expenditures influence economic growth and the role of different health financing systems in this relationship. Methods: Utilizing a comprehensive analysis spanning 2000 to 2019 across 38 OECD countries, advanced econometric methodologies were employed. Both second-generation panel data estimators (Dynamic CCEMG, CS-ARDL, AMG) and first-generation models (Panel ARDL with PMG, FMOLS, DOLS) were utilized to test the hypothesis. Results: The findings confirm the positive impact of health expenditures on economic growth, supporting the HLGH. Significant disparities were observed in the ability of health expenditures to stimulate economic growth across different health financing systems, including the Bismarck, Beveridge, Private Health Insurance, and System in Transition models. Discussion: This study enriches the ongoing academic dialog by providing an exhaustive analysis of the relationship between health expenditures and economic growth. It offers valuable insights for policymakers on how to optimize health investments to enhance economic development, considering the varying effects of different health financing frameworks.

Out-of-pocket and catastrophic health expenditure among patients of sexually transmitted infections at a tertiary care center: A cross-sectional study.

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.

Air pollution and life expectancy in the USA: Do medical innovation, health expenditure, and economic complexity matter?

Regardless of a country's income level, air pollution poses a significant environmental threat to human health. Long-term exposure to air pollution often triggers cardiovascular and respiratory diseases. Thus, air pollution significantly reduces life expectancy worldwide. The USA is one of the world's largest polluters of CO2 emissions, often used to represent air pollution. In this context, the main objective of this study is to examine the relationship between air pollution and life expectancy in the USA. In doing so, we control for the role of medical innovation, health expenditures, economic complexity, and government effectiveness using data for the period 1995-2019. The results indicate the existence of a cointegration relationship in the proposed model. The long-run coefficients are statistically positive for medical innovation and negative for CO2 emissions, economic complexity, and government effectiveness. On the other hand, health expenditures are ineffective in terms of life expectancy. Accordingly, medical innovation raises life expectancy, whereas CO2 emissions, economic complexity, and government effectiveness decrease it. Higher economic prosperity and health expenditures are not always beneficial to life expectancy. Therefore, policymakers need to take action to reduce air pollution and increase the comprehensiveness of economic prosperity benefits and health expenditure efficiency.