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1.
BMC Health Serv Res ; 21(1): 1327, 2021 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-34895226

RESUMO

BACKGROUND: The National Health Insurance in Korea has been in operation for more than 30 years since having achieved universal health coverage in 1989 and has gone through several policy reforms. Despite its achievements, the Korean health insurance has some shortfalls, one of which concerns the fairness of paying for health care. METHOD: Using the population representative Household Income and Expenditure Survey data in Korea, this study examined the yearly changes in the vertical equity of paying for health care between 1990 and 2016 by the source of financing using the Kakwani index, considering health insurance and other related policy reforms in Korea during this period. RESULTS: The study results suggest that direct tax was the most progressive mode of health care financing in all years, whereas indirect tax was proportional. The out-of-pocket payments were weakly regressive in all years. The Kakwani index for health insurance contributions was regressive but now is proportional to the ability to pay, whereas the Kakwani index for private health insurance premiums turned from progressive to weakly regressive. The Kakwani index for overall health care financing showed a weak regressivity during the study period. DISCUSSION: The overall health care financing in Korea has transformed from a slight regressivity to proportional over time between 1990 and 2016. It is expected that these changes were closely related to the improved equity of health insurance contributions from 1998 to 2008, which was the result of a merger of the health insurance societies and an amendment in the health insurance contribution structure. These results suggest that standardizing insurance managing organizations and financing rules potentially has positive implications for the equity of healthcare financing in a country where the major method of health care financing is social health insurance.


Assuntos
Financiamento Pessoal , Financiamento da Assistência à Saúde , Atenção à Saúde , Gastos em Saúde , Humanos , República da Coreia
2.
PLoS One ; 16(12): e0261737, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34972129

RESUMO

Potential relationship among loan applicants can provide valuable information for evaluating default risk. However, most of the existing credit scoring models either ignore this relationship or consider a simple connection information. This study assesses the applicants' relation in terms of their distance estimated based on their characteristics. This information is then utilized in a proposed spatial probit model to reflect the different degree of borrowers' relation on the default prediction of loan applicant. We apply this method to peer-to-peer Lending Club Loan data. Empirical results show that the consideration of information on the spatial autocorrelation among loan applicants can provide high predictive power for defaults.


Assuntos
Administração Financeira , Financiamento Pessoal/economia , Financiamento Pessoal/normas , Renda , Economia , Humanos , Modelos Estatísticos , Análise de Regressão , Risco , Fatores Socioeconômicos
3.
JAMA ; 326(18): 1873-1874, 2021 11 09.
Artigo em Inglês | MEDLINE | ID: mdl-34751712
4.
JAMA ; 326(18): 1873, 2021 11 09.
Artigo em Inglês | MEDLINE | ID: mdl-34751715
5.
Orv Hetil ; 162(41): 1658-1668, 2021 10 10.
Artigo em Húngaro | MEDLINE | ID: mdl-34633982

RESUMO

Összefoglaló. Bevezetés: Magyarországon 2021. január 1-jétol a hálapénz minden formájának adása és elfogadása buncselekmény, kivéve a legföljebb a minimálbér 5%-át (8370 forintot) eléro ajándékot. Míg a tilalmat az orvosok esetében jelentos béremelés kompenzálja, addig a szakdolgozók korábban is kevéssé vizsgált hálapénzjuttatásának helyzetére és megváltozására vonatkozóan alig vannak adatok. Célkituzés: A szakdolgozói hálapénz 2020 végi kiinduló helyzetének feltárása és az új jogszabályi eloírások becsülheto hatásainak vizsgálata a szakdolgozók által nyújtott információ alapján. Módszer: 2020 oszén 167 egészségügyi szakdolgozó kérdoíves felmérése történt meg a Szegedi Tudományegyetem Szent-Györgyi Albert Klinikai Központjában a hálapénzadás motivációinak, formáinak és körülményeinek, valamint összegének megismerése érdekében. Az eredményeket elsosorban leíró statisztikai formában elemeztük, különös tekintettel a mutéti, a belgyógyászati és a gyermekgyógyászati szakterületek között mutatkozó különbségekre; és összevetettük az új törvény hatására várható változásokkal. Eredmények: A 167 válaszadóból 93-an mutéti/operatív területen, 54-en belgyógyászati jellegu területen, 18-an pedig a gyermek/ifjúsági ellátásban dolgoznak. Mindegyik szakterületen megjelent a hála mellett a korrupciós célú juttatás, de ezzel és a hálapénzjelenséggel legkevésbé a gyermekgyógyászati terület volt érintett. A nagyobb értéku ajándék ritka, de a kisebb értéku rendszeresen alkalmazott juttatás. Egy hét benntartózkodás esetén a válaszadók átlagosan 10 851 forintot (36 USD) kaptak hálapénzként, míg egy-egy alkalommal 5326 forintot (18 USD). Az összegek - hasonlóan az orvosi hálapénzhez - jelentos eltérést mutattak az egyes területek között, a mutéti szakmákban pedig meghaladták az új törvényi korlátot. A magánellátásban kapott hálapénz kisebb arányú, a munkahelyen kívül átadott juttatás pedig kifejezetten ritka. Következtetés: A korrupciós célú hálapénz az egészségügyi szakdolgozói szférában ugyan jelen van, de nem jellemzo. A szakdolgozóknak juttatott hálapénz büntetojogi szankcionálását nem kompenzálja az orvosokéhoz hasonló béremelés. A pénzbeli juttatás ajándéktárgy formájában történo juttatása minden területen jelent veszteséget, a mutéti területen az értékben kifejezett veszteség is jelentosebb lehet. A büntetoeljárási fenyegetettség nem elegendo a magyarországi hálapénzrendszer megszüntetéséhez, további társadalompolitikai intézkedések szükségesek az egészségügyi dolgozók és a betegek attitudjének megváltoztatásához. Orv Hetil. 2021; 162(41): 1658-1668. INTRODUCTION: In Hungary, since January 1st, 2021, the giving and acceptance of all forms of informal payments constitute a crime, except for gifts of a value of no more than 5% of the minimal monthly salary. While in the case of physicians, a pay rise compensates the loss of revenue, we hardly have data on the nurses' attitude in relation to the acceptance of informal payments. OBJECTIVE: We intend to uncover the situation of informal payments at the end of 2020 and to examine the effects of the new legal regulation, based on information from nurses. METHOD: In the fall of 2020, we questioned 167 nurses in the Albert Szent-Györgyi Health Center of the University of Szeged, Hungary, in order to highlight the motivations, forms, circumstances, and sums of informal payments. We analyzed the results by means of descriptive statistical methods, with special regard to the differences among surgical, internal medical and pediatric fields. We analyzed the results with a view to the new legal regulations. RESULTS: Out of 167 respondents, 93 work in operative field, 54 in internal medical care, and 18 in pediatric care. Besides gratitude, corruption appeared in all the three fields, however, pediatric care was the least touched by corruption. Gifts of a higher value are rare, however, small gifts are common. The respondents received 10 851 HUF (i.e., 36 USD) as informal payment from in-patients after one week, while, occasionally, 5326 HUF (i.e., 18 USD). The sums - similarly to informal payments to physicians - vary from field to field in healthcare. In the surgical field, the sums surpassed the new legal limit. Informal payments are given in private healthcare more rarely than in public healthcare. Informal payments given outside the workplace hardly ever occur. CONCLUSION: The informal payment with the goal of corruption is present in the sphere of nurses, however, it is not typical. The criminal sanctioning of informal payments to nurses is not compensated by a pay rise similar to that of physicians. The fact that informal payments are substituted by gifts results in loss of revenue in all fields of healthcare, however, this loss is the most salient in the surgical field. The criminal sanctioning is not sufficient to eliminate informal payments in Hungary; further socio-political measures are to be taken with the goal to change the attitude of healthcare workers and patients. Orv Hetil. 2021; 162(41): 1658-1668.


Assuntos
Financiamento Pessoal , Enfermeiras e Enfermeiros , Criança , Atenção à Saúde , Humanos , Hungria , Motivação
6.
Artigo em Inglês | MEDLINE | ID: mdl-34682651

RESUMO

Confronted with a global pandemic, public healthcare systems are under pressure, making access to healthcare services difficult for patients. This provides fertile ground for using illegal practices such as informal payments to gain access. This paper aims to evaluate the use of informal payments by patients during the COVID-19 pandemic and the institutions that affect the prevalence of this practice. Various measurements of formal and informal institutions are here investigated, namely the acceptability of corruption, the level of trust, transparency, and performance of the healthcare system. To do so, a logistic regression of 10,859 interviews with patients conducted across 11 Central and Eastern Europe countries in October-December 2020 is employed. The finding is that there are large disparities between countries in the prevalence of informal payments, and that the practice is more likely to occur where there are poorer formal and informal institutions, namely higher acceptability of corruption, lower trust in authorities, lower perceived transparency in handling the COVID-19 pandemic, difficult access to, and poor quality of, healthcare services, and higher mortality rates due to the COVID-19 pandemic. These findings suggest that policy measures for tackling informal payments need to address the current state of the institutional environment.


Assuntos
COVID-19 , Pandemias , Europa Oriental , Financiamento Pessoal , Gastos em Saúde , Humanos , SARS-CoV-2
7.
Artigo em Inglês | MEDLINE | ID: mdl-34639551

RESUMO

(1) Background: Informal patient payments continue to persist in the Serbian health care system, exposing vulnerable groups to private spending on health care. Migrants may in particular be subject to such payments, as they often experience barriers in access to health care. Little is known about migrants paying informally to access health care in Serbia. The study aims to explore pathways of accessing health care, including the role of informal patient payments, from the perspectives of civil servants and non-western migrants in Serbia. (2) Methods: Respondents (n = 8 civil servants and n = 6 migrants) were recruited in Belgrade in 2018, where semi-structured interviews were conducted. The interviews were analysed applying the grounded theory methodological steps. (3) Results: Data reveal different pathways to navigate the Serbian health care system, and ultimately whether paying informally occurs. Migrants appear less prone to paying informally and receive the same or better-quality health care. Locals experience the need to pay informal patient payments, quasi-formal payments and to bring medicine, materials or equipment when in health facilities. (4) Conclusions: Paying informally or using private care in Serbia appear to have become common. Despite a comprehensive health insurance coverage, high levels of out-of-pocket payments show barriers in accessing health care. It is highly important to not confuse the cultural beliefs with forced spending on health care and such private spending should be reduced to not push people into poverty.


Assuntos
Financiamento Pessoal , Gastos em Saúde , Teoria Fundamentada , Instalações de Saúde , Acesso aos Serviços de Saúde , Humanos , Percepção , Sérvia
8.
PLoS One ; 16(9): e0256910, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34492056

RESUMO

Out of pocket health payment (OOPs) has been identified by the System of Health Accounts (SHA) as the largest source of health care financing in most low and middle-income countries. This means that most low and middle-income countries will rely on user fees and co-payments to generate revenue, rationalize the use of services, contain health systems costs or improve health system efficiency and service quality. However, the accurate measurement of OOPs has been challenged by several limitations which are attributed to both sampling and non-sampling errors when OOPs are estimated from household surveys, the primary source of information in LICs and LMICs. The incorrect measurement of OOP health payments can undermine the credibility of current health spending estimates, an otherwise important indicator for tracking UHC, hence there is the need to address these limitations and improve the measurement of OOPs. In an attempt to improve the measurement of OOPs in surveys, the INDEPTH-Network Household out-of-pocket expenditure project (iHOPE) developed new modules on household health utilization and expenditure by repurposing the existing Ghana Living Standards Survey instrument and validating these new tools with a 'gold standard' (provider data) with the aim of proposing alternative approaches capable of producing reliable data for estimating OOPs in the context of National Health Accounts and for the purpose of monitoring financial protection in health. This paper reports on the challenges and opportunities in using and linking household reported out-of-pocket health expenditures to their corresponding provider records for the purpose of validating household reported out-of-pocket health expenditure in the iHOPE project.


Assuntos
Financiamento Pessoal/economia , Programas Governamentais/economia , Gastos em Saúde , Adolescente , Adulto , Idoso , Características da Família , Feminino , Gana/epidemiologia , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Inquéritos e Questionários/economia , Adulto Jovem
9.
Sci Rep ; 11(1): 18759, 2021 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-34548599

RESUMO

Repayment failures of borrowers have greatly affected the sustainable development of the peer-to-peer (P2P) lending industry. The latest literature reveals that existing risk evaluation systems may ignore important signals and risk factors affecting P2P repayment. In our study, we applied four machine learning methods (random forest (RF), extreme gradient boosting tree (XGBT), gradient boosting model (GBM), and neural network (NN)) to predict important factors affecting repayment by utilizing data from Renrendai.com in China from Thursday, January 1, 2015, to Tuesday, June 30, 2015. The results showed that borrowers who have passed video, mobile phone, job, residence or education level verification are more likely to default on loan repayment, whereas those who have passed identity and asset certification are less likely to default on loans. The accuracy and kappa value of the four methods all exceed 90%, and RF is superior to the other classification models. Our findings demonstrate important techniques for borrower screening by P2P companies and risk regulation by regulatory agencies. Our methodology and findings will help regulators, banks and creditors combat current financial disasters caused by the coronavirus disease 2019 (COVID-19) pandemic by addressing various financial risks and translating credit scoring improvements.


Assuntos
Financiamento Pessoal/economia , Aprendizado de Máquina , COVID-19/epidemiologia , COVID-19/virologia , China/epidemiologia , Administração Financeira , Financiamento Pessoal/normas , Humanos , Internet , Pandemias , Fatores de Risco , SARS-CoV-2/isolamento & purificação
11.
BMJ Open ; 11(9): e045807, 2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-34475146

RESUMO

INTRODUCTION: Achieving universal health coverage goal by ensuring access to quality health service without financial hardship is a policy target in many countries. Thus, routine assessments of financial risk protection, and equity in financing and service delivery are required in order to track country progress towards realising this universal coverage target. This study aims to undertake a system-wide assessment of equity in health financing and benefits distribution as well as catastrophic and impoverishing health spending by using the recent national survey data in Tanzania. We aim for updated analyses and compare with previous assessments for trend analyses. METHODS AND ANALYSIS: We will use cross-sectional data from the national Household Budget Survey 2017/2018 covering 9463 households and 45 935 individuals cross all 26 regions of mainland Tanzania. These data include information on service utilisation, healthcare payments and consumption expenditure. To assess the distribution of healthcare benefits (and in relation to healthcare need) across population subgroups, we will employ a benefit incidence analysis across public and private health providers. The distributions of healthcare benefits across population subgroups will be summarised by concentration indices. The distribution of healthcare financing burdens in relation to household ability-to-pay across population subgroups will be assessed through a financing incidence analysis. Financing incidence analysis will focus on domestic sources (tax revenues, insurance contributions and out-of-pocket payments). Kakwani indices will be used to summarise the distributions of financing burdens according to households' ability to pay. We will further estimate two measures of financial risk protection (ie, catastrophic health expenditure and impoverishing effect of healthcare payments). ETHICS AND DISSEMINATION: We will involve secondary data analysis that does not require ethical approval. The results of this study will be disseminated through stakeholder meetings, peer-reviewed journal articles, policy briefs, local and international conferences and through social media platforms.


Assuntos
Financiamento Pessoal , Financiamento da Assistência à Saúde , Estudos Transversais , Gastos em Saúde , Humanos , Tanzânia , Cobertura Universal do Seguro de Saúde
12.
BMC Cancer ; 21(1): 1055, 2021 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-34563142

RESUMO

BACKGROUND: Patient medical out-of-pocket expenses are thought to be rising worldwide yet data describing trends over time is scant. We evaluated trends of out-of-pocket expenses for patients in Australia with one of five major cancers in the first-year after diagnosis. METHODS: Participants from the QSKIN Sun and Health prospective cohort Study with a histologically confirmed breast, colorectal, lung, melanoma, or prostate cancer diagnosed between 2011 and 2015 were included (n = 1965). Medicare claims data on out-of-pocket expenses were analysed using a two-part model adjusted for year of diagnosis, health insurance status, age and education level. Fisher price and quantity indexes were also calculated to assess prices and volumes separately. RESULTS: On average, patients with cancer diagnosed in 2015 spent 70% more out-of-pocket on direct medical expenses than those diagnosed in 2011. Out-of-pocket expenses increased significantly for patients with breast cancer (mean AU$2513 in 2011 to AU$6802 in 2015). Out-of-pocket expenses were higher overall for individuals with private health insurance. For prostate cancer, expenses increased for those without private health insurance over time (mean AU$1586 in 2011 to AU$4748 in 2014) and remained stable for those with private health insurance (AU$4397 in 2011 to AU$5623 in 2015). There were progressive increases in prices and quantities of medical services for patients with melanoma, breast and lung cancer. For all cancers, prices increased for medicines and doctor attendances but fluctuated for other medical services. CONCLUSION: Out-of-pocket expenses for patients with cancer have increased substantially over time. Such increases were more pronounced for women with breast cancer and those without private health insurance. Increased out-of-pocket expenses arose from both higher prices and higher volumes of health services but differ by cancer type. Further efforts to monitor patient out-of-pocket costs and prevent health inequities are required.


Assuntos
Financiamento Pessoal/tendências , Gastos em Saúde/tendências , Neoplasias/economia , Adulto , Fatores Etários , Idoso , Austrália , Neoplasias da Mama/economia , Neoplasias da Mama/terapia , Neoplasias Colorretais/economia , Neoplasias Colorretais/terapia , Custos Diretos de Serviços/tendências , Custos de Medicamentos/tendências , Escolaridade , Honorários Médicos/tendências , Feminino , Financiamento Pessoal/economia , Humanos , Cobertura do Seguro , Seguro Saúde/economia , Seguro Saúde/tendências , Neoplasias Pulmonares/economia , Neoplasias Pulmonares/terapia , Masculino , Melanoma/economia , Melanoma/terapia , Pessoa de Meia-Idade , Neoplasias/terapia , Estudos Prospectivos , Neoplasias da Próstata/economia , Neoplasias da Próstata/terapia , Queensland , Fatores Sexuais , Fatores de Tempo
13.
Front Public Health ; 9: 710633, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34336780

RESUMO

In 2020, President Xi Jinping put forward a constructing cycle that has been given priority in this study. This particular cycle, when considered within the inner loop and outer loop, promotes the guiding ideology of the new development pattern of the binary economy that exists in recent times. Therefore, to gauge the extent of the promotion of domestic production and consumption, from the perspectives of medical expenses, this study refers to the bootstrap rolling window causality method, which considers the evidence-based medical spending on the consumption Granger causality. The results show that the Granger causality exists between medical expenditure and consumption expenditure at different time interval endpoints. In contrast, however, the variable of consumption does not produce Granger causality between medical expenditure and consumption. In this regard, a series of measures, such as increasing medical insurance expenditure, improvement of the medical insurance system, reduction of the housing price rise, and increasing government investment have been proposed to promote the development of the domestic circular economy.


Assuntos
Gastos em Saúde , Seguro Saúde , China , Financiamento Pessoal , Produto Interno Bruto
14.
Soc Sci Med ; 285: 114271, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34352505

RESUMO

Many developing nations witness systemic healthcare reforms where the expansion of health financing mechanisms and reforms of the service delivery system are being rolled out simultaneously. Yet, poorly coordinated reforms and negative interactions between multiple policies may offset synergies and undermine intended reform outcomes. This study examines how multiple healthcare reforms affect catastrophic health spending of low-income households in China. We characterize two broad types of health policy reforms: expansion- and constraint-oriented policies in the domains of financing, services delivery, and pharmaceuticals introduced since 2009. We adopt an innovative methodology by matching macro-level policy text data collected using big data techniques with micro-level health expenditure data drawn from a nationally representative survey. Employing a linear probability analysis and controlling for household and year fixed effects, we find that more expansion-oriented policies, especially in the domain of financing, increased the incidence of catastrophic health spending of poor households. In contrast, constraint-oriented policies, particularly in the domain of health services delivery, lead to a lower incidence of catastrophic health spending. This type of policy is thus better able to mitigate the positive relationship between expansion-oriented policies and the incidence of catastrophic health spending. This study suggests that while the expansion of benefit package in the domain of financing is indeed a decisive move towards universal health coverage, the essential financial protection of the poor cannot be achieved without strong and coordinated supply-side reforms towards cost containment. Health policy makers must take a strategic view of the complex interactions of multiple policy interventions in both financing and service delivery domains.


Assuntos
Doença Catastrófica , Reforma dos Serviços de Saúde , China , Características da Família , Financiamento Pessoal , Gastos em Saúde , Humanos
15.
Soc Sci Med ; 285: 114022, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34384625

RESUMO

Financial protection is a health system goal for all countries. Assessing progress on this relies on measuring the incidence of catastrophic health expenditures (proportion of the population whose out-of-pocket (OOP) payments for health surpass a certain threshold of household resources). Standard approaches rely on selective thresholds, however this masks varying intensities of financial hardship and poses a measurement challenge as incidence is sensitive to the choice of the threshold. We address this problem by applying the dominance approach, which tests differences in catastrophic incidence curves over a continuous range of thresholds. Iran is an interesting country for empirical application of the dominance approach given its historically high reliance on OOP payments to finance its health system and its commitment to improving financial protection through several national health policies over the last two decades. Using data from annual Household Income and Expenditure Surveys from 2005 to 2017 (sample size: 26,851-39,088 households), incidence was analyzed following this novel approach. Distribution of incidence across socio-economic status was also analyzed by estimating concentration indices and across health services or products by estimating average shares of each item. Results showed that over time catastrophic health expenditures increased for thresholds lower than 25% and decreased for thresholds higher than 35%. Catastrophic health expenditures were more equally distributed across income levels at lower thresholds, becoming concentrated amongst the rich as the threshold rose. Medicines represented the largest share of catastrophic spending for the poorest; medicines, dentistry, inpatient and ancillary services for the richest. This is the first study to apply dominance methods to analyze catastrophic health expenditures in a country over time. The analysis provides a nuanced picture of who incurs catastrophic health expenditures, to what extent hardship is experienced and what were the drivers of these expenditures - thus providing a better basis for policy responses.


Assuntos
Doença Catastrófica , Gastos em Saúde , Doença Catastrófica/epidemiologia , Financiamento Pessoal , Humanos , Incidência , Irã (Geográfico)/epidemiologia
16.
AMA J Ethics ; 23(8): E601-606, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34459726

RESUMO

Before updating any willingness-to-pay (WTP) per quality-adjusted life-year (QALY) threshold, a few points must be recognized. Ethical justification for using WTP thresholds and QALYs lies in incorporating the preferences of those whose treatment could be affected by resulting resource allocations. For WTP thresholds, such justification depends on the sufficiency of a match between a group-members of an insurance pool from which health care payments and services are drawn-and those whose health care is potentially affected. For QALYs, that justification depends on eliciting the right persons' preferences to inform quality-adjustment ratings; on balance it should be from those who have the conditions being rated. Because the value of simply being alive is not adequately accounted for, how life extension and quality improvement are combined in constructing the QALY is its most significant shortcoming as a measure. Although updating WTP thresholds might be better than not updating them, this manuscript suggests why drawing on a less fundamentally flawed concept than the conventional QALY is more important.


Assuntos
Atenção à Saúde , Financiamento Pessoal , Análise Custo-Benefício , Humanos , Anos de Vida Ajustados por Qualidade de Vida
17.
Int J Health Plann Manage ; 36(6): 2094-2105, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34196432

RESUMO

BACKGROUND: Financial protection is a challenge for low- and middle-income countries, where the fiscal space is limited, and majority of the population is engaged in the informal economy. This study developed and validated household consumption predictive models for Cambodia to collect contributions according to one's ability to pay. METHODS: This study used nationally representative survey data collected annually between 2010 and 2017, involving 38,472 households. We developed four alternative models: the manually selected linear model, the linear model with stepwise technique, the mixed effects linear model, and the model with regularisation technique. Subsequently, we performed out-of-sample cross-validation for each model, and evaluated the model prediction performance. RESULTS: Overall, observed and predicted household consumptions were linearly related in all four models. While the prediction performance of the models did not substantially differ, the stepwise linear model showed the best performance. The regularisation and the mixed effects were not particularly effective in these regressions. The household consumption was better predicted for those with lower consumption, and the predictivity declined as the consumption level increased. CONCLUSIONS: This study suggests the possibility of predicting household consumption at a reasonable level. This would maximise the contribution revenue, optimise the government subsidy, and ensure equity in healthcare access.


Assuntos
Financiamento Pessoal , Seguro Saúde , Camboja , Financiamento Governamental , Gastos em Saúde
18.
Int J Health Plann Manage ; 36(6): 2106-2117, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34218437

RESUMO

BACKGROUND: Despite improvements in many health indicators, providing access to affordable healthcare remains a considerable challenge in Bangladesh. Financing incidence analysis will enable an evaluation of how well the healthcare system performs to achieve equity in health financing. The objective of this study is to assess the burden of out-of-pocket (OOP) cost on different socio-economic groups by assessing the health financing incidence because OOP cost dominates household expenditure on health in Bangladesh. METHODS: The study was conducted using latest Household Income and Expenditure Survey (HIES) 2016. We focused mainly on four specific indicators: level of monthly household OOP cost on in-patient care, urban-rural differences in OOP cost, socio-economic status differences in different payment mechanisms and the Kakwani index. Descriptive statistics were employed to analyse and summarise the selected variables based on the SES and location of residence (e.g., rural and urban). RESULTS: The study showed the overall OOP healthcare expenditure was 7.7% of the household monthly income while the poorer income group suffered more and spent up to 35% of their household income on healthcare. The Kakwani index indicated that the poorest quintile spends a greater share of their income on healthcare services than the richest quintile. CONCLUSIONS: This study observed that OOP cost in Bangladesh is regressive, that is, poorer members of society contribute a greater share of their income. Therefore, policymakers should initiate health reforms for developing and implementing risk-pooling financing mechanisms such as social health insurance to achieve the Universal Health Coverage in Bangladesh.


Assuntos
Gastos em Saúde , Financiamento da Assistência à Saúde , Bangladesh , Atenção à Saúde , Características da Família , Financiamento Pessoal , Humanos , Incidência
19.
Int J Health Plann Manage ; 36(6): 2129-2144, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34240456

RESUMO

Adults 50-years-old and greater form the group most vulnerable to a high burden from payments for medication. These Czech older adults devote around 60% of out-of-pocket payments for medication, which might influence their consumption patterns and access to health care. This paper extends the empirical evidence of the out-of-pocket burden and catastrophic payments by addressing the consumption of medication among the Czech population aged 50 and higher. Data from the Survey of Health, Ageing and Retirement in Europe, wave 6, is used. A generalised linear model is applied for estimating the out-of-pocket medication burden; a binary logistic regression is used for the investigation of catastrophic medication expenditure. The results showed that medications for pain, joint pain/joint inflammation, anxiety and depression, heart diseases and high blood pressure are robust predictors for the medication burden and risk factors for catastrophic payments. Special attention should also be paid to medications for suppressing inflammation and sleep problems. Despite universal coverage in the Czech Republic, taking medications for specific health problems, especially those related to the nervous system, influences the well-being of older individuals. Policy makers should revise the prescription practice and related reimbursement policies and reconsider current protection from the high medication burden.


Assuntos
Financiamento Pessoal , Gastos em Saúde , Idoso , República Tcheca , Humanos , Pessoa de Meia-Idade , Inquéritos e Questionários , Cobertura Universal do Seguro de Saúde
20.
Front Public Health ; 9: 654362, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34222168

RESUMO

Background: Health insurance is seen as a pathway to achieving Universal health coverage in low- and middle-income countries. The Nigeria Government has mandated states to set up social health insurance as a mechanism to offer financial protection to her citizens. However, the design of these schemes has been left to individual states. In preparation for the set-up of a contributory social health insurance scheme in Akwa Ibom State, Nigeria. This study assesses the willingness-to-pay for a social health insurance among rural residents in the state. Methods: The study was conducted in three local government areas in Akwa Ibom State, South south Nigeria. It was a cross-sectional study with multi-stage data collection using a demand questionnaire. Interviews were conducted with 286 household heads who were bread winners. Contingent valuation using iterative bidding with double bounded dichotomous technique was used to elicit the WTP for health insurance. Multiple regression using least square method was used to create a model for predicting WTP. Findings: About 82% of the household heads were willing to pay insurance premiums for their households. The median WTP for insurance premium was 11,142 Naira ($29), 95% CI: 9,599-12,684 Naira ($25-$33) per annum. The respondents were predominantly middle-aged (46.8%), Ibibio men (71.7%) with an average household size of five persons and bread winners who had secondary education (43.0%) and were mainly pentecostals (51.5%). The mean age of respondents was 46.4 ± 14.5 yrs. The two significant predictors of WTP for insurance premium amongst these rural residents were income of breadwinner (accounts for 79%) and size of household (2%). The regression coefficients for predicting WTP for insurance premium are intercept of 2,419, a slope of 0.1763 for Bread winner income and a slope of 741.5 household size, all values in Naira and kobo. Conclusion: Majority of rural residents in Akwa Ibom State were willing to pay for social health insurance. The amount they were willing to pay was significantly determined by the income of the breadwinner of the household and the size of the family. These findings are relevant to designing a contributory social health insurance scheme that is affordable and sustainable in order to ensure universal health coverage for the citizens.


Assuntos
Financiamento Pessoal , Seguro Saúde , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Inquéritos e Questionários
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