Dataset Information

Effect of User Charges on Secondary Level Surgical Care Utilization and Out-of-Pocket Expenditures in Haryana State, India.

ABSTRACT:

Background

Generation of resources for providing health care services is an important issue in developing countries. User charges in the form of Surgical Package Program (SPP) were introduced in all district hospitals of Haryana to address this problem. We evaluate the effect of this SPP program on surgical care utilization and out-of-pocket (OOP) expenditures.

Methods

Data on 25437 surgeries, from July 2006 to June 2013 in 3 districts of Haryana state, was analyzed using interrupted time series analysis to assess the impact of SPP on utilization of services. Adjustment was made for presence of any autocorrelation and seasonality effects. A cross sectional survey was undertaken among 180 patients in District hospital, Panchkula during June 2013 to assess the extent of out of pocket (OOP) expenditure incurred, financial risk protection and methods to cope with OOP expenditure. Catastrophic health expenditure, estimated as any expenditure in excess of 10% of the household consumption expenditure, was used to assess the extent of financial risk protection.

Results

User charges had a negative effect on the number of surgeries in public sector district hospitals in all the 3 districts. The mean out-of-pocket expenditure incurred by the patients was Rs.4564 (USD 74.6). The prevalence of catastrophic expenditure was 5.6%. A higher proportion among the poorest 20% population coped through borrowing money (47.2%), while majority (86.1%) of those belonging to richest quintile paid from their monthly income or savings, or had insurance.

Conclusion

There is a need to increase the public financing for curative services and it should be based on the needs of population. Any form of user charge in public sector hospitals should be removed.

SUBMITTER: Balasubramanian D

PROVIDER: S-EPMC4418577 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Effect of User Charges on Secondary Level Surgical Care Utilization and Out-of-Pocket Expenditures in Haryana State, India.

Balasubramanian Deepak D Prinja Shankar S Aggarwal Arun Kumar AK

PloS one 20150504 5

<h4>Background</h4>Generation of resources for providing health care services is an important issue in developing countries. User charges in the form of Surgical Package Program (SPP) were introduced in all district hospitals of Haryana to address this problem. We evaluate the effect of this SPP program on surgical care utilization and out-of-pocket (OOP) expenditures.<h4>Methods</h4>Data on 25437 surgeries, from July 2006 to June 2013 in 3 districts of Haryana state, was analyzed using interrup ...[more]

PMID: 25938670

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Project description:BackgroundDespite attempts to improve universal health coverage (UHC) in low income countries like Nepal, most healthcare utilization is still financed by out-of-pocket (OOP) payments, with detrimental effects on the poorest and most in need. Evidence from high income countries shows that depression is associated with increased healthcare utilization, which may lead to increased OOP expenditures, placing greater stress on families. To inform policies for integrating mental healthcare into UHC in LMIC, we must understand healthcare utilization and OOP expenditure patterns in people with depression. We examined associations between symptoms of depression and frequency and type of healthcare utilization and OOP expenditure among adults in Chitwan District, Nepal.MethodsWe analysed data from a population-based survey of 2040 adults in 2013, who completed the PHQ-9 screening tool for depression and answered questions about healthcare utilization. We examined associations between increasing PHQ-9 score and healthcare utilization frequency and OOP expenditure using negative binomial regression. We also compared utilization of specific outpatient service providers and their related costs among adults with and without probable depression, determined by a PHQ-9 score of 10 or more.ResultsWe classified 80 (3.6%) participants with probable depression, 70.9% of whom used some form of healthcare in the past year compared to 43.9% of people without probable depression. Mean annual OOP healthcare expenditures were $118 USD in people with probable depression, compared to $110 USD in people without. With each unit increase in PHQ-9 score, there was a 14% increase in total healthcare visits (95% CI 7-22%, p < 0.0001) and $9 USD increase in OOP expenditures (95% CI $2-$17; p < 0.0001). People with depression sought most healthcare from pharmacists (30.1%) but reported the greatest expenditure on specialist doctors ($36 USD).ConclusionsIn this population-based sample from Central Nepal, we identified dose-dependent increases in healthcare utilization and OOP expenditure with increasing PHQ-9 scores. Future studies should evaluate whether provision of mental health services as an integrated component of UHC can improve overall health and reduce healthcare utilisation and expenditure, thereby alleviating financial pressures on families.

Project description:BACKGROUND: Aligned with the international call for universal coverage of affordable and quality health care, the government of Tajikistan is undertaking reforms of its health system aiming amongst others at reducing the out-of-pocket expenditures (OPE) of patients seeking care. Household surveys were conducted in 2005, 2007, 2008 and 2011 to explore the scale and determinants of OPE of users in four district of Tajikistan, where health care is legally free of charge at the primary level. METHODS: Using the data from four cross-sectional household surveys conducted between 2005 and 2011, time trends in OPE for consultation fees, drugs and transport costs of adult users of family medicine services were analysed. To investigate differences along the economic status, an asset index was constructed using principal component analysis. RESULTS: Adjusted for inflation, OPE for primary care have substantially increased in the period 2005 to 2011. While the proportion of patients reporting the payment of informal consultation fees to providers and their amount were constant over time, the proportion of patients reporting expenditures for drugs has increased, and the median amounts have doubled from 5.3 US$ to 10.7 US$. Thus, the expenditures on medicine represent the biggest financial burden for patients accessing a primary care facility. Regression models showed that in 2011 patients from the most remote district with spread-out villages reported significant higher expenditures on medicine. Besides the steady increase in the median amount for OPE, the proportion of patients reporting making an informal payment to their care provider showed great variations across district of residence (between 20% and 73%) and economic status (between 33% among the 'worst-off' group and 68% among the 'better-off' group). CONCLUSIONS: In a context of limited governmental funds allocated to health and financing reforms aiming to improve financial access to primary care, the present paper indicates that in Tajikistan OPE - especially in relation to expenditures for drugs - have increased over time, and vary substantially across geographical areas and economic status. The fact that better-off households report disbursing more and in higher proportions hints towards a discrimination along the capacity to pay from providers. Increased public investments in the health sector, incentives for family doctors to provide PHC services free of charge and a strengthened drug control and supply system are necessary strategies to improve access of patients to services.

Project description:BackgroundAs low- and middle-income countries progress toward Universal Health Coverage, there is an increasing focus on measuring out-of-pocket (OOP) expenditure and health services utilization within countries. While there have been several reforms to improve health services coverage and financial protection in Pakistan, there is limited empirical research comparing OOP expenditure and health services utilization between public and private facilities and exploring their determinants, a knowledge gap addressed in this study.MethodsWe used data from 2013 to 14 OOP Health Expenditure Survey, a population-based household survey carried out for Pakistan's National Health Accounts. The analysis included 7969 encounters from 4293 households. We conducted bivariate analyses to describe patterns of care utilization, estimated annualized expenditures by type and sector of care, and assessed expenditure composition. We used multivariable logistic regression modeling to identify factors associated with sector of care and generalized linear model (GLM) with log link and gamma distribution to identify determinants of OOP expenditures stratified by type of care (inpatient and outpatient).ResultsMost encounters (82.5%) were in the private sector and were for outpatient visits (85%). Several public-private differences were observed in annualized expenditures and expenditure components. Logistic regression results indicate males, wealthier individuals, Punjab and Sindh residents, and those in smaller households were more likely to access private outpatient care. In the inpatient model, rural residents were more likely to use a private provider, while Khyber Pakhtunkhwa residents were less likely to use private care. GLM results indicate private sector inpatient expenditures were approximately PKR 6660 (USD 61.8) higher than public sector expenditures, but no public-private differences were observed for outpatient expenditures. Several demographic factors were significantly associated with outpatient and inpatient expenditures. Of note, expenditures increased with increasing wealth, decreased with increasing household size, and differed by province and region.ConclusionsThis is the first study comprehensively investigating how healthcare utilization and OOP expenditures vary by sector, type of care, and socio-economic characteristics in Pakistan. The findings are expected to be particularly useful for the next phase of social health protection programs and supply side reforms, as they highlight sub-populations with higher OOP and private sector utilization.

Project description:BackgroundIn Ethiopia, household Out-Of-Pocket healthcare expenditure accounts for one-third of total healthcare expenditure, is one of the highest in the world, and still creates barriers and difficulties for households to healthcare access and may delay or forgo needed healthcare use. Despite the presence of a few highly dispersed and inconsistent studies, no comprehensive study was conducted. Therefore, in this systematic review and meta-analysis, we aimed at estimating the pooled estimates of the burden of household Out-Of-Pocket healthcare expenditures among Ethiopian households and identifying its determinants.MethodsWe systematically searched articles from PubMed / Medline and Google scholar databases and direct Google search engine without restriction on publication period. Cross-sectional and cohort articles and grey literature published in English were included. Data were extracted using Microsoft Excel. Two reviewers screened the titles, reviewed the articles for inclusion, extracted the data, and conducted a quality assessment. The third reviewer commented on the review. Articles with no abstracts or full texts, editorials, and qualitative in design were excluded. To assess quality, Joanna Briggs Critical Appraisal Tools was used. A Forest plot was used to present summary information on each article and pooled common effects. Potential heterogeneity was checked using Cochrane's Q test and I-squared statistic. We checked publication bias using a Funnel plot. Moreover, subgroup and sensitivity analyses were performed. Meta-analysis was used for the pooled estimates using RevMan statistical software Version 5.4.1.ResultsIn this review, a total of 27 primary articles were included (with a total sample size of 331,537 participants). Because of the presence of heterogeneity, we employed a random-effects model; therefore, the pooled burden household Out-Of-Pocket / catastrophic healthcare expenditure in Ethiopia was strongly positively associated with household economic status. The odds of facing Out-Of-Pocket / catastrophic healthcare expenditures among the poorest quintile was about three times that of the richest (AOR = 3.09, 95% CI: 1.63, 5.86) p-value < 0.001. In addition, on pooled analysis, the mean direct Out-Of-Pocket healthcare expenditures were $32 per month (95%CI: $11, $52) (SD = $45), and the mean indirect Out-of-Pocket healthcare expenditures were $15 per month (95%CI: $3, $28) (SD = $17). The mean catastrophic healthcare expenditure at 10% of threshold was also disproportionately higher: 40% (95%CI: 28, 52%) (SD = 20%). Moreover, the common coping mechanisms were a sale of household assets, support from family, or loan: 40% (95%CI: 28, 52%) (SD = 20%).ConclusionOur study revealed the evidence of inequity in financial hardship that the burden of household Out-Of-Pocket / catastrophic healthcare expenditures gap persists among Ethiopian households that is unfair and unjust. To reduce the detected disparities in seeking healthcare among Ethiopian households, national healthcare priorities should target poor households. This calls for the Ministry of Health to improve the challenges and their impact on equity and design better prepayment policies and strengthen financial protection strategies to protect more vulnerable Ethiopian households.Protocol registrationThe details of this protocol have been registered on the PROSPERO database with reference number ID: CRD42021255977 .

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Dataset Information

Effect of User Charges on Secondary Level Surgical Care Utilization and Out-of-Pocket Expenditures in Haryana State, India.

Background

Methods

Results

Conclusion

Publications

Effect of User Charges on Secondary Level Surgical Care Utilization and Out-of-Pocket Expenditures in Haryana State, India.

Similar Datasets

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