A Cross-Sectional Study of the Microeconomic Impact of Cardiovascular Disease Hospitalization in Four Low- and Middle-Income Countries

Abstract

ObjectiveTo estimate individual and household economic impact of cardiovascular disease (CVD) in selected low- and middle-income countries (LMIC).BackgroundEmpirical evidence on the microeconomic consequences of CVD in LMIC is scarce.Methods and FindingsWe surveyed 1,657 recently hospitalized CVD patients (66% male; mean age 55.8 years) from Argentina, China, India, and Tanzania to evaluate the microeconomic and functional/productivity impact of CVD hospitalization. Respondents were stratified into three income groups. Median out-of-pocket expenditures for CVD treatment over 15 month follow-up ranged from 354 international dollars (2007 INT$, Tanzania, low-income) to INT$2,917 (India, high-income). Catastrophic health spending (CHS) was present in >50% of respondents in China, India, and Tanzania. Distress financing (DF) and lost income were more common in low-income respondents. After adjustment, lack of health insurance was associated with CHS in Argentina (OR 4.73 [2.56, 8.76], India (OR 3.93 [2.23, 6.90], and Tanzania (OR 3.68 [1.86, 7.26] with a marginal association in China (OR 2.05 [0.82, 5.11]). These economic effects were accompanied by substantial decreases in individual functional health and productivity.ConclusionsIndividuals in selected LMIC bear significant financial burdens following CVD hospitalization, yet with substantial variation across and within countries. Lack of insurance may drive much of the financial stress of CVD in LMIC patients and their families.

Self-reported illness and household strategies for coping with health-care payments in Bangladesh

“…episode of illness, individual and household). Most previous studies on strategies to cope with health-care costs have focused on the household level; 9,10,17 few related investigations have focused on the individual level 7,24 and almost none at the episode-of-illness level.…”

“…Data on sociodemographic status, household expenditure and illness experienced in the previous 30 days were collected. All illnesses were coded according to a disease list that had been developed in previous studies 2,7,10,22,23 and finalized after pilot testing in 100 households (Appendix A). Data were collected on the time of onset and, if possible, duration of illness, diagnosis, treatment response, treatment cost and coping strategies.…”

“…1,2,5 Noncommunicable and infectious diseases cause financial hardship both directly, via out-of-pocket spending on treatment, and indirectly, by limiting participation in income-generating activities. [6][7][8][9] In low-and middle-income countries where public funding for health services is inadequate and mechanisms for "risk-pooling", such as "demand-side" financing and formal health insurance, are limited or unavailable, out-of-pocket payments and illness-related loss of income can lead to asset depletion, debt and reductions in essential consumption that, together, can result in financial catastrophe. [6][7][8][9][10] Although much progress has been made in measuring the impact of out-of-pocket payments for health care on household welfare, knowledge gaps remain.…”

“…[6][7][8][9] In low-and middle-income countries where public funding for health services is inadequate and mechanisms for "risk-pooling", such as "demand-side" financing and formal health insurance, are limited or unavailable, out-of-pocket payments and illness-related loss of income can lead to asset depletion, debt and reductions in essential consumption that, together, can result in financial catastrophe. [6][7][8][9][10] Although much progress has been made in measuring the impact of out-of-pocket payments for health care on household welfare, knowledge gaps remain. We know relatively little about the strategies that households adopt to cope -or, at least, try to cope -with the financial costs of illness, and we have few data to show how such coping strategies affect the future welfare of the households that implement them.…”

“…We know relatively little about the strategies that households adopt to cope -or, at least, try to cope -with the financial costs of illness, and we have few data to show how such coping strategies affect the future welfare of the households that implement them. 10 In the few relevant studies that have been conducted, the coping strategies that are followed have been found to differ with the type of disease involved, 6,7,[11][12][13] with the sector (private or public) providing the outpatient facilities used, if any, 9,14 with the need for inpatient care, [14][15][16] and with the economic status of the patients or their households. 9,10,14,17 In Bangladesh, a country with high burdens of both noncommunicable and infectious diseases, out-of-pocket payments remain the most important source of funding for health care.…”