Better data on unmet healthcare need can strengthen global monitoring of universal health coverage

Rosenberg, Megumi; Kowal, Paul; Rahman, Md Mizanur; Okamoto, Shohei; Barber, Sarah Louise; Tangcharoensathien, Viroj

doi:10.1136/bmj-2023-075476

Cited by 4 publications

(2 citation statements)

References 14 publications

(20 reference statements)

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“…However, doing so may be unrealistic owing to recall bias, so asking about the frequency of experiencing unmet need may be helpful, even though measurement error is still a concern. By better assessing unmet healthcare need based on a standardised measure, UHC monitoring needs to be strengthened [ 56 ].…”

Section: Discussionmentioning

confidence: 99%

Universal health coverage in the context of population ageing: catastrophic health expenditure and unmet need for healthcare

Okamoto,

Sata,

Rosenberg

et al. 2024

Health Econ Rev

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Background Universal health coverage means that all people can access essential health services without incurring financial hardship. Even in countries with good service coverage and financial protection, the progress towards universal health coverage may decelerate or be limited with respect to the growing older population. This study investigates the incidence/prevalence, determinants, and consequences of catastrophic health expenditure (CHE) and unmet need for healthcare and assesses the potential heterogeneity between younger (≤ 64 years) and older people (65 years≤). Methods Utilising an annual nationally representative survey of Japanese aged 20 years and over, we estimated the incidence of CHE and unmet need for healthcare using disaggregated estimates by household members’ age (i.e. ≤64 years vs. 65 years≤) between 2004 and 2020. Using a fixed-effects model, we assessed the determinants of CHE and unmet need along with the consequences of CHE. We also assessed the heterogeneity by age. Results Households with older members were more likely to have their healthcare needs met but experienced CHE more so than households without older members. The financial consequences of CHE were heterogeneous by age, suggesting that households with older members responded to CHE by reducing food and social expenditures more so than households without older members reducing expenditure on education. Households without older members experienced an income decline in the year following the occurrence of CHE, while this was not found among households with older members. A U-shaped relationship was observed between age and the probability of experiencing unmet healthcare need. Conclusions Households with older members are more likely to experience CHE with different financial consequences compared to those with younger members. Unmet need for healthcare is more common among younger and older members than among their middle-aged counterparts. Different types and levels of health and financial support need to be incorporated into national health systems and social protection policies to meet the unique needs of individuals and households.

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Section: Discussionmentioning

confidence: 99%

Universal health coverage in the context of population ageing: catastrophic health expenditure and unmet need for healthcare

Okamoto,

Sata,

Rosenberg

et al. 2024

Health Econ Rev

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“… 4 Inadequate government spending on health has increased out-of-pocket expenditure and financial hardship or unmet health-care needs for those who cannot afford to pay, with delayed access possibly resulting in disability or death. 5 …”

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confidence: 99%

Digital health solutions to improve health care: a call for papers

Lakhotia,

Suphanchaimat,

Patcharanarumol

et al. 2024

Bull World Health Organ

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The financial burden of noncommunicable diseases from out-of-pocket expenditure in sub-Saharan Africa: a scoping review

Odunyemi,

Islam,

Alam

2024

Health Promotion International

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The growing financial burden of noncommunicable diseases (NCDs) in sub-Saharan Africa (SSA) hinders the attainment of the sustainable development goals. However, there has been no updated synthesis of evidence in this regard. Therefore, our study summarizes the current evidence in the literature and identifies the gaps. We systematically search relevant databases (PubMed, Scopus, ProQuest) between 2015 and 2023, focusing on empirical studies on NCDs and their financial burden indicators, namely, catastrophic health expenditure (CHE), impoverishment, coping strategies, crowding-out effects and unmet needs for financial reasons (UNFRs) in SSA. We examined the distribution of the indicators, their magnitudes, methodological approaches and the depth of analysis. The 71 included studies mostly came from single-country (n = 64), facility-based (n = 52) research in low-income (n = 22), lower-middle-income (n = 47) and upper-middle-income (n = 10) countries in SSA. Approximately 50% of the countries lacked studies (n = 25), with 46% coming from West Africa. Cancer, cardiovascular disease (CVD) and diabetes were the most commonly studied NCDs, with cancer and CVD causing the most financial burden. The review revealed methodological deficiencies related to lack of depth, equity analysis and robustness. CHE was high (up to 95.2%) in lower-middle-income countries but low in low-income and upper-middle-income countries. UNFR was almost 100% in both low-income and lower-middle-income countries. The use of extreme coping strategies was most common in low-income countries. There are no studies on crowding-out effect and pandemic-related UNFR. This study underscores the importance of expanded research that refines the methodological estimation of the financial burden of NCDs in SSA for equity implications and policy recommendations.

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Better data on unmet healthcare need can strengthen global monitoring of universal health coverage

Abstract: Megumi Rosenberg and colleagues argue for standardised survey questions and improved data collection on unmet need, particularly in lower income countries

Cited by 4 publications

References 14 publications

Universal health coverage in the context of population ageing: catastrophic health expenditure and unmet need for healthcare

Universal health coverage in the context of population ageing: catastrophic health expenditure and unmet need for healthcare

Digital health solutions to improve health care: a call for papers

The financial burden of noncommunicable diseases from out-of-pocket expenditure in sub-Saharan Africa: a scoping review

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