Determinantes del gasto de bolsillo en salud de la población pobre atendida en servicios de salud públicos en Perú, 2010–2014

Pavone, M.; Ruíz-Sánchez, Esaú

doi:10.26633/rpsp.2018.20

Cited by 19 publications

(25 citation statements)

References 6 publications

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“…Our results indicate that the probability of CHE in these cases would have been decreased by 13% and 19%, if these households had access to financial protection for hospital costs or for medication costs, respectively. By means of comparison, in Peru, expenses for medicines represented 44% of OOP expenditure for families with social security, compared to 62% for families that were not affiliated with this program (Petrera Pavone and Jiménez Sánchez, 2018 ), indicating the necessity to incorporate strategies for increasing both availability as well as accessibility of financial protection for households caring for a person with an MD.…”

Section: Discussionmentioning

confidence: 99%

Incidence of catastrophic healthcare expenditure and its main determinants in Mexican households caring for a person with a mental disorder

et al. 2021

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Background There are few studies on the impact of out-of-pocket mental health care expenditures and sociodemographic factors on the probability of Mexican households to incur catastrophic healthcare expenditures (CHE). Objective The goal of the present study was to estimate the incidence of CHE and its main determinants among the households of persons with mental disorders (MD) in Mexico. Methods A cross-sectional survey was conducted, including 387 households of persons with MD. The estimation of the CHE was obtained by the health expenditure distribution method. A Logistic Regression (LR) was used to identify the determinants of probability variation of CHE occurrence. Since we expected a proportion of CHE between 20% and 80%, we assume linearity in the probability function, therefore we additionally used an Ordinary Least Squares (OLS) model. Results In our sample, the incidence of CHE was 34.8%. The two mental illnesses most frequently associated with CHE were schizophrenia and hyperactive disorder (35.5% and 32.6% of CHE cases, respectively). The regression coefficients showed that for each unit (US$53.77) increase in income, the probability of CHE was reduced by 8.6%, while for each unit increase in hospitalization or medication expenditures, the probability of CHE increased by 12.9% or 19%, respectively. For each additional household member, the probability of CHE increased by 3%, and households with a male patient had a 7% greater probability of CHE. Conclusion Household income, household size, hospitalization and medication expenses, and sex of the patient were significant predictors of CHE for households caring for a person with MD.

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Section: Discussionmentioning

confidence: 99%

Incidence of catastrophic healthcare expenditure and its main determinants in Mexican households caring for a person with a mental disorder

et al. 2021

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“…Si en el hogar se incrementa un perceptor de ingresos la probabilidad de convertirse en hogar pobre es 14,4%, un asegurado más en el hogar la probabilidad de ser hogar pobre es 13,6%. Una mujer fértil más en el hogar con niños menores o iguales a 5 años, las probabilidades de ser hogar pobre aumentan en 50,0% y 31,0% respectivamente 20 .…”

Section: Discussionunclassified

Gasto De Bolsillo en Salud Y Riesgo De Pobreza en Hogares Peruanos. Perú 2017

Guerrero-Ojeda

2020

SVS

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El objetivo fue determinar la relación entre gasto de bolsillo en salud y riesgo de pobreza mediante una regresión logística multinomial en el año 2017 Fue un estudio descriptivo, no experimental transversal, la muestra de estudio son los hogares con gasto de bolsillo de las viviendas seleccionadas de la Encuesta Nacional de Hogares, la variable dependiente fue Pobreza con tres categorías: pobre extremo, pobre no extremo y no pobre, se utilizó la metodología de Xu K en el estudio de las variables en salud. Como resultados se obtuvo que el aseguramiento fue: 44,2% al SIS, 28,3% a EsSALUD, 24,2% no asegurados y 3,3% a otro tipo de seguro, el gasto de bolsillo en salud fue de 63,0%. Las variables que relacionan salud y pobreza en forma directa son: gasto catastrófico, gasto de bolsillo y número de asegurados del hogar. El gasto en medicinas es del 39,2%. El índice Gini para este gasto es 0,690 Se concluye que según lo contemplado en la ley Nº 29344, aún no se cumple por el no aseguramiento. El gasto de bolsillo es alto aproximadamente el triple de lo recomendado por la OMS, es desigual y concentrado en los quintiles de gasto 4 y 5, que son los de mayor capacidad de pago y es la principal fuente de financiamiento de la salud de los hogares. EsSALUD y el SIS contribuyen con la tercera parte de los cuidados de salud. Los hogares destinan mayor gasto en medicinas, servicio dental y consultas médicas originando gastos catastróficos (40% en gasto de bolsillo del gasto familiar), aumentando la probabilidad de empobrecimiento.

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“…Global literature has indicated that health systems with greater utilization of public sector were likely to have lower levels of OOPE [146,147]. Some studies from LMICs have shown that only those utilizing public facilities could avoid OOPE [148]. Some South East Asian LMICs like Srilanka, Malaysia and Thailand achieved remarkably low levels of CHE by relying mainly on public-sector based healthcare delivery and this form of nancing has been found to be pro-poor [92,[149][150][151].…”

Section: Discussionmentioning

confidence: 99%

Assessing the Pattern of Utilisation and Out of Pocket Expenditure in Public and Private Hospitals in India – Lessons for Universal Health Coverage from the Healthcare Rounds of National Sample Survey 1996 to 2017

Garg

Bebarta

Tripathi

2020

Preprint

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Introduction: Out of Pocket Expenditure (OOPE) contributes to impoverishment and Catastrophic Health Expenditure (CHE) and restricts equitable access to healthcare in many Low and Medium Income Countries (LMICs), including India. Indian government has implemented different strategies to expand access and to reduce OOPE in public and private hospitals in its mixed healthcare system. The study aims to assess the long-term pattern of utilization, OOPE and CHE in public and private hospitals and to draw policy lessons for Universal Health Coverage in India. Methods: Indian government conducts periodic household surveys called National Sample Survey (NSS). Unit data from the last four rounds of NSS (1996 to 2017) on healthcare utilization were analysed. Multivariate analysis was used to find out determinants of utilization, choice of provider, OOPE and CHE. Propensity Score Matching was applied to find effect of specific variables on OOPE and CHE. Results: The share of public-sector in hospital-utilisation fell from 1996 to 2004 but grew consistently after 2004, reaching 51% of utilization in 2017. Socio-economically vulnerable sections were more likely to utilize public-sector. Mean OOPE per hospitalization in public-sector registered a decline from 2004 to 2017, while it increased substantially in private-sector. OOPE in private sector was around six times greater than public sector in 2017 and incidence of CHE was nine times. Utilising private-sector was an important determinant of incurring CHE. Coverage under publicly funded insurance was ineffective in reducing OOPE or CHE. Discussion: Public sector provided effective protection to the poor from financial risk. While, the structural-adjustment policies of 1990s had resulted in reduction in public-sector utilisation, the supply-side strengthening of public sector after 2005 was more effective in improving access and financial-protection. For achieving UHC, Indian health-system needs increased public funding for strengthening public-sector, especially to provide services for NCDs and injuries. Persistently high OOPE in private-sector raises doubts whether public-funding or contracting can align provider incentives with goals of UHC. The debate on public-private provider mix and financing policies continues to hold relevance for health-systems performance across LMICs.

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Determinantes del gasto de bolsillo en salud de la población pobre atendida en servicios de salud públicos en Perú, 2010–2014

Cited by 19 publications

References 6 publications

Incidence of catastrophic healthcare expenditure and its main determinants in Mexican households caring for a person with a mental disorder

Incidence of catastrophic healthcare expenditure and its main determinants in Mexican households caring for a person with a mental disorder

Gasto De Bolsillo en Salud Y Riesgo De Pobreza en Hogares Peruanos. Perú 2017

Assessing the Pattern of Utilisation and Out of Pocket Expenditure in Public and Private Hospitals in India – Lessons for Universal Health Coverage from the Healthcare Rounds of National Sample Survey 1996 to 2017

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