Does disability increase households’ health financial risk: evidence from the Uganda demographic and health survey

BackgroundThe Corona Virus Disease 2019 (COVID-19) pandemic has created a substantial socioeconomic impact, particularly in developing countries such as Indonesia.Purpose(s)/objective(s)This study aimed to describe the COVID-19-related out-of-pocket spending of Indonesian citizens and the proportion of whom experienced catastrophic health spending during the COVID-19 pandemic using the patient's perspective.MethodologyWe conducted a rapid cross-sectional online survey across provinces in Indonesia to capture participants' experiences due to COVID-19. Data were collected between September 23rd to October 7th of 2021 including demographics, income, and expenditures. Descriptive statistics were used to analyze the respondents' characteristics. Patients's perspective of total cost was estimated from out-of-pocket of COVID-19 direct costs and compared them to total expenditure. If the proportion of COVID-19 total costs exceeded 40% of the total expenditure, the respondents were deemed to have faced catastrophic costs.ResultsA total of 1,859 respondents answered the questionnaire. The average monthly income and expenditure of respondents were 800 USD, and 667 USD respectively. The monthly expenditure was categorized into food expenditure (367 USD) and non-food expenditure (320 USD). The average of COVID-19-related monthly expenditure was 226 USD, including diagnostic expenditure (36 USD), preventive expenditure (58 USD), medical expenditure (37 USD for COVID-19 treatment; and 57 USD for post-COVID-19 medical expenses), and non-medical expenditure (30 USD). Analysis showed that 18.6% of all respondents experienced catastrophic costs while 38.6% of the respondents who had COVID-19 treatment experienced catastrophic costs.ConclusionThe high proportion of catastrophic costs among respondents suggests the need for COVID-19 social protection, especially for COVID-19 diagnostic and prevention costs. The survey findings have led the government to increase the benefit coverage other than medical costs at the hospitals.

Section: Discussionsupporting

confidence: 74%

Out-of-pocket expenditure and catastrophic costs due to COVID-19 in Indonesia: A rapid online survey

Hafidz

Adiwibowo

Kusila

et al. 2023

“…Meanwhile, the popularity of mandarin is relatively low among older adults population, and speech recognition ability also impacts cognitive function in older adults ( 28 ). The older adults living alone who were covered by medical insurance were more likely to have better self-rated health, highlighting the importance of health insurance in UHC ( 29 , 30 ).…”

Section: Discussionmentioning

confidence: 99%

“…Household economic status impacts the proportion of medical expenses in total consumption expenditures. Insufficient income cannot ensure basic medical security ( 30 ). Coupled with higher rates of chronic diseases in solitary older adults, lack of medical support greatly reduces their physical health ( 34 ).…”

Section: Discussionmentioning

confidence: 99%

Analysis of health risk factors for older adults living alone in China and establishment and evaluation of a nomogram prediction model

Chen,

Qiu,

Wang

et al. 2024

ObjectiveTo understand the health status of older adults living alone in China and analyze the influencing factors, so as to provide reference for improving the health status of older adults living alone.MethodsBased on CGSS data from China General Social Survey (2017), the influencing factors of health status of older adults living alone were analyzed by unconditional Logistic regression, and the R software was used to develop a nomogram for predicting the risk of self-assessed unhealthy adverse outcomes.ResultsGender, annual income, mandarin listening level and participation in medical insurance were the influencing factors of self-rated health of older adults living alone. Age and annual income are the influencing factors of physiological health. Annual income and Internet use were influential factors for mental health. C-Statistic of nomogram prediction model was 0.645. The calibration curve showed that goodness of fit test (χ2 = 58.09, p < 0.001), and the overall prediction ability of the model was good.ConclusionThe health status of older adults living alone in the home-based older adults care is worrying, and it is affected by various factors. We should pay more attention to older adults living alone, improve the ability of listening and distinguishing mandarin and the use of health information platforms for older adults living alone, and further implement medical insurance policies and health services. Announcing the solution to promote healthy home-based care for older adults living alone.

“…With the ever-increasing aging population, elders with disabilities are growing and their long-term care (LTC) needs have been bringing substantial financial and caregiving burdens to households and governments ( 1 , 2 ). In OECD countries, LTC expenses were 0.5 to 5 times the median disposable income of older adults aged 65 and over in 2020 ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Does home and community-based services use reduce hospital utilization and hospital expenditure among disabled elders? Evidence from China

Yi,

Liu,

Jiang

2023

IntroductionIn the background of aging in place, home and community-based services (HCBS) have been playing an increasingly important role in long-term care (LTC) security systems. However, it is still uncertain whether and how HCBS use affects hospital utilization and the corresponding expenditures.MethodsUsing data from the China Health and Retirement Longitudinal Survey (CHARLS) and the China City Statistical Yearbook, the instrumental variable (IV) approach is applied to identify the causal effects of HCBS use on hospital utilization and hospital expenditure among disabled elders.ResultsWe find that HCBS use significantly reduces the probability of being hospitalized, the times of hospitalization, and the length of inpatient stay, as well as the total, out-of-pocket and reimbursement inpatient expenditures, demonstrating not only the substitution impact of HCBS for hospital care but also the effectiveness of medical expenditure control in LTC security systems. Heterogeneity analysis shows that the impacts of HCBS use on hospital utilization and hospital expenditure concentrate on disabled elders who are younger, male, living in urban areas, or from higher-income households; both healthcare and spiritual consolation services have significant negative effects, while the anticipated effects of daily care service use are not supported. The possible mechanisms are the substitution of HCBS for hospital care and the improvements in both the physical and psychological health of disabled elders. However, the mechanism of adverse events decrease is not verified, which needs to be investigated further with more proxy variables.ConclusionThis study provides empirical evidence that HCBS use can not only reduce hospital utilization and hospital expenditure among disabled elders but also improve their physical and psychological health. Policy designs should emphasize the orientation of HCBS, ensure the fundamental and central position of HCBS in the formal care service system, pay more attention to the accessibility and affordability of HCBS for fragile groups, and diversify and optimize the development of the health service and the spiritual consolation service.