Health service use, out-of-pocket payments and catastrophic health expenditure among older people in India: The WHO Study on global AGEing and adult health (SAGE)

Brinda, Ethel Mary; Kowal, Paul; Attermann, Jørn; Enemark, Ulrika

doi:10.1136/jech-2014-204960

Cited by 119 publications

(108 citation statements)

References 36 publications

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“…More than two thirds of total health expenditures are paid directly by the service users and their families as OOPHE in many LMICs (19). When these OOPHE exceed a household's ability to pay, they turn into catastrophic health expenditures (CHE), and can lead to indebtedness, poverty, and hunger (20).…”

Section: Health Economic Challenges For Older People In Lmicsmentioning

confidence: 99%

“…When they could no longer work, they lost their source of income, and they did not get pension support or medical benefits from their past employers or Governments. Such older people were financially dependent on their families, and their families were burdened by increasing care needs and increasing OOPHE (19).…”

Section: Health Economic Challenges For Older People In Lmicsmentioning

confidence: 99%

“…Poverty (14)(15)(16), economic inequality (17,18), and catastrophic out-of-pocket health expenditures (OOPHE) (19,20) have been associated with depression among older people in LMICs. Besides, women (15,16,21), less education (16), and chronic medical illnesses (14,15) have been reported as correlates of geriatric depression in LMICs.…”

Section: Introductionmentioning

confidence: 99%

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Health, Social, and Economic Variables Associated with Depression Among Older People in Low and Middle Income Countries: World Health Organization Study on Global AGEing and Adult Health

Brinda

Rajkumar

Attermann

et al. 2016

The American Journal of Geriatric Psychiatry

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Objective: Although depression among older people is an important public health problem worldwide, systematic studies evaluating its prevalence and determinants in low and middle income countries (LMICs) are sparse. Biopsychosocial model of depression and prevailing socioeconomic hardships for older people in LMICs have provided the impetus to determine the prevalence of geriatric depression, to study its associations with health, social, and economic variables, and to investigate socioeconomic inequalities in depression prevalence in LMICs. Methods:We accessed World Health Organisation-Study on global AGEing and adult health (WHO-SAGE) wave-1 data that studied nationally representative samples from six large LMICs (N=14,877). A computerised algorithm derived depression diagnoses. We assessed hypothesised associations using survey multivariate logistic regression models for each LMIC, and pooled their risk estimates by meta-analyses. We investigated related socioeconomic inequalities using concentration indices. Results:Cross-national prevalence of geriatric depression was 4.7% (95% CI 1.9-11.9%).Women, illiteracy, poverty, indebtedness, past informal-sector occupation, bereavement, angina, and stroke had significant positive associations, while pension support and health insurance showed significant negative associations with geriatric depression. We documented pro-poor inequality of geriatric depression in five LMICs. 4 population-based public health interventions and policies to prevent and to manage geriatric depression effectively in LMICs cannot be overemphasised.

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Section: Health Economic Challenges For Older People In Lmicsmentioning

confidence: 99%

Section: Health Economic Challenges For Older People In Lmicsmentioning

confidence: 99%

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Health, Social, and Economic Variables Associated with Depression Among Older People in Low and Middle Income Countries: World Health Organization Study on Global AGEing and Adult Health

Brinda

Rajkumar

Attermann

et al. 2016

The American Journal of Geriatric Psychiatry

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“…6 Out-of-pocket health expenditures were higher among participants with increased the number of health visits as shown in a study on health service use by Brinda EM, Kowal P, Attermann J, Enemark U. 7 Catastrophic health expenditure and rural household impoverishment study done in China concluded that higher percentage of households experiencing catastrophic health expenditure and medical impoverishment correlates to increased health care need. 8 This study was limited in Information on social security schemes availed by families which would have given exact insight into out of pocket expenditure on health.…”

Section: Resultsmentioning

confidence: 98%

Catastrophic household expenditure on health in an urban slum: a cross-sectional survey

Nagendra

Belur

Nandini

et al. 2016

Int J Community Med Public Health

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INTRODUCTIONThe World Health Report 2000 identified financial protection against the costs of ill health as a fundamental objective of health systems, on the premise that a fair health system ensures households make health care payments according to their ability to pay rather than the risk of illness.1 Out-of-pocket expenditures are nonreimbursable fees which a patient or family is responsible for paying directly to health practitioners or suppliers, without intervention of a third party.It often occurs, when publicly funded facilities are unable to provide the required health services and supplies for free or through insurance. Health policies are concerned not only with improving health status of population but also with protecting households from financial catastrophe of illness.2 Out-of-pocket spending on health in the previous 30 days that exceeded 10% of the household's total expenditure over the same period was considered to be catastrophic. India was ranked as having the 42 nd highest average out of pocket expenditure with 74.4% of private expenditure being paid as out of pocket. ABSTRACT Background:The World Health Report 2000 identified financial protection against the costs of ill health as a fundamental objective of health systems. Out-of-pocket expenditure accounts for an average increase in poverty by 2.9 percent for urban India. Therefore, this study aims at evaluating the out-of-pocket health expenditures as well as assessing the predictors of catastrophic health costs care in urban slums. The objectives was to find the prevalence of catastrophic household expenditures on health and to assess the determinants and illnesses commonly associated with catastrophic household expenditure on health. Methods: The study was conducted in a notified urban slum of Shivamogga district which was selected randomly and all the households were included in the study. Data was collected after informed consent using pre-tested semistructured questionnaire and analyzed in SPSS vs18. Results: Out of 197 households, 94 (47.7%) households experienced catastrophic health expenditure in past one month. Most common conditions associated with catastrophic expenditure were respiratory infections (cough, cold and fever; p-0.034), arthritis (p-0.001), hypertension (p<0.01) and diabetes (p-0.015). Conclusions: We conclude that almost half of the community incurred catastrophic health expenses. Findings have important policy implications and can be used to ensure higher degree of financial protection against the economic impact of illnesses.

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“…Older men and individuals with chronic diseases were at higher risk of catastrophic health expenditure. 23 In India CHE was experienced by 84 per cent as a consequence of treating acute coronary syndromes (ACS). 17 For ACS, Catastrophic health expenditure was reported by 66% of those without insurance versus 52% of those with health insurance.…”

Section: Introductionmentioning

confidence: 99%

Catastrophic Expense & Financial Protection Mechanisms to Achieve Universal Health Coverage: A Review

Aggarwal¹

2017

MOJPH

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Health service use, out-of-pocket payments and catastrophic health expenditure among older people in India: The WHO Study on global AGEing and adult health (SAGE)

Cited by 119 publications

References 36 publications

Health, Social, and Economic Variables Associated with Depression Among Older People in Low and Middle Income Countries: World Health Organization Study on Global AGEing and Adult Health

Health, Social, and Economic Variables Associated with Depression Among Older People in Low and Middle Income Countries: World Health Organization Study on Global AGEing and Adult Health

Catastrophic household expenditure on health in an urban slum: a cross-sectional survey

Catastrophic Expense & Financial Protection Mechanisms to Achieve Universal Health Coverage: A Review

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