Hospitalization costs of breast cancer before and after the implementation of the Health Sector Evolution Plan (HSEP), Iran, 2017: a retrospective single-centre study

Afkar, Abolhasan; Heydari, Somayeh; Jalilian, Habib; Pourreza, Abolghasem; Sigaroudi, Abdolhosein Emami

doi:10.1016/j.jcpo.2020.100228

Cited by 5 publications

(13 citation statements)

References 22 publications

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“…The Iranian health system implemented some policies to reduce out-of-pocket payments to a maximum of 6% of total costs in the public sector, increasing insurance coverage, and regulating the market to cushion breast cancer patients against the costs [ 17 ]. Due to the lack of insurance coverage for some needed services and medicines and receiving part of the benefits from the private sector, it seems that the health system has not had much success in this field [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Incidence of household catastrophic and impoverishing health expenditures among patients with Breast Cancer in Iran

Ahmadi

Farrokh‐Eslamlou

Alinia

2021

BMC Health Serv Res

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Background Breast cancer disease is the most common cancer among Iranian women and imposing a significant financial burden on the households. This study calculated out-of-pocket (OOP), catastrophic health expenditure (CHE), and impoverishing health spending attributed to breast cancer in Iran. Methods In this cross-sectional household study, clinical and financial information on breast cancer and also household information (expenditures and income) were obtained through face-to-face interviews and completing a questionnaire by 138 women with this disease in 2019. We applied three non-food expenditure thresholds of 40, 20, and 10% to defining the CHE. Disease costs included periodical visits, diagnostic services, hospitalization care, treatment and rehabilitation services, home, and informal care. Households were disaggregated into socioeconomic status quintiles based on their Adult Equivalent values standardized monthly consumption expenditures. To identify the factors affecting these indicators, we performed the two different multivariate logistic regression models. Results This study finds that each patient had a monthly average OOP payment of $US 97.87 for the requested services, leading to impoverished of 5.07% and exposed 13.77% of their households to CHE. These indicators have been mainly concentrated among the poor, as they have spent a large part of their meager income on buying the needed services, and for this purpose, most of them forced to sell their assets, borrow, or take a bank loan. Conclusions The patients in lower SES quintiles can be protected from impoverishing and catastrophic health spending by expanding insurance coverage, providing financial risk protection programs, and increasing access to quality and effective public sector services. Alongside, expanding inpatient coverage and adding drug benefits for the poor can significantly decrease their OOP payments.

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Section: Introductionmentioning

confidence: 99%

Incidence of household catastrophic and impoverishing health expenditures among patients with Breast Cancer in Iran

Ahmadi

Farrokh‐Eslamlou

Alinia

2021

BMC Health Serv Res

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“…This nancial pressure will obviously be even more tremendous for vulnerable groups such as poor or unemployed households. [6] The Iranian health system implemented some policies to reduce out-of-pocket payments to a maximum of 6% of total costs in the public sector, increasing insurance coverage, and regulating the market to cushion breast cancer patients against the costs [10]. Due to the lack of insurance coverage for some services and needed medicines, as well as receiving part of the services from the private sector, it seems that the health system has not had much success in this eld [11].…”

Section: Introductionmentioning

confidence: 99%

Incidence of Household Catastrophic and Impoverishing Health Expenditures among Patients with Breast Cancer in Iran

Ahmadi

Farrokh‐Eslamlou

Alinia

2020

Preprint

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Background: Breast cancer disease is the most common cancer among Iranian women. Management of this disease requires expensive services and care, imposing a significant financial burden on the households. This study calculated out-of-pocket (OOP), catastrophic health expenditure (CHE), and impoverishing health spending attributed to breast cancer in Iran.Methods: In this cross-sectional household study, clinical and financial information on breast cancer and also household information (expenditures and income) were obtained through face-to-face interviews and completing a questionnaire by 138 women with this disease in 2019. To defining the CHE, we applied three non-food expenditure thresholds of 40%, 20%, and 10%. Disease costs included periodical visits, diagnostic services, hospitalization care, treatment and rehabilitation services, home, and informal care. Households were disaggregated into socioeconomic status quintiles based on their monthly consumption expenditures, where SES classifications were standardized by Adult Equivalent values of consumption expenditures. For statistical comparisons of the incidence of CHE and impoverishing spending, we applied the independent t-test and one-way ANOVA respectively for two and more than two separate subgroups. Besides identifying the factors affecting these indicators, we performed the two different multivariate logistic regression models.Results: This study finds that each patient had an average OOP payment of $US 97.87 for the requested services, leading to impoverished of 5.07% and exposed to CHE of 13.77% of their households. These indicators have been mainly concentrated among the poor, as they have spent a large part of their meager income on buying the needed services, and for this purpose, most of them have been forced to sell their assets, borrow, or take a bank loan.Conclusions: Vulnerable people should be supported by expanding insurance coverage, governmental supporting programs, and increasing access to quality and effective public sector services.

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“…There were seven studies describing financial interventions targeting diagnosis and treatment stages of breast cancer, including four from the United States, [32][33][34][35] one from Iran, 41 and two from Mexico. 37,38 Complete descriptions are available in Supplemental Digital Contents 2 and 3.…”

Section: Breast Cancer Diagnosis and Treatment Interventionsmentioning

confidence: 99%

“…Absolute OOPC increased from $272 to $281 due to tariffs that increased total hospitalization cost. 41 The final study in the United States examined the ability of a safety-net hospital system providing free or low-cost care to eliminate breast cancer diagnosis and treatment delays for uninsured compared with insured women. The outcome assessed was stage at diagnosis and time to diagnosis and treatment.…”

Section: Breast Cancer Diagnosis and Treatment Interventionsmentioning

confidence: 99%

Evaluation of Financial Interventions in Breast Cancer Care Worldwide: A Systematic Review

Ehsan,

Wu,

Minasian

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Background: Out-of-pocket costs are burdensome for breast cancer patients. Cost-reducing interventions, though implemented, have unclear comparative efficacy. This study aimed to critically evaluate characteristics of successful versus unsuccessful interventions designed to decrease out-of-pocket costs for breast cancer patients. Methods: A systematic review was conducted in accordance with the PRISMA checklist. Embase, PubMed, Global Index Medicus, and Global Health were queried from inception to February 2021. Articles describing a financial intervention targeting costs for breast cancer screening, diagnosis, or treatment and addressing clinical or patient-level financial outcomes were included. Methodological quality was evaluated using the QualSyst tool. Interventions were organized in accordance with timing of implementation, with narrative description of intervention type, success, and outcomes. Results: Of the 11,086 articles retrieved, 21 were included in this review. Of these, 14 consisted of interventions during screening, and seven during diagnosis or treatment. Free/subsidized screening mammography was the most common screening intervention; 91% of these programs documented successful outcomes. Patient navigation and gift voucher programs demonstrated mixed success. The most successful intervention implemented during diagnosis/treatment was reducing medication costs. Low-cost programs and direct patient financial assistance were also successful. Limitations included lack of standardization in outcome metrics across studies. Conclusions: Financial interventions reducing prices through free screening mammography and decreasing medication costs were most successful. Less successful interventions were not contextually tailored, including gift card incentivization and low-cost treatment modalities. These findings can facilitate implementation of broader, more generalizable programs to reduce costs and improve outcomes during evaluation and management of breast cancer.

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Hospitalization costs of breast cancer before and after the implementation of the Health Sector Evolution Plan (HSEP), Iran, 2017: a retrospective single-centre study

Cited by 5 publications

References 22 publications

Incidence of household catastrophic and impoverishing health expenditures among patients with Breast Cancer in Iran

Incidence of household catastrophic and impoverishing health expenditures among patients with Breast Cancer in Iran

Incidence of Household Catastrophic and Impoverishing Health Expenditures among Patients with Breast Cancer in Iran

Evaluation of Financial Interventions in Breast Cancer Care Worldwide: A Systematic Review

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