Inequity &amp; burden of out-of-pocket health spending: District level evidences from India

Chowdhury, Samik; Gupta, Indrani; Trivedi, Mayur; Prinja, Shankar

doi:10.4103/ijmr.ijmr_90_17

Cited by 30 publications

(28 citation statements)

References 20 publications

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“…This is the case especially in the upper middle-income country such as Turkey (Yardim, Cilingiroglu, & Yardim, 2013), Iran (Rezapour et al, 2015) and China (Chen, Zhao, & Si, 2014) and some lower middle-income countries such as the Philippines (O'donnell et al, 2008), where OOP payments are paid according to population's ATP. However, some lower middle-income countries with big populations such as India (Chowdhury, Gupta, Trivedi, & Prinja, 2018) and Bangladesh (Molla & Chi, 2017), have a regressive OOP payments where the lower income populations, particularly in rural areas spent high proportion of OOP payments due to lack of access to public health care and lack of health protection scheme for the poor (Mondal, 2013), thus exposing the poorer population to risk of financial catastrophe and poverty.…”

Section: Progressivity Of Out-of-pocket Payments For Health Care: Intmentioning

confidence: 99%

Assesing Progressivity of Out-of-Pocket Expenditures for Health Care: Evidence From Households in Malaysia

M.A.B.¹,

Juni

Rosliza³

2019

IJPHCS

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Background: Out-of-pocket (OOP) payments is a principal means of financing health care throughout both developed and developing countries. Over-reliance on OOP payments may pose an undesirable effect from an equity perspective, where equity in financing is an important policy objective of the health care system. Objectives:To assess the progressivity of OOP payments for health care among Malaysian households.Methods: This paper used cross-sectional nationally representative data derived from the Malaysian Household Expenditure Survey (HES) 2014/15, which comprised of 14,473 households. Progressivity measures deviation from proportionality in the relation between OOP payments and ability to pay (ATP). This paper combined evidence from proportion approach, graphical measures (concentration curve) and summary indices (Gini coefficient, concentration index and Kakwani index) to demonstrate the progressivity of OOP health payments among Malaysian households.Result: More than two-third (77%) of Malaysian households surveyed reported to have made OOP health payments. The average shares of OOP payments from household consumption was 1.65% and was increasing across the household consumption quintiles. The OOP payments distribution was progressive demonstrated by all three approaches. The household consumption and burden of OOP payments was concentrated among the richer populations, with positive Gini coefficient and concentration index. The Kakwani index of OOP payments was 0.0910, indicates mildly progressive OOP payments in Malaysia. Conclusion:The OOP health payments in Malaysia has a progressive distribution. However, reducing progressivity trend should be monitored by the policymakers, and to decide further strategies on policy improvements pertaining to the country's health financing.

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Section: Progressivity Of Out-of-pocket Payments For Health Care: Intmentioning

confidence: 99%

Assesing Progressivity of Out-of-Pocket Expenditures for Health Care: Evidence From Households in Malaysia

M.A.B.¹,

Juni

Rosliza³

2019

IJPHCS

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“…A health system is equitable if all people have fair access to healthcare, and if the people’s ability to pay is not limiting their healthcare utilization. In healthcare, the perspective of equity study is either healthcare utilization or healthcare financing [ 4 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

Trend and status of out-of-pocket payments for healthcare in Iran: equity and catastrophic effect

Rezaei

Woldemichael

Ebrahimi

et al. 2020

J. Egypt. Public. Health. Assoc.

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Background Equity in the distribution of health care resources and mitigating the risk of out-of-pocket (OOP) catastrophic healthcare expenditures (CHE) are the major objectives of the health system of a country. This study aims to measure equity in OOP payments for healthcare and the incidence of CHE among Iranian households over time. Methods This retrospective cross-sectional study utilized data extracted from the household income and expenditure survey (HIES) of Iran, collected by the Statistical Center of Iran. The analysis included a total of 174,341 households’ five yearly data of 6 years starting from 1991 to 2017. Kakwani progressivity index (KPI) was used to measure the equity in OOP payment for each year and examine the households’ incidence of CHE at 20%, 30%, and 40% of their capacities to pay (CTP). The trend series regression analysis was used to examine the trend in the KPI and the incidence of the CHE over time. Results The findings indicated that the households’ expenditure on health out of their monthly budgets for the years 1991 and 2017 were 2.1% and 10.1%, respectively. The KPI for the OOP payment was negative for all 6-year observations (1991 = − 0.680; 1996 = − 0.608; 2001 = − 0.554; 2006 = − 0.265; 2011 = − 0.225, and 2017 = − 0.207), indicating that the OOP payments for healthcare are regressive and more concentrated among the socioeconomically disadvantaged households. There was a statistically significant (p = 0.003) increase in the KPI (i.e., decline in the regressivity) over time. The incidence of the CHE (1.12, 1.93, and 3.71%) in 1991 at the CTP levels of 20%, 30%, and 40% was lower than the incidence at the corresponding levels of CTP (5.26, 10.88, and 22.16) in 2017. The findings of the time-series regression indicated a statistically significant (p < 0.05) increase in the incidence of the CHE at the 20%, 30%, and 40% levels of the households’ CTP. Conclusions The current study demonstrated that OOP payment as a source of healthcare funding in Iran is inequitable. While the use of interventions such as the prepaid and publicly funded programs may contribute to the reduction of CHE and improvement of equity in healthcare financing, further inequality analyses in the incidence of the CHE among households and its main determinants can contribute to evidence-informed planning to reduce the CHE in the context.

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“…We estimated the LC and calculated the GI for the years 2000 and 2015 to ascertain any changes in inequality among countries for each selected development indicator. Many studies have applied these calculations to address levels of inequality in different disciplines (Yang et al 2019;Chowdhury et al 2018;Alinia et al 2018;Malakar et al 2018;Saez et al 2018;Stensrud and Valberg 2017). In this study, we use the cumulative percentage of a given indicator for each country to derive a global GI.…”

Section: Methodsmentioning

confidence: 99%

Assessing Changes in Inequality for Millennium Development Goals among Countries: Lessons for the Sustainable Development Goals

Fuller

Dwivedi

2019

Social Sciences

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In 2000, the United Nations adopted the Millennium Development Goals (MDGs), a set of eight global development goals to be achieved between 2000 and 2015. We estimated the Lorenz Curve and Gini Index for determining any changes in inequality at the global level with countries as a unit of analysis for eight development indicators (proportion of population undernourished, school enrollment rates, the percentage of women in parliament, infant mortality rates, maternal mortality rates, HIV (Human Immunodeficiency Virus) rates, access to improved water sources, and access to a cellular device), representing one MDG each. All of the selected indicators improved on average between 2000 and 2015. An average improvement in an indicator does not necessarily imply a decrease in inequality. For instance, the average infant mortality rate decreased from 39.17 deaths per 1000 births in 2000 to 23.40 in 2015, but the Gini Index remained almost stable over the same period, suggesting no reduction in inequality among countries. For other indicators, inequality among countries decreased at varying rates. A significant data gap existed across countries. For example, only 91 countries had data on primary school enrollment rates in 2000 and 2015. We emphasize developing a global data collection and analysis protocol for measuring the impacts of global development programs, especially in reducing inequality across social, economic, and environmental indicators. This study will feed into currently enacted Sustainable Development Goals (SDGs) for ensuring more inclusive and equitable growth worldwide.

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Inequity & burden of out-of-pocket health spending: District level evidences from India

Cited by 30 publications

References 20 publications

Assesing Progressivity of Out-of-Pocket Expenditures for Health Care: Evidence From Households in Malaysia

Assesing Progressivity of Out-of-Pocket Expenditures for Health Care: Evidence From Households in Malaysia

Trend and status of out-of-pocket payments for healthcare in Iran: equity and catastrophic effect

Assessing Changes in Inequality for Millennium Development Goals among Countries: Lessons for the Sustainable Development Goals

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