Nature and determinants of out-of-pocket health expenditure among older people in a rural Indian community

Brinda, Ethel Mary; Rajkumar, Anto P.; Enemark, Ulrika; Prince, Martin; Jacob, K. S.

doi:10.1017/s104161021200083x

Cited by 66 publications

(72 citation statements)

References 34 publications

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“…Fourthly, CHE have been reported to be associated with geriatric depression in India (19,20). A longitudinal study, not specific to older people, from Northwest China has reported that participants without health insurance developed significantly more depressive symptoms during their follow-up (52).…”

Section: Health Economic Challenges For Older People In Lmicsmentioning

confidence: 97%

“…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). Older people with disability should either minimise using health services, or risk such CHE in LMICs (51).…”

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: 97%

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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“…However, the nature of healthcare utilisation and out-of-pocket and catastrophic health expenditure in the older population in India remains vaguely defined. We have previously defined chronic medical diseases, infectious diseases, illiteracy and poor sanitation as major determinants of out-of-pocket and catastrophic health expenditure among older individuals in a rural Indian community 24. As prior studies have not investigated nationally representative samples,7 24 we extend this study to a larger, nationally representative sample to investigate factors associated with health service utilisation, out-of-pocket and catastrophic health expenditures among older people in India.…”

Section: Introductionmentioning

confidence: 99%

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

Kowal

Attermann

et al. 2015

J Epidemiol Community Health

111

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“…In a study done by Brinda EM, Rajkumar AP, Enemark U, Prince M, Jacob KS, in Vellore, India showed male gender, poor sanitation, diabetes, tuberculosis, malaria, respiratory ailments, gastrointestinal diseases, dementia, depression, and disability were associated with higher out-of-pocket expenditures. 5 In spite of our study area which was located just adjacent to public health care facility households were spending catastrophic amount on such common illnesses which are easily treatable in primary health care setting.…”

Section: Resultsmentioning

confidence: 90%

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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Nature and determinants of out-of-pocket health expenditure among older people in a rural Indian community

Abstract: Interactions between determinants of out-of-pocket health expenditure, economic inequality, and inequities on essential health care delivery to older people are complex. We highlight the need for equitable health services and policies, focusing on both medical and social determinants.

Cited by 66 publications

References 34 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

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)

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

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