Catastrophic healthcare expenditure and poverty related to out-of-pocket payments for healthcare in Bangladesh—an estimation of financial risk protection of universal health coverage
The Sustainable Development Goals target to achieve Universal Health Coverage (UHC), including financial risk protection (FRP) among other dimensions. There are four indicators of FRP, namely incidence of catastrophic health expenditure (CHE), mean positive catastrophic overshoot, incidence of impov...
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| description | The Sustainable Development Goals target to achieve Universal Health Coverage (UHC), including financial risk protection (FRP) among other dimensions. There are four indicators of FRP, namely incidence of catastrophic health expenditure (CHE), mean positive catastrophic overshoot, incidence of impoverishment and increase in the depth of poverty occur for high out-of-pocket (OOP) healthcare spending. OOP spending is the major payment strategy for healthcare in most low-andmiddle-income countries, such as Bangladesh. Large and unpredictable health payments can expose households to substantial financial risk and, at their most extreme, can result in poverty. The aim of this study was to estimate the impact of OOP spending on CHE and poverty, i.e. status of FRP for UHC in Bangladesh. A nationally representative Household Income and Expenditure Survey 2010 was used to determine household consumption expenditure and health-related spending in the last 30 days. Mean CHE headcount and its concentration indices (CI) were calculated. The propensity of facing CHE for households was predicted by demographic and socioeconomic characteristics. The poverty headcount was estimated using ‘total household consumption expenditure’and such expenditure without OOP payments for health in comparison with the poverty-line measured by cost of basic need. In absolute values, a pro-rich distribution of OOP payment for healthcare was found in urban and rural Bangladesh. At the 10%-threshold level, in total 14.2% of households faced CHE with 1.9% overshoot. 16.5% of the poorest and 9.2% of the richest households faced CHE. An overall pro-poor distribution was found for CHE (CI = -0.064) in both urban and rural households, while the former had higher CHE incidences. The poverty headcount increased by 3.5% (5.1 million individuals) due to OOP payments. Reliance on OOP payments for healthcare in Bangladesh should be reduced for poverty alleviation in urban and rural Bangladesh in order to secure FRP for UHC.
Les objectifs de développement durable visent à atteindre la couverture sanitaire universelle (CSU), notamment la protection contre les risques financiers (FRP) entre autres aspects. Il y a quatre indicateurs FRP, à savoir l’incidence des dépenses de santé catastrophiques (CHE), le dépassement catastrophique moyen, l’incidence de l’appauvrissement et l’augmentation de la pauvreté en raison du développement du paiement direct des dépenses de santé. Les paiements directs constituent la |
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Les objectifs de développement durable visent à atteindre la couverture sanitaire universelle (CSU), notamment la protection contre les risques financiers (FRP) entre autres aspects. Il y a quatre indicateurs FRP, à savoir l’incidence des dépenses de santé catastrophiques (CHE), le dépassement catastrophique moyen, l’incidence de l’appauvrissement et l’augmentation de la pauvreté en raison du développement du paiement direct des dépenses de santé. Les paiements directs constituent la principale stratégie de paiement des soins de santé dans la plupart des pays à revenu faible ou intermédiaire, à l’instar du Bangladesh. Des paiements de santé substantiels et imprévisibles peuvent exposer les ménages à des risques financiers importants et, dans les cas extrêmes, être cause de pauvreté. Le but de la présente étude est d’estimer l’impact des dépenses directes sur les CHE et la pauvreté, en d’autres termes le niveau de protection de la couverture universelle contre les risques financiers au Bangladesh. Les données de l’enquête nationale sur les revenus et les dépenses des ménages en 2010 ont permis de déterminer les dépenses de consommation des ménages ainsi que les dépenses liées à la santé au cours des 30 derniers jours. On a calculé la moyenne des CHE et leurs indices de concentration (IC). Les caractéristiques démographiques et socio-économiques donnent un aperçu de la propension des ménages à faire face aux CHE. La pauvreté est estimée en se fondant sur «l’ensemble des dépenses de consommation des ménages» et sur les dépenses autres que les paiements directs pour la santé par rapport au seuil de pauvreté mesuré par le coût de la vie. En valeurs absolues, on a observé une répartition pro-riche des dépenses directes pour les soins de santé dans les zones urbaines et rurales du Bangladesh. Dans le seuil de 10%, un total de 14,2% des ménages est confronté à des dépenses CHE avec un dépassement de 1,9%. 16,5% des ménages les plus démunis et 9,2% des ménages les plus riches font face à des dépenses catastrophiques. On a observé une répartition globale des CHE (CI= -0,064) favorable aux pauvres aussi bien dans les ménages urbains que ruraux, mais l’incidence des CHE était plus élevée chez les premiers. La pauvreté a connu une augmentation de 3,5% (5,1 millions de personnes) en raison des paiements directs. Il faudrait diminuer le recours aux paiements directs pour les soins de santé au Bangladesh afin de réduire la pauvreté dans les zones urbaines et rurales du pays et garantir une protection de la couverture sanitaire universelle contre les risques financiers.
可持续发展目标之一是实现全民健康覆盖 （UHC）, 其中包括 财务风险保护 （FRP） 。 FRP有四个指标, 即灾难性卫生支出 （CHE） 发生率、平均灾难性超支、致贫率和高额医疗自付 费用 （OOP） 加剧的贫困。 OOP是孟加拉等多数中低收入国 家的主要医疗费用支付方式。不可预知的高额医疗费用会使 家庭陷入巨大的财务风险, 极端情况下会导致贫困。本研究目 的是评估OOP对CHE和贫困的影响, 即孟加拉全民健康覆盖中 的财务风险保护状况。我们采用有全国代表性的2010年住户 收入和支出调查数据, 获取过去30天内家庭消费支出和卫生相 关支出。计算平均CHE人数和集中指数。根据人口和社会经 济特征预测家庭面临CHE的倾向。采用两种方式估算贫困人 数, 一种依据“总家庭消费支出”, 一种比较剔除OOP医疗支 出后的消费支出和根据基本需求成本计算的贫困线。从绝对 值来看, 孟加拉城市和农村地区OOP医疗付费分布倾向于富 人。阈值为10%时, 总计14.2%的家庭发生了CHE, 超支1.9%。 16.5%的最贫困家庭和9.2%的最富裕家庭发生了CHE。在城市 和农村地区家庭中, CHE更多发生于贫困家庭（CI=0.064）, 城市中CHE发生率更高。贫困人数因OOP增加了3.5% （510万 人） 。为了减小财务风险, 实现全民健康覆盖, 孟加拉应降低 对OOP医疗付费的依赖, 缓解城市和农村的贫困问题。
Las Metas del Desarrollo Sostenible tienen como objetivo lograr la Cobertura Universal de Salud (CUS), incluyendo la protección del riesgo financiero (PRF), entre otras dimensiones. Hay cuatro indicadores de PRF, a saber, la incidencia del gasto catastrófico de la salud (GCS), el exceso catastrófico positivo promedio, la incidencia del empobrecimiento y el aumento en la profundidad de la pobreza producida por el alto gasto de bolsillo (GDB) para la atención de salud. El GDB es la mayor estrategia de pago para la atención de la salud en la mayoría de los países de ingresos bajos y medios, como Bangladesh. Los pagos de salud grandes e impredecibles pueden exponer a los hogares a un riesgo financiero considerable y, en su extremo, pueden generar pobreza. El objetivo de este estudio fue estimar el impacto del GDB en GCS y la pobreza, es decir, el estado de PRF para CUS en Bangladesh. Se usó una Encuesta de Ingresos y Gastos del Hogar de 2010 representativa a nivel nacional para determinar el gasto de consumo de los hogares y el gasto relacionado con la salud en los últimos 30 días. Se calcularon el promedio de GCS y sus índices de concentración (IC). La propensión de los hogares de enfrentar el GCS se predijo por características demográficas y socioeconómicas. El recuento de la pobreza se calculó usando el ‘gasto total de consumo de los hogares’ y ese gasto sin los GDB para la salud en comparación con la línea de pobreza medida por el costo de la necesidad básica. En valores absolutos, se encontró una distribución pro-ricos del pago de GDB para la atención de salud en Bangladesh urbana y rural. En el nivel de umbral del 10%, en total el 14.2% de los hogares enfrentaron GCS con un exceso del 1.9%. El 16.5% de los hogares más pobres y el 9.2% de los más ricos se enfrentaron a GCS. Se encontró una distribución general pro-pobres para GCS (IC=-0.064) en hogares urbanos y rurales, mientras que en los primeros el GCS tuvo incidencias más altas. El recuento de la pobreza aumentó en un 3.5% (5.1 millones de personas) debido a los GDB. La dependencia de los GDB para la atención de la salud en Bangladesh debería reducirse para aliviar la pobreza en Bangladesh urbana y rural con el fin de asegurar la PRF para la CUS.</description><identifier>ISSN: 0268-1080</identifier><identifier>EISSN: 1460-2237</identifier><identifier>DOI: 10.1093/heapol/czx048</identifier><identifier>PMID: 28575415</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Bangladesh ; Catastrophic Illness - economics ; Consumption ; Demography ; Expenditures ; Extreme values ; Family Characteristics ; Financing, Personal - statistics & numerical data ; Health administration ; Health care ; Health care expenditures ; Health Expenditures - statistics & numerical data ; Health risks ; Health services ; Households ; Humans ; Income ; ORIGINAL ARTICLES ; Payments ; Personal expenditure ; Poverty ; Poverty - statistics & numerical data ; Reliance ; Risk ; Rural areas ; Socioeconomic factors ; Sustainable development ; Universal Health Insurance - economics</subject><ispartof>Health policy and planning, 2017-10, Vol.32 (8), p.1102-1100</ispartof><rights>The Author 2017</rights><rights>The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. 2017</rights><rights>The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c482t-986fcdd55c3a90b74245d421816c707e2c4c3a9797cf5d70f3349e7612ce1e6f3</citedby><cites>FETCH-LOGICAL-c482t-986fcdd55c3a90b74245d421816c707e2c4c3a9797cf5d70f3349e7612ce1e6f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/48509243$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/48509243$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>230,314,550,776,780,799,881,1598,27843,27901,27902,30976,57992,58225</link.rule.ids><linktorsrc>$$Uhttps://dx.doi.org/10.1093/heapol/czx048$$EView_record_in_Oxford_University_Press$$FView_record_in_$$GOxford_University_Press</linktorsrc><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28575415$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:136763906$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Khan, Jahangir A M</creatorcontrib><creatorcontrib>Ahmed, Sayem</creatorcontrib><creatorcontrib>Evans, Timothy G</creatorcontrib><title>Catastrophic healthcare expenditure and poverty related to out-of-pocket payments for healthcare in Bangladesh—an estimation of financial risk protection of universal health coverage</title><title>Health policy and planning</title><addtitle>Health Policy Plan</addtitle><description>The Sustainable Development Goals target to achieve Universal Health Coverage (UHC), including financial risk protection (FRP) among other dimensions. There are four indicators of FRP, namely incidence of catastrophic health expenditure (CHE), mean positive catastrophic overshoot, incidence of impoverishment and increase in the depth of poverty occur for high out-of-pocket (OOP) healthcare spending. OOP spending is the major payment strategy for healthcare in most low-andmiddle-income countries, such as Bangladesh. Large and unpredictable health payments can expose households to substantial financial risk and, at their most extreme, can result in poverty. The aim of this study was to estimate the impact of OOP spending on CHE and poverty, i.e. status of FRP for UHC in Bangladesh. A nationally representative Household Income and Expenditure Survey 2010 was used to determine household consumption expenditure and health-related spending in the last 30 days. Mean CHE headcount and its concentration indices (CI) were calculated. The propensity of facing CHE for households was predicted by demographic and socioeconomic characteristics. The poverty headcount was estimated using ‘total household consumption expenditure’and such expenditure without OOP payments for health in comparison with the poverty-line measured by cost of basic need. In absolute values, a pro-rich distribution of OOP payment for healthcare was found in urban and rural Bangladesh. At the 10%-threshold level, in total 14.2% of households faced CHE with 1.9% overshoot. 16.5% of the poorest and 9.2% of the richest households faced CHE. An overall pro-poor distribution was found for CHE (CI = -0.064) in both urban and rural households, while the former had higher CHE incidences. The poverty headcount increased by 3.5% (5.1 million individuals) due to OOP payments. Reliance on OOP payments for healthcare in Bangladesh should be reduced for poverty alleviation in urban and rural Bangladesh in order to secure FRP for UHC.
Les objectifs de développement durable visent à atteindre la couverture sanitaire universelle (CSU), notamment la protection contre les risques financiers (FRP) entre autres aspects. Il y a quatre indicateurs FRP, à savoir l’incidence des dépenses de santé catastrophiques (CHE), le dépassement catastrophique moyen, l’incidence de l’appauvrissement et l’augmentation de la pauvreté en raison du développement du paiement direct des dépenses de santé. Les paiements directs constituent la principale stratégie de paiement des soins de santé dans la plupart des pays à revenu faible ou intermédiaire, à l’instar du Bangladesh. Des paiements de santé substantiels et imprévisibles peuvent exposer les ménages à des risques financiers importants et, dans les cas extrêmes, être cause de pauvreté. Le but de la présente étude est d’estimer l’impact des dépenses directes sur les CHE et la pauvreté, en d’autres termes le niveau de protection de la couverture universelle contre les risques financiers au Bangladesh. Les données de l’enquête nationale sur les revenus et les dépenses des ménages en 2010 ont permis de déterminer les dépenses de consommation des ménages ainsi que les dépenses liées à la santé au cours des 30 derniers jours. On a calculé la moyenne des CHE et leurs indices de concentration (IC). Les caractéristiques démographiques et socio-économiques donnent un aperçu de la propension des ménages à faire face aux CHE. La pauvreté est estimée en se fondant sur «l’ensemble des dépenses de consommation des ménages» et sur les dépenses autres que les paiements directs pour la santé par rapport au seuil de pauvreté mesuré par le coût de la vie. En valeurs absolues, on a observé une répartition pro-riche des dépenses directes pour les soins de santé dans les zones urbaines et rurales du Bangladesh. Dans le seuil de 10%, un total de 14,2% des ménages est confronté à des dépenses CHE avec un dépassement de 1,9%. 16,5% des ménages les plus démunis et 9,2% des ménages les plus riches font face à des dépenses catastrophiques. On a observé une répartition globale des CHE (CI= -0,064) favorable aux pauvres aussi bien dans les ménages urbains que ruraux, mais l’incidence des CHE était plus élevée chez les premiers. La pauvreté a connu une augmentation de 3,5% (5,1 millions de personnes) en raison des paiements directs. Il faudrait diminuer le recours aux paiements directs pour les soins de santé au Bangladesh afin de réduire la pauvreté dans les zones urbaines et rurales du pays et garantir une protection de la couverture sanitaire universelle contre les risques financiers.
可持续发展目标之一是实现全民健康覆盖 （UHC）, 其中包括 财务风险保护 （FRP） 。 FRP有四个指标, 即灾难性卫生支出 （CHE） 发生率、平均灾难性超支、致贫率和高额医疗自付 费用 （OOP） 加剧的贫困。 OOP是孟加拉等多数中低收入国 家的主要医疗费用支付方式。不可预知的高额医疗费用会使 家庭陷入巨大的财务风险, 极端情况下会导致贫困。本研究目 的是评估OOP对CHE和贫困的影响, 即孟加拉全民健康覆盖中 的财务风险保护状况。我们采用有全国代表性的2010年住户 收入和支出调查数据, 获取过去30天内家庭消费支出和卫生相 关支出。计算平均CHE人数和集中指数。根据人口和社会经 济特征预测家庭面临CHE的倾向。采用两种方式估算贫困人 数, 一种依据“总家庭消费支出”, 一种比较剔除OOP医疗支 出后的消费支出和根据基本需求成本计算的贫困线。从绝对 值来看, 孟加拉城市和农村地区OOP医疗付费分布倾向于富 人。阈值为10%时, 总计14.2%的家庭发生了CHE, 超支1.9%。 16.5%的最贫困家庭和9.2%的最富裕家庭发生了CHE。在城市 和农村地区家庭中, CHE更多发生于贫困家庭（CI=0.064）, 城市中CHE发生率更高。贫困人数因OOP增加了3.5% （510万 人） 。为了减小财务风险, 实现全民健康覆盖, 孟加拉应降低 对OOP医疗付费的依赖, 缓解城市和农村的贫困问题。
Las Metas del Desarrollo Sostenible tienen como objetivo lograr la Cobertura Universal de Salud (CUS), incluyendo la protección del riesgo financiero (PRF), entre otras dimensiones. Hay cuatro indicadores de PRF, a saber, la incidencia del gasto catastrófico de la salud (GCS), el exceso catastrófico positivo promedio, la incidencia del empobrecimiento y el aumento en la profundidad de la pobreza producida por el alto gasto de bolsillo (GDB) para la atención de salud. El GDB es la mayor estrategia de pago para la atención de la salud en la mayoría de los países de ingresos bajos y medios, como Bangladesh. Los pagos de salud grandes e impredecibles pueden exponer a los hogares a un riesgo financiero considerable y, en su extremo, pueden generar pobreza. El objetivo de este estudio fue estimar el impacto del GDB en GCS y la pobreza, es decir, el estado de PRF para CUS en Bangladesh. Se usó una Encuesta de Ingresos y Gastos del Hogar de 2010 representativa a nivel nacional para determinar el gasto de consumo de los hogares y el gasto relacionado con la salud en los últimos 30 días. Se calcularon el promedio de GCS y sus índices de concentración (IC). La propensión de los hogares de enfrentar el GCS se predijo por características demográficas y socioeconómicas. El recuento de la pobreza se calculó usando el ‘gasto total de consumo de los hogares’ y ese gasto sin los GDB para la salud en comparación con la línea de pobreza medida por el costo de la necesidad básica. En valores absolutos, se encontró una distribución pro-ricos del pago de GDB para la atención de salud en Bangladesh urbana y rural. En el nivel de umbral del 10%, en total el 14.2% de los hogares enfrentaron GCS con un exceso del 1.9%. El 16.5% de los hogares más pobres y el 9.2% de los más ricos se enfrentaron a GCS. Se encontró una distribución general pro-pobres para GCS (IC=-0.064) en hogares urbanos y rurales, mientras que en los primeros el GCS tuvo incidencias más altas. El recuento de la pobreza aumentó en un 3.5% (5.1 millones de personas) debido a los GDB. La dependencia de los GDB para la atención de la salud en Bangladesh debería reducirse para aliviar la pobreza en Bangladesh urbana y rural con el fin de asegurar la PRF para la CUS.</description><subject>Bangladesh</subject><subject>Catastrophic Illness - economics</subject><subject>Consumption</subject><subject>Demography</subject><subject>Expenditures</subject><subject>Extreme values</subject><subject>Family Characteristics</subject><subject>Financing, Personal - statistics & numerical data</subject><subject>Health administration</subject><subject>Health care</subject><subject>Health care expenditures</subject><subject>Health Expenditures - statistics & numerical data</subject><subject>Health risks</subject><subject>Health services</subject><subject>Households</subject><subject>Humans</subject><subject>Income</subject><subject>ORIGINAL ARTICLES</subject><subject>Payments</subject><subject>Personal expenditure</subject><subject>Poverty</subject><subject>Poverty - statistics & numerical data</subject><subject>Reliance</subject><subject>Risk</subject><subject>Rural areas</subject><subject>Socioeconomic factors</subject><subject>Sustainable development</subject><subject>Universal Health Insurance - economics</subject><issn>0268-1080</issn><issn>1460-2237</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><sourceid>7TQ</sourceid><sourceid>D8T</sourceid><recordid>eNqFks2O0zAUhS0EYkphyRJkiQ2bMP6NkyWM-JNGYgPryHVupm5T29jOMGXFQ_AwPA9Pgqt0OogNkiVf-X469xz5IvSUkleUtPx8DTr48dx8vyGiuYcWVNSkYoyr-2hBWN1UlDTkDD1KaUMIFULIh-iMNVJJQeUC_brQWaccfVhbg4vYmNdGR8BwE8D1Nk-l1q7HwV9DzHscYdQZepw99lOu_FAFb7aQcdD7Hbic8ODj30LW4TfaXY26h7T-_eOndhhStjudrXfYD3iwTjtj9YijTVscos9gbpuTs2VuKs1ZEpuDD30Fj9GDQY8JnhzvJfry7u3niw_V5af3Hy9eX1ZGNCxXbVMPpu-lNFy3ZKUEE7IXjDa0NoooYEYcOqpVZpC9IgPnogVVU2aAQj3wJapm3fQNwrTqQizW477z2nbHp22poBNtzctZopczX3J8nUrSbmeTgXHUDvyUOtoSqXiZwgr64h9046foSpqOCU4JVVyKOwMm-pQiDCcLlHSHFejmFejmFSj886PqtNpBf6Jv__zOoZ_Cf7WezegmZR9PsGgkaYtF_gcJwMxO</recordid><startdate>20171001</startdate><enddate>20171001</enddate><creator>Khan, Jahangir A M</creator><creator>Ahmed, Sayem</creator><creator>Evans, Timothy G</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>7T2</scope><scope>7TQ</scope><scope>8BJ</scope><scope>C1K</scope><scope>DHY</scope><scope>DON</scope><scope>FQK</scope><scope>JBE</scope><scope>K9.</scope><scope>7X8</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>ZZAVC</scope></search><sort><creationdate>20171001</creationdate><title>Catastrophic healthcare expenditure and poverty related to out-of-pocket payments for healthcare in Bangladesh—an estimation of financial risk protection of universal health coverage</title><author>Khan, Jahangir A M ; Ahmed, Sayem ; Evans, Timothy G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c482t-986fcdd55c3a90b74245d421816c707e2c4c3a9797cf5d70f3349e7612ce1e6f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Bangladesh</topic><topic>Catastrophic Illness - economics</topic><topic>Consumption</topic><topic>Demography</topic><topic>Expenditures</topic><topic>Extreme values</topic><topic>Family Characteristics</topic><topic>Financing, Personal - statistics & numerical data</topic><topic>Health administration</topic><topic>Health care</topic><topic>Health care expenditures</topic><topic>Health Expenditures - statistics & numerical data</topic><topic>Health risks</topic><topic>Health services</topic><topic>Households</topic><topic>Humans</topic><topic>Income</topic><topic>ORIGINAL ARTICLES</topic><topic>Payments</topic><topic>Personal expenditure</topic><topic>Poverty</topic><topic>Poverty - statistics & numerical data</topic><topic>Reliance</topic><topic>Risk</topic><topic>Rural areas</topic><topic>Socioeconomic factors</topic><topic>Sustainable development</topic><topic>Universal Health Insurance - economics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Khan, Jahangir A M</creatorcontrib><creatorcontrib>Ahmed, Sayem</creatorcontrib><creatorcontrib>Evans, Timothy G</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>PAIS Index</collection><collection>International Bibliography of the Social Sciences (IBSS)</collection><collection>Environmental Sciences and Pollution Management</collection><collection>PAIS International</collection><collection>PAIS International (Ovid)</collection><collection>International Bibliography of the Social Sciences</collection><collection>International Bibliography of the Social Sciences</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SwePub Articles full text</collection><jtitle>Health policy and planning</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext_linktorsrc</fulltext></delivery><addata><au>Khan, Jahangir A M</au><au>Ahmed, Sayem</au><au>Evans, Timothy G</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Catastrophic healthcare expenditure and poverty related to out-of-pocket payments for healthcare in Bangladesh—an estimation of financial risk protection of universal health coverage</atitle><jtitle>Health policy and planning</jtitle><addtitle>Health Policy Plan</addtitle><date>2017-10-01</date><risdate>2017</risdate><volume>32</volume><issue>8</issue><spage>1102</spage><epage>1100</epage><pages>1102-1100</pages><issn>0268-1080</issn><eissn>1460-2237</eissn><abstract>The Sustainable Development Goals target to achieve Universal Health Coverage (UHC), including financial risk protection (FRP) among other dimensions. There are four indicators of FRP, namely incidence of catastrophic health expenditure (CHE), mean positive catastrophic overshoot, incidence of impoverishment and increase in the depth of poverty occur for high out-of-pocket (OOP) healthcare spending. OOP spending is the major payment strategy for healthcare in most low-andmiddle-income countries, such as Bangladesh. Large and unpredictable health payments can expose households to substantial financial risk and, at their most extreme, can result in poverty. The aim of this study was to estimate the impact of OOP spending on CHE and poverty, i.e. status of FRP for UHC in Bangladesh. A nationally representative Household Income and Expenditure Survey 2010 was used to determine household consumption expenditure and health-related spending in the last 30 days. Mean CHE headcount and its concentration indices (CI) were calculated. The propensity of facing CHE for households was predicted by demographic and socioeconomic characteristics. The poverty headcount was estimated using ‘total household consumption expenditure’and such expenditure without OOP payments for health in comparison with the poverty-line measured by cost of basic need. In absolute values, a pro-rich distribution of OOP payment for healthcare was found in urban and rural Bangladesh. At the 10%-threshold level, in total 14.2% of households faced CHE with 1.9% overshoot. 16.5% of the poorest and 9.2% of the richest households faced CHE. An overall pro-poor distribution was found for CHE (CI = -0.064) in both urban and rural households, while the former had higher CHE incidences. The poverty headcount increased by 3.5% (5.1 million individuals) due to OOP payments. Reliance on OOP payments for healthcare in Bangladesh should be reduced for poverty alleviation in urban and rural Bangladesh in order to secure FRP for UHC.
Les objectifs de développement durable visent à atteindre la couverture sanitaire universelle (CSU), notamment la protection contre les risques financiers (FRP) entre autres aspects. Il y a quatre indicateurs FRP, à savoir l’incidence des dépenses de santé catastrophiques (CHE), le dépassement catastrophique moyen, l’incidence de l’appauvrissement et l’augmentation de la pauvreté en raison du développement du paiement direct des dépenses de santé. Les paiements directs constituent la principale stratégie de paiement des soins de santé dans la plupart des pays à revenu faible ou intermédiaire, à l’instar du Bangladesh. Des paiements de santé substantiels et imprévisibles peuvent exposer les ménages à des risques financiers importants et, dans les cas extrêmes, être cause de pauvreté. Le but de la présente étude est d’estimer l’impact des dépenses directes sur les CHE et la pauvreté, en d’autres termes le niveau de protection de la couverture universelle contre les risques financiers au Bangladesh. Les données de l’enquête nationale sur les revenus et les dépenses des ménages en 2010 ont permis de déterminer les dépenses de consommation des ménages ainsi que les dépenses liées à la santé au cours des 30 derniers jours. On a calculé la moyenne des CHE et leurs indices de concentration (IC). Les caractéristiques démographiques et socio-économiques donnent un aperçu de la propension des ménages à faire face aux CHE. La pauvreté est estimée en se fondant sur «l’ensemble des dépenses de consommation des ménages» et sur les dépenses autres que les paiements directs pour la santé par rapport au seuil de pauvreté mesuré par le coût de la vie. En valeurs absolues, on a observé une répartition pro-riche des dépenses directes pour les soins de santé dans les zones urbaines et rurales du Bangladesh. Dans le seuil de 10%, un total de 14,2% des ménages est confronté à des dépenses CHE avec un dépassement de 1,9%. 16,5% des ménages les plus démunis et 9,2% des ménages les plus riches font face à des dépenses catastrophiques. On a observé une répartition globale des CHE (CI= -0,064) favorable aux pauvres aussi bien dans les ménages urbains que ruraux, mais l’incidence des CHE était plus élevée chez les premiers. La pauvreté a connu une augmentation de 3,5% (5,1 millions de personnes) en raison des paiements directs. Il faudrait diminuer le recours aux paiements directs pour les soins de santé au Bangladesh afin de réduire la pauvreté dans les zones urbaines et rurales du pays et garantir une protection de la couverture sanitaire universelle contre les risques financiers.
可持续发展目标之一是实现全民健康覆盖 （UHC）, 其中包括 财务风险保护 （FRP） 。 FRP有四个指标, 即灾难性卫生支出 （CHE） 发生率、平均灾难性超支、致贫率和高额医疗自付 费用 （OOP） 加剧的贫困。 OOP是孟加拉等多数中低收入国 家的主要医疗费用支付方式。不可预知的高额医疗费用会使 家庭陷入巨大的财务风险, 极端情况下会导致贫困。本研究目 的是评估OOP对CHE和贫困的影响, 即孟加拉全民健康覆盖中 的财务风险保护状况。我们采用有全国代表性的2010年住户 收入和支出调查数据, 获取过去30天内家庭消费支出和卫生相 关支出。计算平均CHE人数和集中指数。根据人口和社会经 济特征预测家庭面临CHE的倾向。采用两种方式估算贫困人 数, 一种依据“总家庭消费支出”, 一种比较剔除OOP医疗支 出后的消费支出和根据基本需求成本计算的贫困线。从绝对 值来看, 孟加拉城市和农村地区OOP医疗付费分布倾向于富 人。阈值为10%时, 总计14.2%的家庭发生了CHE, 超支1.9%。 16.5%的最贫困家庭和9.2%的最富裕家庭发生了CHE。在城市 和农村地区家庭中, CHE更多发生于贫困家庭（CI=0.064）, 城市中CHE发生率更高。贫困人数因OOP增加了3.5% （510万 人） 。为了减小财务风险, 实现全民健康覆盖, 孟加拉应降低 对OOP医疗付费的依赖, 缓解城市和农村的贫困问题。
Las Metas del Desarrollo Sostenible tienen como objetivo lograr la Cobertura Universal de Salud (CUS), incluyendo la protección del riesgo financiero (PRF), entre otras dimensiones. Hay cuatro indicadores de PRF, a saber, la incidencia del gasto catastrófico de la salud (GCS), el exceso catastrófico positivo promedio, la incidencia del empobrecimiento y el aumento en la profundidad de la pobreza producida por el alto gasto de bolsillo (GDB) para la atención de salud. El GDB es la mayor estrategia de pago para la atención de la salud en la mayoría de los países de ingresos bajos y medios, como Bangladesh. Los pagos de salud grandes e impredecibles pueden exponer a los hogares a un riesgo financiero considerable y, en su extremo, pueden generar pobreza. El objetivo de este estudio fue estimar el impacto del GDB en GCS y la pobreza, es decir, el estado de PRF para CUS en Bangladesh. Se usó una Encuesta de Ingresos y Gastos del Hogar de 2010 representativa a nivel nacional para determinar el gasto de consumo de los hogares y el gasto relacionado con la salud en los últimos 30 días. Se calcularon el promedio de GCS y sus índices de concentración (IC). La propensión de los hogares de enfrentar el GCS se predijo por características demográficas y socioeconómicas. El recuento de la pobreza se calculó usando el ‘gasto total de consumo de los hogares’ y ese gasto sin los GDB para la salud en comparación con la línea de pobreza medida por el costo de la necesidad básica. En valores absolutos, se encontró una distribución pro-ricos del pago de GDB para la atención de salud en Bangladesh urbana y rural. En el nivel de umbral del 10%, en total el 14.2% de los hogares enfrentaron GCS con un exceso del 1.9%. El 16.5% de los hogares más pobres y el 9.2% de los más ricos se enfrentaron a GCS. Se encontró una distribución general pro-pobres para GCS (IC=-0.064) en hogares urbanos y rurales, mientras que en los primeros el GCS tuvo incidencias más altas. El recuento de la pobreza aumentó en un 3.5% (5.1 millones de personas) debido a los GDB. La dependencia de los GDB para la atención de la salud en Bangladesh debería reducirse para aliviar la pobreza en Bangladesh urbana y rural con el fin de asegurar la PRF para la CUS.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>28575415</pmid><doi>10.1093/heapol/czx048</doi><tpages>-1</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext_linktorsrc |
| identifier | ISSN: 0268-1080 |
| ispartof | Health policy and planning, 2017-10, Vol.32 (8), p.1102-1100 |
| issn | 0268-1080 1460-2237 |
| language | eng |
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| source | Oxford Journals Open Access Collection |
| subjects | Bangladesh Catastrophic Illness - economics Consumption Demography Expenditures Extreme values Family Characteristics Financing, Personal - statistics & numerical data Health administration Health care Health care expenditures Health Expenditures - statistics & numerical data Health risks Health services Households Humans Income ORIGINAL ARTICLES Payments Personal expenditure Poverty Poverty - statistics & numerical data Reliance Risk Rural areas Socioeconomic factors Sustainable development Universal Health Insurance - economics |
| title | Catastrophic healthcare expenditure and poverty related to out-of-pocket payments for healthcare in Bangladesh—an estimation of financial risk protection of universal health coverage |
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