Blog
About

  • Record: found
  • Abstract: found
  • Article: found
Is Open Access

Catastrophic out-of-pocket payments for households of people with severe mental disorder: a comparative study in rural Ethiopia

Read this article at

Bookmark
      There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

      Abstract

      Background

      There are limited data on healthcare spending by households containing a person with severe mental disorder (SMD) in low- and middle-income countries (LMIC). This study aimed to estimate the incidence and intensity of catastrophic out-of-pocket (OOP) payments and coping strategies implemented by households with and without a person with SMD in a rural district of Ethiopia.

      Methods

      A comparative cross-sectional community household survey was carried out from January to November 2015 as part of the Emerald programme (emerging mental health systems in low- and middle-income countries). A sample of 290 households including a person with SMD and 289 comparison households without a person with SMD participated in the study. An adapted and abbreviated version of the World Health Organization SAGE (Study on global Ageing and adult health) survey instrument was used. Households were considered to have incurred catastrophic health expenditure if their annual OOP health expenditures exceeded 40% of their annual non-food expenditure. Multiple logistic regression was used to explore factors associated with catastrophic expenditure and types of coping strategies employed.

      Results

      The incidence of catastrophic OOP payments in the preceding 12 months was 32.2% for households of a person with SMD and 18.2% for comparison households (p = 0.006). In households containing a person with SMD, there was a significant increase in the odds of hardship financial coping strategies (p < 0.001): reducing medical visits, cutting down food consumption, and withdrawing children from school. Households of a person with SMD were also less satisfied with their financial status and perceived their household income to be insufficient to meet their livelihood needs (p < 0.001).

      Conclusions

      Catastrophic OOP health expenditures in households of a person with SMD are high and associated with hardship financial coping strategies which may lead to poorer health outcomes, entrenchment of poverty and intergenerational disadvantage. Policy interventions aimed at financial risk pooling mechanisms are crucial to reduce the intensity and impact of OOP payments among vulnerable households living with SMD and support the goal of universal health coverage.

      Electronic supplementary material

      The online version of this article (10.1186/s13033-019-0294-7) contains supplementary material, which is available to authorized users.

      Related collections

      Most cited references 59

      • Record: found
      • Abstract: found
      • Article: not found

      Household catastrophic health expenditure: a multicountry analysis.

      Health policy makers have long been concerned with protecting people from the possibility that ill health will lead to catastrophic financial payments and subsequent impoverishment. Yet catastrophic expenditure is not rare. We investigated the extent of catastrophic health expenditure as a first step to developing appropriate policy responses. We used a cross-country analysis design. Data from household surveys in 59 countries were used to explore, by regression analysis, variables associated with catastrophic health expenditure. We defined expenditure as being catastrophic if a household's financial contributions to the health system exceed 40% of income remaining after subsistence needs have been met. The proportion of households facing catastrophic payments from out-of-pocket health expenses varied widely between countries. Catastrophic spending rates were highest in some countries in transition, and in certain Latin American countries. Three key preconditions for catastrophic payments were identified: the availability of health services requiring payment, low capacity to pay, and the lack of prepayment or health insurance. People, particularly in poor households, can be protected from catastrophic health expenditures by reducing a health system's reliance on out-of-pocket payments and providing more financial risk protection. Increase in the availability of health services is critical to improving health in poor countries, but this approach could raise the proportion of households facing catastrophic expenditure; risk protection policies would be especially important in this situation.
        Bookmark
        • Record: found
        • Abstract: found
        • Article: not found

        Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993-1998.

        This paper presents and compares two threshold approaches to measuring the fairness of health care payments, one requiring that payments do not exceed a pre-specified proportion of pre-payment income, the other that they do not drive households into poverty. We develop indices for 'catastrophe' that capture the intensity of catastrophe as well as its incidence and also allow the analyst to capture the degree to which catastrophic payments occur disproportionately among poor households. Measures of poverty impact capturing both intensity and incidence are also developed. The arguments and methods are empirically illustrated with data on out-of-pocket payments from Vietnam in 1993 and 1998. This is not an uninteresting application given that 80% of health spending in that country was paid out-of-pocket in 1998. We find that the incidence and intensity of 'catastrophic' payments - both in terms of pre-payment income as well as ability to pay - were reduced between 1993 and 1998, and that both incidence and intensity of 'catastrophe' became less concentrated among the poor. We also find that the incidence and intensity of the poverty impact of out-of-pocket payments diminished over the period in question. Finally, we find that the poverty impact of out-of-pocket payments is primarily due to poor people becoming even poorer rather than the non-poor being made poor, and that it was not expenses associated with inpatient care that increased poverty but rather non-hospital expenditures. Copyright 2003 John Wiley & Sons, Ltd.
          Bookmark
          • Record: found
          • Abstract: found
          • Article: not found

          What are the economic consequences for households of illness and of paying for health care in low- and middle-income country contexts?

          This paper presents the findings of a critical review of studies carried out in low- and middle-income countries (LMICs) focusing on the economic consequences for households of illness and health care use. These include household level impacts of direct costs (medical treatment and related financial costs), indirect costs (productive time losses resulting from illness) and subsequent household responses. It highlights that health care financing strategies that place considerable emphasis on out-of-pocket payments can impoverish households. There is growing evidence of households being pushed into poverty or forced into deeper poverty when faced with substantial medical expenses, particularly when combined with a loss of household income due to ill-health. Health sector reforms in LMICs since the late 1980s have particularly focused on promoting user fees for public sector health services and increasing the role of the private for-profit sector in health care provision. This has increasingly placed the burden of paying for health care on individuals experiencing poor health. This trend seems to continue even though some countries and international organisations are considering a shift away from their previous pro-user fee agenda. Research into alternative health care financing strategies and related mechanisms for coping with the direct and indirect costs of illness is urgently required to inform the development of appropriate social policies to improve access to essential health services and break the vicious cycle between illness and poverty.
            Bookmark

            Author and article information

            Affiliations
            [1 ]ISNI 0000 0001 1250 5688, GRID grid.7123.7, Department of Reproductive Health and Health Services Management, School of Public Health, College of Health Sciences, , Addis Ababa University, ; Addis Ababa, Ethiopia
            [2 ]ISNI 0000 0001 1250 5688, GRID grid.7123.7, Department of Psychiatry, School of Medicine, College of Health Sciences, , Addis Ababa University, ; Addis Ababa, Ethiopia
            [3 ]ISNI 0000 0001 2322 6764, GRID grid.13097.3c, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, , King’s College, ; London, UK
            [4 ]ISNI 0000 0004 1937 1151, GRID grid.7836.a, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, , University of Cape Town, ; Cape Town, South Africa
            [5 ]ISNI 0000 0001 1250 5688, GRID grid.7123.7, Aklilu-Lemma Institute of Pathobiology, , Addis Ababa University, ; Addis Ababa, Ethiopia
            [6 ]ISNI 0000000121633745, GRID grid.3575.4, Department of Mental Health and Substance Abuse, , World Health Organization, ; Geneva, Switzerland
            [7 ]ISNI 0000 0001 2322 6764, GRID grid.13097.3c, Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, , King’s College, ; London, UK
            Contributors
            yohannes.h.michael@gmail.com
            damen_h@hotmail.com
            kebede.tirfessa@yahoo.com
            s.docrat@uct.ac.za
            atalay.alem@gmail.com
            gtmedhin@yahoo.com
            crick.lund@uct.ac.za
            chisholmd@who.int
            abe.wassie@kcl.ac.uk
            charlotte.hanlon@kcl.ac.uk
            Journal
            Int J Ment Health Syst
            Int J Ment Health Syst
            International Journal of Mental Health Systems
            BioMed Central (London )
            1752-4458
            1 June 2019
            1 June 2019
            2019
            : 13
            6544918 294 10.1186/s13033-019-0294-7
            © The Author(s) 2019

            Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

            Funding
            Funded by: European Union's Seventh Framework
            Award ID: FP7/2007-2013
            Categories
            Research
            Custom metadata
            © The Author(s) 2019

            Comments

            Comment on this article