Out-of-pocket health expenditure and debt in poor households: evidence from Cambodia

Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
Tropical Medicine & International Health (Impact Factor: 2.3). 03/2004; 9(2):273-80. DOI: 10.1046/j.1365-3156.2003.01194.x
Source: PubMed

ABSTRACT To document how out-of-pocket health expenditure can lead to debt in a poor rural area in Cambodia.
After a dengue epidemic, 72 households with a dengue patient were interviewed to document health-seeking behaviour, out-of-pocket expenditure, and how they financed such expenditure. One year later, a follow-up visit investigated how the 26 households with an initial debt had coped with it.
The amount of out-of-pocket health expenditure depended mostly on where households sought care. Those who had used exclusively private providers paid on average US dollars 103; those who combined private and public providers paid US dollars 32, and those who used only the public hospital US dollars 8. The households used a combination of savings, selling consumables, selling assets and borrowing money to finance this expenditure. One year later, most families with initial debts had been unable to settle these debts, and continued to pay high interest rates (range between 2.5 and 15% per month). Several households had to sell their land.
In Cambodia, even relatively modest out-of-pocket health expenditure frequently causes indebtedness and can lead to poverty. A credible and accessible public health system is needed to prevent catastrophic health expenditure, and to allow for other strategies, such as safety nets for the poor, to be fully effective.

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    ABSTRACT: Many countries in the EU rely on patients’ out-of-pocket payments (OPP) as a source of health care financing and as an efficiency improvement tool. Past research suggested that a high reliance on OPP may result in a financial catastrophe and impoverishment for the households. Objective: A major issue for public health is to elaborate on the poverty effects of OPP with the intent of reducing poverty. One way is thereby to determine the impact of these payments on a household level. This thesis aims to review the literature and to identify empirical studies that analyze the poverty effects of OPP and factors that are associated with these effects for households in EU and accession countries. Methods: The method of systematic literature review of studies is applied in the thesis. The following databases were used: Pubmed and Embase. The databases were sought for a combination of the following keywords: “European Union”, “Accession countries”, “Patient Payment” and “Poverty”. Results: Poverty effects appear independent of geographical area. Catastrophic expenditures range from 0.0% to 3.7% and the range of impoverishment goes from 0.5% to 4.3%. Analyses carried out in single studies reveal that living in a household with at least one pensioner contributes most to high payments for health care, and thus, to catastrophic health care expenditure. However, information on the impoverishing effects of OPP in EU and accession countries is scarce, although impoverishing effects are relatively easy to compute, once data on household out-of-pocket expenditure is available. Conclusions: In countries with low financial protection mechanisms, a proportion of poor-income households incur high costs when paying for OPP. For those households, OPP and care-related costs were considered to be catastrophic or these households were said to be impoverished due to high HC payments. In EU, Patient catastrophic costs incurred can be amounted to more than 15% of the households’ effective income to pay for health care expenses. The results support calls for health policy changes to decrease direct OPP. Those policies are needed to prevent poverty, especially due to pharmaceutical expenditures. Moreover Special regard should be given to risk groups such as pensioner households, female-headed households and poor-income households.
    06/2013, Degree: Bachelor, Supervisor: Milena Pavlova
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    ABSTRACT: Protecting households from risk of impoverishment due to out-of-pocket costs in health care is a major challenge for health systems. Therefore, this study aimed at evaluating some health expenditure of inpatient and outpatient care as well as assessing the predictors of catastrophic costs for inpatient care in one of central provinces of Iran. In this cross-sectional study, 760 household were selected by multistage sampling method in Markazi province of Iran and interviewed in order to complete a standard questionnaire. Catastrophic costs were evaluated in a scale that varied from 0 (no money for care) to 100 (spending all income and wealth). Patients who were paid over 20% of household financial sources or 40% of month income were regarded as being exposed to catastrophic costs. Negative binomial model with robust estimator logit function was used for prediction of catastrophic costs. Based on data analysis, 42.6% of hospitalized subjects encountered catastrophic costs. Moreover, 11.2% households faced catastrophic cost among all participated households and 39.3% were reported to need inpatient need care. Multivariate regression model showed that age range 40-59 years and being in the lower levels of wealth index were significant predictors of facing catastrophic costs (P < 0.05). Lack of money is the most important cause of un-seeking care. Hospitalizations due to inpatient care needs, household members aged 40-59 years old, especially with chronic diseases and nonrich status of the household were the highest predictors of facing catastrophic costs. Reducing out-of-pocket costs can increase health care utilization.
    International journal of preventive medicine 08/2014; 5(8):1023-1028.
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    DESCRIPTION: PhD Thesis, defended on September 21, 2011

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