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[PMID]:28728347
[Au] Autor:Homaie Rad E; Yazdi-Feyzabad V; Yousefzadeh-Chabok S; Afkar A; Naghibzadeh A
[Ad] Endereço:Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran.
[Ti] Título:Pros and cons of the health transformation program in Iran: evidence from financial outcomes at the household level.
[So] Source:Epidemiol Health;39:e2017029, 2017.
[Is] ISSN:2092-7193
[Cp] País de publicação:Korea (South)
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: The health transformation program was a recent reform in the health system of Iran that was implemented in early 2014. Some of the program's important goals were to improve the equity of payments and to reduce out-of-pocket (OOP) payments and catastrophic health expenditures (CHE). In this study, these goals were evaluated using a before-and-after analysis. METHODS: Data on household income and expenditures in Guilan Province were gathered for the years 2013 and 2015. OOP payments for outpatient, inpatient, and drug services were calculated, and the results were compared using the propensity score matching technique after adjusting for confounding variables. Concentration indices and curves were added to quantify changes in inequity before and after the reform. The incidence of catastrophic expenditures was then calculated. RESULTS: Overall and outpatient service OOP payments increased by approximately 10 dollars, while for other types of services, no significant changes were found. Inequity and utilization of services did not change after the reform. However, a significant reduction was observed in CHE incidence (5.75 to 3.82%). CONCLUSIONS: The reform was successful in decreasing the incidence of CHE, but not in reducing the monetary amount of OOP payments or affecting the frequency of health service utilization.
[Mh] Termos MeSH primário: Doença Catastrófica/economia
Características da Família
Reforma dos Serviços de Saúde
Gastos em Saúde/estatística & dados numéricos
[Mh] Termos MeSH secundário: Metas
Seres Humanos
Renda/estatística & dados numéricos
Irã (Geográfico)
Avaliação de Programas e Projetos de Saúde
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171122
[Lr] Data última revisão:
171122
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170722
[St] Status:MEDLINE
[do] DOI:10.4178/epih.e2017029


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[PMID]:28719772
[Au] Autor:Kien VD; Minh HV; Ngoc NB; Phuong TB; Ngan TT; Quam MB
[Ad] Endereço:1 Hanoi University of Public Health, Hanoi, Vietnam.
[Ti] Título:Inequalities in Household Catastrophic Health Expenditure and Impoverishment Associated With Noncommunicable Diseases in Chi Linh, Hai Duong, Vietnam.
[So] Source:Asia Pac J Public Health;29(5_suppl):35S-44S, 2017 Jul.
[Is] ISSN:1941-2479
[Cp] País de publicação:China
[La] Idioma:eng
[Ab] Resumo:A costly modern-day double burden, the expenses of noncommunicable diseases (NCDs) are becoming a devastating epidemic. The World Health Organization estimates $7 trillion in economic losses from NCDs in 2011-2025. Although regarded as affluent diseases, the burden of NCDs is shifting into poorer groups. In this study, we assessed the socioeconomic inequalities in catastrophic health expenditure and impoverishment associated with NCDs in Northern Vietnam. We also identified associated factors for catastrophic health expenditure and impoverishment. Households self-reporting NCD diagnoses had the highest association with both catastrophic health expenditure and impoverishment, followed by those in urban areas. Such households were likely poorer according to our calculations estimating socioeconomic inequalities. Households with at least 1 member older than 60 years were also more likely to suffer catastrophic health expenditures. These findings suggest that targeted policy to prevent or subsidize care for NCDs could prevent catastrophic health expenditure and impoverishment among those already most disadvantaged.
[Mh] Termos MeSH primário: Doença Catastrófica/economia
Doença Crônica/economia
Efeitos Psicossociais da Doença
Características da Família
Gastos em Saúde/estatística & dados numéricos
Pobreza/estatística & dados numéricos
[Mh] Termos MeSH secundário: Doença Crônica/epidemiologia
Seres Humanos
População Rural/estatística & dados numéricos
Autorrelato
Fatores Socioeconômicos
População Urbana/estatística & dados numéricos
Vietnã/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170719
[St] Status:MEDLINE
[do] DOI:10.1177/1010539517712919


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[PMID]:28376808
[Au] Autor:Islam MR; Rahman MS; Islam Z; Nurs CZ; Sultana P; Rahman MM
[Ad] Endereço:Department of Computer Science, Uttara Commerce College, Dhaka, Bangladesh.
[Ti] Título:Inequalities in financial risk protection in Bangladesh: an assessment of universal health coverage.
[So] Source:Int J Equity Health;16(1):59, 2017 Apr 04.
[Is] ISSN:1475-9276
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Financial risk protection and equity are major components of universal health coverage (UHC), which is defined as ensuring access to health services for all citizens without any undue financial burden. We investigated progress towards UHC financial risk indicators and assessed variability of inequalities in financial risk protection indicators by wealth quintile. We further examined the determinants of different financial hardship indicators related to healthcare costs. METHODS: A cross-sectional, three-stage probability survey was conducted in Bangladesh, which collected information from 1600 households from August to November 2011. Catastrophic health payments, impoverishment, and distress financing (borrowing or selling assets) were treated as financial hardship indicators in UHC. Poisson regression models were used to identify the determinants of catastrophic payment, impoverishment and distress financing separately. Slope, relative and concentration indices of inequalities were used to assess wealth-based inequalities in financial hardship indicators. RESULTS: The study found that around 9% of households incurred catastrophic payments, 7% faced distress financing, and 6% experienced impoverishing health payments in Bangladesh. Slope index of inequality indicated that the incidence of catastrophic health payment and distress financing among the richest households were 12 and 9 percentage points lower than the poorest households respectively. Multivariable Poisson regression models revealed that all UHC financial hardship indicators were significantly higher among household that had members who received inpatient care or were in the poorest quintile. The presence of a member with chronic illness in a household increased the risk of impoverishment by nearly double. CONCLUSION: This study identified a greater inequality in UHC financial hardship indicators. Rich households in Bangladesh were facing disproportionately less financial hardship than the poor ones. Households can be protected from financial hardship associated with healthcare costs by implementing risk pooling mechanism, increasing GDP spending on health, and properly monitoring subsidized programs in public health facilities.
[Mh] Termos MeSH primário: Financiamento Pessoal
Equidade em Saúde/economia
Gastos em Saúde
Disparidades em Assistência à Saúde/economia
Pobreza
Classe Social
Cobertura Universal
[Mh] Termos MeSH secundário: Adulto
Idoso
Bangladesh
Doença Catastrófica/economia
Criança
Doença Crônica/economia
Efeitos Psicossociais da Doença
Estudos Transversais
Características da Família
Feminino
Financiamento Governamental
Serviços de Saúde/economia
Hospitalização/economia
Seres Humanos
Masculino
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171018
[Lr] Data última revisão:
171018
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170406
[St] Status:MEDLINE
[do] DOI:10.1186/s12939-017-0556-4


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[PMID]:28359550
[Au] Autor:Koch KJ; Cid Pedraza C; Schmid A
[Ad] Endereço:Universität Bayreuth, Universitätsstr. 30, Bayreuth, 95447, Germany. Electronic address: kira-johanna.koch@uni-bayreuth.de.
[Ti] Título:Out-of-pocket expenditure and financial protection in the Chilean health care system-A systematic review.
[So] Source:Health Policy;121(5):481-494, 2017 May.
[Is] ISSN:1872-6054
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Protection against financial risk due to medical spending is an explicit health guarantee within Chile's AUGE health reform. This paper seeks to analyze the degree to which out-of-pocket expenditure still expose Chilean households to financial catastrophe and impoverishment, and to explore inequalities in financial protection. METHODS: A systematic literature review was conducted to identify empirical studies analyzing financial protection in Chile. The search included databases as well as grey literature, i.e. governmental and institutional webpages. The indicators are based on the conceptual framework of financial protection, as portrayed in the World Health Report 2013. RESULTS: We identify n=16 studies that fulfill the inclusion criteria. Empirical studies indicate that 4% of Chilean households faced catastrophic health expenditure defined as out-of-pocket expenditure exceeding 30% of household's capacity to pay, while less than 1% were pushed into poverty in 2012. In contrast to prior studies, recent data report that even publicly insured who should be fully protected from co-payments were affected by catastrophic health expenditure. Also in the private insurance system financial catastrophe is a common risk. CONCLUSION: Despite health reform efforts, financial protection is insufficient and varies to the disadvantage of the poor and vulnerable groups. More research is required to understand why current mechanisms are not as effective as expected and to enable according reforms of the insurance system.
[Mh] Termos MeSH primário: Doença Catastrófica/economia
Financiamento Pessoal/estatística & dados numéricos
Gastos em Saúde/estatística & dados numéricos
[Mh] Termos MeSH secundário: Chile
Reforma dos Serviços de Saúde
Seres Humanos
Seguro Saúde/economia
Pobreza
Fatores Socioeconômicos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171113
[Lr] Data última revisão:
171113
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:170401
[St] Status:MEDLINE


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[PMID]:28166779
[Au] Autor:Barasa EW; Maina T; Ravishankar N
[Ad] Endereço:Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, P.O Box 43640-00100, Nairobi, Kenya. edwinebarasa@gmail.com.
[Ti] Título:Assessing the impoverishing effects, and factors associated with the incidence of catastrophic health care payments in Kenya.
[So] Source:Int J Equity Health;16(1):31, 2017 Feb 06.
[Is] ISSN:1475-9276
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Monitoring the incidence and intensity of catastrophic health expenditure, as well as the impoverishing effects of out of pocket costs to access healthcare, is a key part of benchmarking Kenya's progress towards reducing the financial burden that households experience when accessing healthcare. METHODS: The study relies on data from the nationally-representative Kenya Household Expenditure and Utilization Survey conducted in 2013 (n =33,675). We undertook health equity analysis to estimate the incidence and intensity of catastrophic expenditure. Households were considered to have incurred catastrophic expenditures if their annual out of-pocket health expenditures exceeded 40% of their annual non-food expenditure. We assessed the impoverishing effects of out of pocket payments using the Kenya national poverty line. We distinguished between direct payments for healthcare such as payments for consultation, medicines, medical procedures, and total healthcare expenditure that includes direct healthcare payments and the cost of transportation to and from health facilities. We used logistic regression analysis to explore the factors associated with the incidence of catastrophic expenditures. RESULTS: When only direct payments to healthcare providers were considered, the incidence of catastrophic expenditures was 4.52%. When transport costs are included, the incidence of catastrophic expenditure increased to 6.58%. 453,470 Kenyans are pushed into poverty annually as a result of direct payments for healthcare. When the cost of transport is included, that number increases by more than one third to 619,541. Unemployment of the household head, presence of an elderly person, a person with a chronic ailment, a large household size, lower household social-economic status, and residence in marginalized regions of the country are significantly associated with increased odds of incurring catastrophic expenditures. CONCLUSIONS: Kenyan policy makers should prioritize extending pre-payment mechanisms to more vulnerable groups, specifically the poor, the elderly, those suffering from chronic ailments and those living in marginalized regions of the country. The range of services covered under these mechanisms should also be extended such that the proportion of direct costs paid to access care is reduced. Policy makers should also prioritize reducing supply side bottlenecks such as availability of healthcare facilities in close proximity to the population, especially in rural and marginalized areas, and improvements in quality of care. For the poor and the vulnerable, initiatives to cover the cost of transport to and from a health facility, such as transport vouchers could also be explored.
[Mh] Termos MeSH primário: Doença Catastrófica/economia
Financiamento Pessoal
Gastos em Saúde
Acesso aos Serviços de Saúde/economia
Pobreza
Classe Social
[Mh] Termos MeSH secundário: Adulto
Idoso
Criança
Características da Família
Feminino
Seres Humanos
Quênia
Modelos Logísticos
Masculino
Meia-Idade
Distribuição Espacial da População
Transportes
Desemprego
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171018
[Lr] Data última revisão:
171018
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170208
[St] Status:MEDLINE
[do] DOI:10.1186/s12939-017-0526-x


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[PMID]:28100226
[Au] Autor:Mohanty SK; Agrawal NK; Mahapatra B; Choudhury D; Tuladhar S; Holmgren EV
[Ad] Endereço:Department of Fertility Studies, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088, India. sanjayiips@yahoo.co.in.
[Ti] Título:Multidimensional poverty and catastrophic health spending in the mountainous regions of Myanmar, Nepal and India.
[So] Source:Int J Equity Health;16(1):21, 2017 Jan 18.
[Is] ISSN:1475-9276
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Economic burden to households due to out-of-pocket expenditure (OOPE) is large in many Asian countries. Though studies suggest increasing household poverty due to high OOPE in developing countries, studies on association of multidimensional poverty and household health spending is limited. This paper tests the hypothesis that the multidimensionally poor are more likely to incur catastrophic health spending cutting across countries. DATA AND METHODS: Data from the Poverty and Vulnerability Assessment (PVA) Survey carried out by the International Center for Integrated Mountain Development (ICIMOD) has been used in the analyses. The PVA survey was a comprehensive household survey that covered the mountainous regions of India, Nepal and Myanmar. A total of 2647 households from India, 2310 households in Nepal and 4290 households in Myanmar covered under the PVA survey. Poverty is measured in a multidimensional framework by including the dimensions of education, income and energy, water and sanitation using the Alkire and Foster method. Health shock is measured using the frequency of illness, family sickness and death of any family member in a reference period of one year. Catastrophic health expenditure is defined as 40% above the household's capacity to pay. RESULTS: Results suggest that about three-fifths of the population in Myanmar, two-fifths of the population in Nepal and one-third of the population in India are multidimensionally poor. About 47% of the multidimensionally poor in India had incurred catastrophic health spending compared to 35% of the multidimensionally non-poor and the pattern was similar in both Nepal and Myanmar. The odds of incurring catastrophic health spending was 56% more among the multidimensionally poor than among the multidimensionally non-poor [95% CI: 1.35-1.76]. While health shocks to households are consistently significant predictors of catastrophic health spending cutting across country of residence, the educational attainment of the head of the household is not significant. CONCLUSION: The multidimensionally poor in the poorer regions are more likely to face health shocks and are less likely to afford professional health services. Increasing government spending on health and increasing households' access to health insurance can reduce catastrophic health spending and multidimensional poverty.
[Mh] Termos MeSH primário: Doença Catastrófica/economia
Efeitos Psicossociais da Doença
Financiamento Pessoal
Gastos em Saúde
Pobreza
Classe Social
[Mh] Termos MeSH secundário: Adolescente
Adulto
Ásia
Criança
Países em Desenvolvimento
Características da Família
Feminino
Acesso aos Serviços de Saúde
Seres Humanos
Renda
Índia
Seguro Saúde
Masculino
Mianmar
Nepal
População Rural
Inquéritos e Questionários
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170120
[St] Status:MEDLINE
[do] DOI:10.1186/s12939-016-0514-6


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[PMID]:27396539
[Au] Autor:Deng S; Shen J; Ni J; Gong Y; Zhu H
[Ad] Endereço:Department of Intensive Care Unit, HuaShan Hospital, Fudan University Shanghai, China.
[Ti] Título:Cutaneous gangrene of the arms and legs after cardiopulmonary resuscitation: A rare presentation of catastrophic antiphospholipid syndrome.
[So] Source:Am J Emerg Med;35(1):191.e3-191.e5, 2017 Jan.
[Is] ISSN:1532-8171
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Lesão Renal Aguda/etiologia
Síndrome Antifosfolipídica/complicações
Dermatoses do Pé/etiologia
Dermatoses da Mão/etiologia
Pele/patologia
Síncope/etiologia
Fibrilação Ventricular/etiologia
[Mh] Termos MeSH secundário: Lesão Renal Aguda/terapia
Anticoagulantes/uso terapêutico
Síndrome Antifosfolipídica/diagnóstico
Síndrome Antifosfolipídica/terapia
Reanimação Cardiopulmonar/efeitos adversos
Doença Catastrófica
Febre/etiologia
Gangrena
Glucocorticoides/uso terapêutico
Seres Humanos
Imunoglobulinas Intravenosas/uso terapêutico
Fatores Imunológicos/uso terapêutico
Masculino
Meia-Idade
Oligúria/etiologia
Prednisolona/uso terapêutico
Terapia de Substituição Renal
Fibrilação Ventricular/terapia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticoagulants); 0 (Glucocorticoids); 0 (Immunoglobulins, Intravenous); 0 (Immunologic Factors); 9PHQ9Y1OLM (Prednisolone)
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160712
[St] Status:MEDLINE


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[PMID]:27977756
[Au] Autor:Sun X; Bernabé E; Liu X; Gallagher JE; Zheng S
[Ad] Endereço:Department of Preventive Dentistry, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Haidian District, Beijing, People's Republic of China.
[Ti] Título:Determinants of Catastrophic Dental Health Expenditure in China.
[So] Source:PLoS One;11(12):e0168341, 2016.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This study explored catastrophic health expenditure in China, due to out-of-pocket payments for dental care, and its associated individual- and contextual-level factors. We pooled data from 31,566 adults who participated in the third National Oral Health Survey with province-level data from different sources. We defined catastrophic dental health expenditure (CDHE) as payments for dental services and/or medication for dental problems during the last year that exceeded the 10% and 20% of the household income. The association of individual and contextual factors with catastrophic dental health expenditure was evaluated using two-level logistic regression models with individuals nested within provinces. Socioeconomic position (education and household income), household size and dental status (pain in teeth or mouth and number of teeth) were the individual-level factors associated with CDHE among the full sample of participants; and, also, among those who used dental services in the past year. Greater gross domestic product per capita was the only contextual factor associated with CDHE, and only at the lower income threshold. This study shows that out-of-pocket expenses for dental services may put a considerable, and unnecessary, burden on households' finances. Our findings also help characterise those households more likely to face catastrophic expenditure on health if they have to pay for dental services.
[Mh] Termos MeSH primário: Doença Catastrófica/economia
Doença Catastrófica/epidemiologia
Efeitos Psicossociais da Doença
Assistência Odontológica/economia
Assistência Odontológica/estatística & dados numéricos
Gastos em Saúde/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Doença Catastrófica/terapia
Criança
Pré-Escolar
China/epidemiologia
Inquéritos de Saúde Bucal
Fatores Epidemiológicos
Feminino
Financiamento Pessoal/estatística & dados numéricos
Seres Humanos
Masculino
Meia-Idade
Saúde Bucal
Fatores Socioeconômicos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170705
[Lr] Data última revisão:
170705
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161216
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0168341


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[PMID]:27886797
[Au] Autor:Rodriguez-Pintó I; Espinosa G; Cervera R
[Ad] Endereço:Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain.
[Ti] Título:Catastrophic antiphospholipid syndrome: The current management approach.
[So] Source:Best Pract Res Clin Rheumatol;30(2):239-249, 2016 Apr.
[Is] ISSN:1532-1770
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:The current recommendation for catastrophic antiphospholipid syndrome (CAPS) management is the standard triple therapy with anticoagulation (AC), glucocorticoids (GCs), plasma exchange (PE), and/or intravenous immunoglobulins (IVIGs). Of note, only AC has a significant effect on the prognosis of these patients. However, from the experimental or basic point of view, there is only indirect evidence to advocate the use of these immunomodulatory therapies (GC, PE, and IVIG) in CAPS. Recently, there have been reports of severe or refractory CAPS patients treated with the monoclonal antibodies rituximab and eculizumab. The first blocks CD20, a surface protein expressed on the cytoplasmic membrane of B cells, and decreases the generation of pathogenic autoantibodies such as antiphospholipid (aPL) antibodies. The second binds with high affinity to C5 complement protein, inhibiting its cleavage and thus preventing the generation of C5b-C9 complex.
[Mh] Termos MeSH primário: Síndrome Antifosfolipídica/terapia
[Mh] Termos MeSH secundário: Anticorpos Monoclonais/uso terapêutico
Anticorpos Monoclonais Humanizados/uso terapêutico
Anticoagulantes/uso terapêutico
Síndrome Antifosfolipídica/imunologia
Doença Catastrófica
Glucocorticoides/uso terapêutico
Seres Humanos
Imunoglobulinas Intravenosas/uso terapêutico
Troca Plasmática/métodos
Prognóstico
Rituximab/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Antibodies, Monoclonal); 0 (Antibodies, Monoclonal, Humanized); 0 (Anticoagulants); 0 (Glucocorticoids); 0 (Immunoglobulins, Intravenous); 4F4X42SYQ6 (Rituximab); A3ULP0F556 (eculizumab)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170816
[Lr] Data última revisão:
170816
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161126
[St] Status:MEDLINE


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[PMID]:27694669
[Au] Autor:Piroozi B; Moradi G; Nouri B; Mohamadi Bolbanabad A; Safari H
[Ad] Endereço:Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
[Ti] Título:Catastrophic Health Expenditure After the Implementation of Health Sector Evolution Plan: A Case Study in the West of Iran.
[So] Source:Int J Health Policy Manag;5(7):417-423, 2016 Mar 14.
[Is] ISSN:2322-5939
[Cp] País de publicação:Iran
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: One of the main objectives of health systems is the financial protection against out-of-pocket (OOP) health expenditures. OOP health expenditures can lead to catastrophic payments, impoverishment or poverty among households. In Iran, health sector evolution plan (HSEP) has been implemented since 2014 in order to achieve universal health coverage and reduce the OOP health expenditures as a percentage of total health expenditures. This study aimed to explore the percentage of households facing catastrophic health expenditures (CHE) after the implementation of HSEP and the factors that determine CHE. METHODS: A total of 663 households were selected through a cluster sampling based on the census framework of Sanandaj Health Center in July 2015. Data were gathered using face-to-face interviews based on the household section of the World Health Survey questionnaire. In this study, according to the World Health Organization (WHO) definition, if household health expenditures were equal to or more than 40% of the household capacity to pay, household was considered to be facing CHE. The determinants of CHE were analyzed using logistic regression model. RESULTS: The rates of households facing CHE were 4.8%. The key determinants of CHE were household economic status, presence of elderly or disabled members in the household and utilization of inpatient or rehabilitation services. CONCLUSION: The comparison of our findings and those of other studies carried out using a methodology comparable with ours in different parts of Iran before the implementation of HSEP suggests that the implementation of recent reforms has reduced CHE at the household level. Utilization of inpatient and rehabilitation services, the presence of elderly or disabled members in the household and the low economic status of the household would increase the likelihood of facing CHE. These variables should be considered by health policy-makers in order to review and revise content of recent reform, thus financially protecting public against CHE.
[Mh] Termos MeSH primário: Doença Catastrófica/economia
Gastos em Saúde/estatística & dados numéricos
Política de Saúde/economia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Criança
Pré-Escolar
Análise por Conglomerados
Estudos Transversais
Feminino
Financiamento Pessoal/economia
Financiamento Pessoal/estatística & dados numéricos
Seres Humanos
Entrevistas como Assunto
Irã (Geográfico)
Masculino
Meia-Idade
Fatores Socioeconômicos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:H; IM
[Da] Data de entrada para processamento:161004
[St] Status:MEDLINE
[do] DOI:10.15171/ijhpm.2016.31



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