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Health care payments in the Asia Pacific: validation of five survey measures of economic burden.

Reddy SR, Ross-Degnan D, Zaslavsky AM, Soumerai SB, Wagner AK - Int J Equity Health (2013)

Bottom Line: Measures of impoverishment and indebtedness most often correlated with health care need, wealth, and risk protection as expected.Having any health expenditure, a large health expenditure, or even a catastrophic health expenditure did not consistently predict degree of economic burden.Studies that examine economic burden attributable to health care payments should include measures of impoverishment and indebtedness.

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Affiliation: Ph.D. Program in Health Policy, Harvard University, Cambridge, MA, USA. sheilareddy@post.harvard.edu

ABSTRACT

Introduction: Many low and middle-income countries rely on out-of-pocket payments to help finance health care. These payments can pose financial hardships for households; valid measurement of this type of economic burden is therefore critical. This study examines the validity of five survey measures of economic burden caused by health care payments.

Methods: We analyzed 2002/03 World Health Survey household-level data from four Asia Pacific countries to assess the construct validity of five measures of economic burden due to health care payments: any health expenditure, health expenditure amount, catastrophic health expenditure, indebtedness, and impoverishment. We used generalized linear models to assess the correlations between these measures and other constructs with which they have expected associations, such as health care need, wealth, and risk protection.

Results: Measures of impoverishment and indebtedness most often correlated with health care need, wealth, and risk protection as expected. Having any health expenditure, a large health expenditure, or even a catastrophic health expenditure did not consistently predict degree of economic burden.

Conclusions: Studies that examine economic burden attributable to health care payments should include measures of impoverishment and indebtedness.

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Relationship between indebtedness and indicators of health care need, wealth and risk protection. Point estimates with 95% confidence intervals shown.
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Figure 4: Relationship between indebtedness and indicators of health care need, wealth and risk protection. Point estimates with 95% confidence intervals shown.

Mentions: Table 4 summarizes the directions of associations from adjusted models; detailed results for each measure of economic burden are displayed in Figures 1, 2, 3, 4 and 5. Overall, the impoverishment measure had the most consistent associations across countries and constructs that agreed with our hypotheses (12), while the indebtedness, catastrophic health expenditure, any health expenditure, and health expenditure amount measures displayed fewer consistent relationships (11, 10, 10, and 9, respectively).


Health care payments in the Asia Pacific: validation of five survey measures of economic burden.

Reddy SR, Ross-Degnan D, Zaslavsky AM, Soumerai SB, Wagner AK - Int J Equity Health (2013)

Relationship between indebtedness and indicators of health care need, wealth and risk protection. Point estimates with 95% confidence intervals shown.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3716807&req=5

Figure 4: Relationship between indebtedness and indicators of health care need, wealth and risk protection. Point estimates with 95% confidence intervals shown.
Mentions: Table 4 summarizes the directions of associations from adjusted models; detailed results for each measure of economic burden are displayed in Figures 1, 2, 3, 4 and 5. Overall, the impoverishment measure had the most consistent associations across countries and constructs that agreed with our hypotheses (12), while the indebtedness, catastrophic health expenditure, any health expenditure, and health expenditure amount measures displayed fewer consistent relationships (11, 10, 10, and 9, respectively).

Bottom Line: Measures of impoverishment and indebtedness most often correlated with health care need, wealth, and risk protection as expected.Having any health expenditure, a large health expenditure, or even a catastrophic health expenditure did not consistently predict degree of economic burden.Studies that examine economic burden attributable to health care payments should include measures of impoverishment and indebtedness.

View Article: PubMed Central - HTML - PubMed

Affiliation: Ph.D. Program in Health Policy, Harvard University, Cambridge, MA, USA. sheilareddy@post.harvard.edu

ABSTRACT

Introduction: Many low and middle-income countries rely on out-of-pocket payments to help finance health care. These payments can pose financial hardships for households; valid measurement of this type of economic burden is therefore critical. This study examines the validity of five survey measures of economic burden caused by health care payments.

Methods: We analyzed 2002/03 World Health Survey household-level data from four Asia Pacific countries to assess the construct validity of five measures of economic burden due to health care payments: any health expenditure, health expenditure amount, catastrophic health expenditure, indebtedness, and impoverishment. We used generalized linear models to assess the correlations between these measures and other constructs with which they have expected associations, such as health care need, wealth, and risk protection.

Results: Measures of impoverishment and indebtedness most often correlated with health care need, wealth, and risk protection as expected. Having any health expenditure, a large health expenditure, or even a catastrophic health expenditure did not consistently predict degree of economic burden.

Conclusions: Studies that examine economic burden attributable to health care payments should include measures of impoverishment and indebtedness.

Show MeSH