Limits...
The effectiveness of interventions to reduce the household economic burden of illness and injury: a systematic review.

Essue BM, Kimman M, Svenstrup N, Lindevig Kjoege K, Lea Laba T, Hackett ML, Jan S - Bull. World Health Organ. (2014)

Bottom Line: The only interventions found to reduce out-of-pocket expenditure significantly were those that eliminated or substantially reduced co-payments for a given patient population.However, the reductions only represented marginal changes in the total expenditures of patients.We found no studies that had been effective in addressing broader household economic impacts – such as catastrophic health expenditure – in the disease populations investigated.

View Article: PubMed Central - PubMed

Affiliation: The George Institute for Global Health, PO Box M201, Missenden Road, Camperdown, NSW 2050, Australia .

ABSTRACT

Objective: To determine the nature, scope and effectiveness of interventions to reduce the household economic burden of illness or injury.

Methods: We systematically reviewed reports published on or before 31 January 2014 that we found in the CENTRAL, CINAHL, Econlit, Embase, MEDLINE, PreMEDLINE and PsycINFO databases. We extracted data from prospective controlled trials and assessed the risk of bias. We narratively synthesized evidence.

Findings: Nine of the 4330 studies checked met our inclusion criteria – seven had evaluated changes to existing health-insurance programmes and two had evaluated different modes of delivering information. The only interventions found to reduce out-of-pocket expenditure significantly were those that eliminated or substantially reduced co-payments for a given patient population. However, the reductions only represented marginal changes in the total expenditures of patients. We found no studies that had been effective in addressing broader household economic impacts – such as catastrophic health expenditure – in the disease populations investigated.

Conclusion: In general, interventions designed to reduce the complex household economic burden of illness and injury appear to have had little impact on household economies. We only found a few relevant studies using rigorous study designs that were conducted in defined patient populations. The studies were limited in the range of interventions tested and they evaluated only a narrow range of household economic outcomes. There is a need for method development to advance the measurement of the household economic consequences of illness and injury and facilitate the development of innovative interventions to supplement the strategies based on health insurance.

No MeSH data available.


Related in: MedlinePlus

Risk of bias in the randomized and nonrandomized controlled trials and the controlled before-and-after studies on interventions to reduce the household economic burden of ill health
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4339963&req=5

Figure 2: Risk of bias in the randomized and nonrandomized controlled trials and the controlled before-and-after studies on interventions to reduce the household economic burden of ill health

Mentions: There was a high or unclear risk of bias in the randomized and nonrandomized controlled trials and controlled before-and-after studies (Fig. 2; available from: http://www.who.int/bulletin/volumes/93/2/14-139287). In these studies, inadequate allocation-sequence generation and concealment could have resulted in an overestimate of the effects of an intervention on the household economic burden – particularly since absolute out-of-pocket expenditure was often the main outcome and such expenditure was self-reported in three studies.35–37 Attrition bias due to incomplete reporting of outcome data – which may also lead to overestimates of an intervention – was potentially an issue in three studies.35–37 There was also a high risk of reporting bias in two of the studies.35,36


The effectiveness of interventions to reduce the household economic burden of illness and injury: a systematic review.

Essue BM, Kimman M, Svenstrup N, Lindevig Kjoege K, Lea Laba T, Hackett ML, Jan S - Bull. World Health Organ. (2014)

Risk of bias in the randomized and nonrandomized controlled trials and the controlled before-and-after studies on interventions to reduce the household economic burden of ill health
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4339963&req=5

Figure 2: Risk of bias in the randomized and nonrandomized controlled trials and the controlled before-and-after studies on interventions to reduce the household economic burden of ill health
Mentions: There was a high or unclear risk of bias in the randomized and nonrandomized controlled trials and controlled before-and-after studies (Fig. 2; available from: http://www.who.int/bulletin/volumes/93/2/14-139287). In these studies, inadequate allocation-sequence generation and concealment could have resulted in an overestimate of the effects of an intervention on the household economic burden – particularly since absolute out-of-pocket expenditure was often the main outcome and such expenditure was self-reported in three studies.35–37 Attrition bias due to incomplete reporting of outcome data – which may also lead to overestimates of an intervention – was potentially an issue in three studies.35–37 There was also a high risk of reporting bias in two of the studies.35,36

Bottom Line: The only interventions found to reduce out-of-pocket expenditure significantly were those that eliminated or substantially reduced co-payments for a given patient population.However, the reductions only represented marginal changes in the total expenditures of patients.We found no studies that had been effective in addressing broader household economic impacts – such as catastrophic health expenditure – in the disease populations investigated.

View Article: PubMed Central - PubMed

Affiliation: The George Institute for Global Health, PO Box M201, Missenden Road, Camperdown, NSW 2050, Australia .

ABSTRACT

Objective: To determine the nature, scope and effectiveness of interventions to reduce the household economic burden of illness or injury.

Methods: We systematically reviewed reports published on or before 31 January 2014 that we found in the CENTRAL, CINAHL, Econlit, Embase, MEDLINE, PreMEDLINE and PsycINFO databases. We extracted data from prospective controlled trials and assessed the risk of bias. We narratively synthesized evidence.

Findings: Nine of the 4330 studies checked met our inclusion criteria – seven had evaluated changes to existing health-insurance programmes and two had evaluated different modes of delivering information. The only interventions found to reduce out-of-pocket expenditure significantly were those that eliminated or substantially reduced co-payments for a given patient population. However, the reductions only represented marginal changes in the total expenditures of patients. We found no studies that had been effective in addressing broader household economic impacts – such as catastrophic health expenditure – in the disease populations investigated.

Conclusion: In general, interventions designed to reduce the complex household economic burden of illness and injury appear to have had little impact on household economies. We only found a few relevant studies using rigorous study designs that were conducted in defined patient populations. The studies were limited in the range of interventions tested and they evaluated only a narrow range of household economic outcomes. There is a need for method development to advance the measurement of the household economic consequences of illness and injury and facilitate the development of innovative interventions to supplement the strategies based on health insurance.

No MeSH data available.


Related in: MedlinePlus