ORCID Profile
0000-0003-4160-0777
Current Organisations
Monash University
,
University of Oxford
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Publisher: Springer Science and Business Media LLC
Date: 19-06-2021
DOI: 10.1186/S12939-021-01480-9
Abstract: This study aims to examine: (1) temporal trends in the percentage of cost-sharing and amount of out-of-pocket expenditure (OOPE) from 2011 to 2015 (2) factors associated with cost-sharing and OOPE and (3) the relationships between province-level economic development and cost-sharing and OOPE in China. A total of 10,316 adults aged ≥45 years from China followed-up from 2011 to 2015 were included in the analysis. We measured two main outcome variables: (1) patient cost sharing, measured by the percentage of OOPE as total healthcare expenditure, and (2) absolute amount of OOPE. Based on self-reported data, we did not find substantial differences in the percentage of cost sharing, but a significant increase in the absolute amount of OOPE among the middle-aged and older Chinese between 2011 and 2015. The percentage of cost-sharing was considerably higher for outpatient than inpatient care, and the majority paid more than 80% of the total cost for prescription drugs. Provinces with higher GDP per capita tend to have lower cost-sharing and a higher OOPE than their counterparts, but the relationship for OOPE became insignificant after adjusting for in idual factors. Reducing out-of-pocket expenditure and patient cost sharing is required to improve financial protection from illness, especially for those with those with chronic conditions and reside in less developed regions in China. Ongoing monitoring of financial protection using data from various sources is warranted.
Publisher: BMJ
Date: 02-2021
DOI: 10.1136/BMJOPEN-2020-041870
Abstract: To examine non-communicable diseases (NCDs) multimorbidity level and its relation to households’ socioeconomic characteristics, health service use, catastrophic health expenditures and productivity loss. This study used panel data of the Indonesian Family Life Survey conducted in 2007 (Wave 4) and 2014 (Wave 5). The original s ling frame was based on 13 out of 27 provinces in 1993, representing 83% of the Indonesian population. We included respondents aged 50 years and above in 2007, excluding those who did not participate in both Waves 4 and 5. The total number of participants in this study are 3678 respondents. We examined three main outcomes health service use (outpatient and inpatient care), financial burden (catastrophic health expenditure) and productivity loss (labour participation, days primary activity missed, days confined in bed). We applied multilevel mixed-effects regression models to assess the associations between NCD multimorbidity and outcome variables, Women were more likely to have NCD multimorbidity than men and the prevalence of NCD multimorbidity increased with higher socioeconomic status. NCD multimorbidity was associated with a higher number of outpatient visits (compared with those without NCD, incidence rate ratio (IRR) 4.25, 95% CI 3.33 to 5.42 for in iduals with NCDs) and inpatient visits (IRR 3.68, 95% CI 2.21 to 6.12 for in iduals with NCDs). NCD multimorbidity was also associated with a greater likelihood of experiencing catastrophic health expenditure (for NCDs, adjusted OR (aOR) 1.69, 95% CI 1.02 to 2.81) and lower participation in the labour force (aOR 0.23, 95% CI 0.16 to 0.33) compared with no NCD. NCD multimorbidity is associated with substantial direct and indirect costs to in iduals, households and the wider society. Our study highlights the importance of preparing health systems for addressing the burden of multimorbidity in low-income and middle-income countries.
Publisher: BMJ
Date: 03-2021
DOI: 10.1136/BMJGH-2020-004127
Abstract: There is an interest to understand how social impact bonds (SIBs), a type of innovative financing instrument used in impact investment, can be used to finance the prevention of non-communicable diseases (NCDs). This is the first scoping review that explores the evidence of SIBs for NCDs and their key characteristics and performance. The review used both published and grey literature from eight databases (MEDLINE, NCBI, Elsevier, Cochrane Library, Google, Google Scholar, WHO publications and OECD iLibrary). A total of 83 studies and articles were eligible for inclusion, identifying 11 SIBs implemented in eight countries. The shared characteristics of the SIBs used for NCDs were impact investment companies as investors, local governments as outcome payers, not-for-profit service providers and an average US$2 015 456 private initial investment. The review revealed a lack of empirical evidence on SIBs for NCDs. Conflict of interest and lack of public disclosure were common issues in both the published and grey literature on SIBs. Furthermore, only three SIBs implemented for financing NCDs were meeting all their target outcomes. The common characteristics of the SIBs meeting their target outcomes were evidence-based interventions, multiple service providers and an intermediated structure. Overall, there is a need for more high-quality studies, particularly economic evaluations and qualitative studies on the benefits to target populations, and greater transparency from the private sector, in order to ensure improved SIBs for preventing NCDs.
Publisher: Wiley
Date: 04-2022
DOI: 10.1002/JIA2.25902
Abstract: Due to the effectiveness of combined antiretroviral therapy and its growing availability worldwide, most people living with HIV (PLHIV) have a near‐normal life expectancy. However, PLHIV continue to face various health and social challenges that severely impact their health‐related quality‐of‐life (HRQoL). The UNAIDS Global AIDS Strategy discusses the need to optimize quality‐of‐life, but no guidance was given regarding which instruments were appropriate measures of HRQoL. This study aimed to review and assess the use of HRQoL instruments for PLHIV. We conducted a global systematic review and meta‐analysis, searching five databases for studies published between January 2010 and February 2021 that assessed HRQoL among PLHIV aged 16 years and over. Multivariable regression analyses were performed to identify factors associated with the choice of HRQoL instruments. We examined the domains covered by each instrument. Random‐effects meta‐analysis was conducted to explore the average completion rates of HRQoL instruments. From 714 publications, we identified 65 different HRQoL instruments. The most commonly used instruments were the World Health Organization Quality‐of‐Life‐ HIV Bref (WHOQOL‐HIV BREF)—19%, Medical Outcome Survey‐HIV (MOS‐HIV)—17%, Short Form‐36 (SF‐36)—12%, European Quality‐of‐Life Instrument‐5 Dimension (EQ‐5D)—10%, World Health Organization Quality‐of‐Life Bref (WHOQOL BREF)—8%, Short Form‐12 (SF‐12)—7% and HIV/AIDS Targeted Quality‐of‐Life (HAT‐QOL)—6%. There were greater odds of using HIV‐specific instruments for middle‐ and low‐income countries (than high‐income countries), studies in the Americas and Europe (than Africa) and target population of PLHIV only (than both PLHIV and people without HIV). Domains unique to the HIV‐specific instruments were worries about death, stigma and HIV disclosure. There were no significant differences in completion rates between different HRQoL instruments. The overall pooled completion rate was 95.9% (95% CI: 94.7−97.0, I 2 = 99.2%, p 0.01) some heterogeneity was explained by country‐income level and study type. A wide range of instruments have been used to assess HRQoL in PLHIV, and the choice of instrument might be based on their different characteristics and reason for application. Although completion rates were high, future studies should explore the feasibility of implementing these instruments and the appropriateness of domains covered by each instrument.
Publisher: Springer Science and Business Media LLC
Date: 17-09-2022
DOI: 10.1186/S12913-022-08546-6
Abstract: Indonesia is in the middle of a rapid epidemiological transition with an ageing population and increasing exposure to risk factors for chronic conditions. This study examines the relative impacts of obesity, tobacco consumption, and physical inactivity, on non-communicable diseases multimorbidity, health service use, catastrophic health expenditure (CHE), and loss in employment productivity in Indonesia. Secondary analyses were conducted of cross-sectional data from adults aged ≥ 40 years ( n = 12,081) in the Indonesian Family Life Survey 2014/2015. We used propensity score matching to assess the associations between behavioural risk factors and health service use, CHE, employment productivity, and multimorbidity. Being obese, overweight and a former tobacco user was associated with a higher number of chronic conditions and multimorbidity ( p 0.05). Being a former tobacco user contributed to a higher number of outpatient and inpatient visits as well as CHE incidences and work absenteeism. Physical inactivity relatively increased the number of outpatient visits (30% increase, p 0.05) and work absenteeism (21% increase, P 0.06). Although being underweight was associated with an increased outpatient care utilisation (23% increase, p 0.05), being overweight was negatively associated with CHE incidences (50% decrease, p 0.05). Combined together, obesity, overweight, physical inactivity and tobacco use contributed to an increased number of NCDs as well as medical costs and productivity loss in Indonesia. Interventions addressing physical and behavioural risk factors are likely to have substantial benefits for in iduals and the wider society in Indonesia.
Publisher: Cold Spring Harbor Laboratory
Date: 17-06-2020
DOI: 10.1101/2020.06.15.20131813
Abstract: Understanding the variation in user fees is essential for the design of targeted health financing strategies and monitoring progress towards universal health coverage. This study examines user fees in terms of: (1) temporal trends in cost sharing and out-of-pocket payment (OOPs) (2) factors associated with cost sharing and OOPs and (3) the relationships between province-level economic development and cost sharing and OOPs in China. 28 provinces of China A total of 10316 elderly aged ≥45 years were included in the analysis. Overall, there were no substantial changes in cost sharing, but the OOPs continued to rise among the middle-aged and older Chinese. Cost sharing was substantially higher for outpatient than inpatient care (84.0% vs 69.2% in 2011 80.8% vs 62.2% in 2015), and the majority paid more than 80% of the total cost for prescription drugs when visiting outpatient or inpatient care. Provinces with higher GDP per capita tend to have lower cost sharing and a higher OOPs than their counterparts, but the relationship for OOPs became insignificant after adjusting for in idual factors. Respondents with health insurance and older age were associated with lower cost sharing. The respondents with higher socioeconomic status and a higher number of chronic conditions incurred higher OOPs for outpatient and inpatient utilisation. Cost sharing and OOPs remain very high despite near-universal insurance coverage. Health financing reforms should prioritise improving health services coverage and reducing cost sharing to improve financial protection and reduce health inequalities. Although such improvement will likely have the greatest benefits for financial protection for populations from less developed regions, developed provinces with a higher OOPs will benefit as well. This is the first longitudinal study to measure the trend of and variation in patient cost sharing and OOPs in China. User fees was self-reported by the respondents, which may be subject to recall bias. User fees in this study only reflected the general cost burden from formal healthcare services, therefore, user fees from informal care services were not captured. There were no substantial changes in patient cost sharing for outpatient and inpatient services, but the amount of out-of-pocket payment (OOPs) continued to rise during 2011-2015, especially for outpatient services from 371 Yuan in 2011 to 1031 Yuan in 2015. Despite universal health insurance coverage, patient cost sharing was still high among the middle-aged and older Chinese: 84.0% for outpatient care and 69.2% for inpatient care in 2011 and 80.8% vs 62.2% in 2015. The majority of patients paid more than 80% of the total cost for prescription drugs when visiting outpatient or inpatient care. Several patient-level characteristics affected cost-sharing and OOPs, including insurance status, age, education, household economic status and number of chronic conditions. Cost sharing was lower for those with insurance compared to those without insurance. Provinces with higher GDP per capita had lower cost sharing than provinces with lower GDP per capita, but no significant difference was found in the amount of OOPs after controlling for in idual-level factors.
Publisher: Elsevier BV
Date: 10-2021
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 10-12-2020
DOI: 10.5888/PCD17.200155
Publisher: Springer Science and Business Media LLC
Date: 18-02-2021
DOI: 10.1186/S12889-021-10414-7
Abstract: The co-occurrence of mental and physical chronic conditions (mental-physical multimorbidity) is a growing and largely unaddressed challenge for health systems and wider economies in low-and middle-income countries. This study investigated the independent and combined (additive or synergistic) effects of mental and physical chronic conditions on disability, work productivity, and social participation in China. Panel data study design utilised two waves of the China Health and Retirement Longitudinal Study (2011, 2015), including 5616 participants aged ≥45 years, 12 physical chronic conditions and depression. We used a panel data approach of random-effects regression models to assess the relationships between mental-physical multimorbidity and outcomes. After adjusting for socio-economic and demographic factors, an increased number of physical chronic conditions was independently associated with a higher likelihood of disability (Adjusted odds ratio (AOR) = 1.39 95% CI: 1.33, 1.45), early retirement (AOR = 1.37 [1.26, 1.49]) and increased sick leave days (1.25 days [1.16, 1.35]). Depression was independently associated with disability (AOR = 3.78 [3.30, 4.34]), increased sick leave days (2.18 days [1.72, 2.77]) and a lower likelihood of social participation (AOR = 0.57 [0.47, 0.70]), but not with early retirement (AOR = 1.24 [0.97, 1.58]). There were small and statistically insignificant interactions between physical chronic conditions and mental health on disability, work productivity and social participation, suggesting an additive effect of mental-physical multimorbidity on productivity loss. Mental-physical multimorbidity poses substantial negative health and economic effects on in iduals, health systems, and societies. More research that addresses the challenges of mental-physical multimorbidity is needed to inform the development of interventions that can be applied to the workplace and the wider community in China.
Publisher: MDPI AG
Date: 25-05-2021
Abstract: Reducing the burden of disability is key priority in many countries where the population is aging rapidly. The relationships between disability, health expenditure and economic burden are complex, particularly when disability is recognized as a continuum rather than a dichotomous phenomenon. However, these complex relationships are not adequately addressed in national health policy and management plans in Vietnam. This paper examines the economic consequences of disability across its continuum or levels of severity. Two-part regression models were applied to assess the relationships between disability, health service use and the out-of-pocket expenditure. We found that Vietnamese adults with disabilities had multiple characteristics of vulnerability, e.g., older, less likely to be employed, lower education, and poorer than adults without disabilities. These characteristics are associated with poorer health and higher need of healthcare utilization but, after controlling for these factors, disability still had an independent association with higher health expenditure and greater economic burden at their household (p 0.05). Our study provides empirical evidence of the economic burden associated across the continuum of disability in Vietnam. Decisive action is critical for protecting persons with disability from medical impoverishment, and such targeted interventions should include those with moderate disability rather than the current focus on severe disability.
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Emily Hulse.