Out-of-pocket and catastrophic expenses in households of patients with schizophrenia lacking social security / Gastos de bolsillo y catastróficos en hogares de pacientes con esquizofrenia sin seguridad social

Abstract: Objective: To estimate the magnitude of out-of-pocket (OOP) and catastrophic health expenses as well as impoverishment experienced by households of schizophrenia patients lacking social security coverage. Materials and methods: We conducted a cross-sectional study of 96 individuals treated outpatient consultation between February and December 2018, in a psychiatric hospital. Results: All households sustained OOP health expenses; the median was 510 USD (95%CI: 456-628). The OOP expenses represented 28 and 4% of the capacity to pay of poor and rich households, respectively. The 16% of households incurred catastrophic expenses and 6.6% have impoverishment for health reasons. Conclusions: Our results illustrate that pocket expenses and catastrophic expenses in patients with schizophrenia are higher than those reported for the general population. Therefore, it is necessary to rethink the financial protection policies aimed at patients with schizophrenia and their households.

Resumen: Objetivo: Estimar la magnitud del gasto de bolsillo y catastrófico en salud, así como el empobrecimiento experimentado por hogares de pacientes con esquizofrenia que carecen de cobertura en seguridad social. Material y métodos: Se hizo un estudio transversal de 96 pacientes tratados en consulta externa entre febrero y diciembre de 2018, en un hospital psiquiátrico. Resultados: Todos los hogares soportaron gastos de bolsillo (GB), la mediana fue 510 USD (IC95%: 456-628). Los GB representan 28 y 4% de la capacidad de pago de los hogares pobres y ricos respectivamente. El 16% de los hogares incurrió en gastos catastróficos y 6.6% tiene empobrecimiento por motivos de salud. Conclusiones: Los resultados muestran que los gastos de bolsillo y gastos catastróficos en pacientes con esquizofrenia son mayores que los reportados para población general, por lo que es necesario repensar las políticas de protección financiera dirigidas a pacientes con esquizofrenia y sus hogares.

Hospitalization expenditure of COVID-19 patients at the University of the Philippines-Philippine General Hospital (UP-PGH) with PhilHealth coverage

@#Objective. This research aimed to determine the in-patient expenditure of COVID-19 adult patient s and their out-of-pocket (OOP) payments at the University of the Philippines-Philippine General Hospital (UP-PGH) after the new PhilHealth case rate coverage was instituted last 15 April 2020. It also intended to present the preliminary data on the expenses incurred by COVID patients during the initial phase of the pandemic in the country. Methods. This study was a retrospective chart review of admitted COVID-19 patients aged 19 years old and above from 15 April to 14 August 2020 at UP-PGH that availed of PhilHealth COVID-19 case rate benefits package (C19C1-C4). Data were analyzed to extract overall expenses, out-of-pocket (OOP) charges, cost centers utilization, and other hospitalization expenditure sources. Results. Of the 691 COVID-19 patients included during the study period, 55.72% were male, mostly belonging to the 61-70 age range with a median age of 58. The average in-hospital stay was 14.20 days, and 76.99% were under charity services, with the moderate (42.84%) and mild (25.33%) pneumonia cases accounting for 68.17% of the admissions. Total hospital expenses clustered around Php51,000 to 200,000 (~USD 1,041 to 4,156), most spending between Php101,000 to 150,000 (~USD 2,078 to 3,118). The top three cost centers and expenditure sources were pharmacies, personal protective equipment (PPE) usage, and laboratory. The average OOP payment for patients less than 60 years old was higher, ranging from Php 25,899 to Php 44,428.63 (USD 538 to USD 924.44) compared to patients older than 60 (Php4,005.60 to Php 32,920.20 ~ USD 83.35 to 684.98). The most OOP charges were for the age group 19-30, amounting to Php 44,428.63 (USD 924.44). Conclusion. Preliminary findings of this study gave an actual representation of the expenses of COVID-19 patients, which can guide future utilization of the national health insurance during unexpected pandemics. Early price regulation of new therapeutic interventions, diagnostic tests, and medical supplies, e.g., PPEs, disinfectants, air filters, are measures that can be implemented.

Análisis económico del costo de los medicamentos usados en patologías psiquiátricas: el tercio de los ingresos de un paciente se consumen en fármacos / Economic analysis of the cost of medicines used in psychiatric pathologies: one third of a patient's income is consumed in drugs

Contexto: los pacientes con enfermedades crónicas gastan entre el 5% a 18% del presupuesto individual o familiar destinado a salud en países europeos. Estas cifras pueden ser mayores en Ecuador. Objetivo: realizar un análisis del costo económico de los medicamentos usados para patologías psiquiátricas. Metodología: estudio descriptivo en 439 pacientes con diagnóstico de esquizofrenia, trastorno bipolar, depresión y adicciones para determinar el costo del tratamiento según la patología diagnosticada y el número de fármacos requeridos en su tratamiento. Resultados: el 95% de sujetos provienen de la región sierra, el 2,2% provienen de la costa y el 1,8% del oriente. Predominan pacientes del sexo femenino (53%), con una edad promedio de 36,7±15,8 años. El 68% es desempleado y apenas el 20% tiene un empleo inadecuado. Respecto al diagnóstico, el 28,6% corresponde a ansiedad, 27,2% a depresión, 21% consumen sustancias, 16,3% es esquizofrénico y el 6,7% tiene trastorno bipolar. El 80% de individuos tiene adherencia al tratamiento de un mes. La mayoría de patologías ameritan un tratamiento con dos fármacos, lo que implica un costo mensual promedio 30,67±24,94 dólares. La esquizofrenia es la patología que tiene un mayor costo de tratamiento con un valor mensual de 51,28±85,04 dólares Conclusión: el 80% de los pacientes estudiados requiere tratamiento farmacológico superior a 30 días; la mayoría de pacientes encuestados, el 28,6%, sufre síndrome de ansiedad generalizada, el 40% del total de pacientes necesita al menos dos medicamentos de forma simultánea, el trastorno bipolar es la patología que demanda mayor costo mensual, con más de US$ 112 con tres medicamentos de uso simultáneo, lo que representa el 29% de sus ingresos si ganase un remuneración mínima unificada en Ecuador, al 2017.(AU)

Context: patients with chronic diseases spend between 5% and 18% of the individual or family budget for health in European countries. These expenditures could be higher in Ecuador. Objective: to carry out an analysis of the economic cost of medicines used for psychiatric pathologies Methodology: descriptive study in 439 patients diagnosed with schizophrenia, bipolar disorder, depression and addictions, to determine the cost of treatment according to the pathology diagnosed, and the number of drugs required in their treatment. Results: 95% of subjects come from the sierra region, 2,2% come from the coast and 1,8% from the east. Female patients predominate (53%), with an average age of 36,7 ± 15,8 years. 68% are unemployed and only 20% have inadequate employment. Regarding the diagnosis, 28,6% corresponds to anxiety, 27,2% to depression, 21% consume substances, 16,3% are schizophrenic and 6.7% have bipolar disorder. 80% of individuals have adherence to the treatment of one month. Most pathologies merit a treatment with two drugs, which implies an average monthly cost of 30,67 ± 24,94 dollars. Schizophrenia is the pathology that has a higher cost of treatment with a monthly value of 51,28 ± 85,04 dollars Conclusion: 80% of the patients studied require pharmacological treatment of more than 30 days; the majority of patients surveyed, 28,6%, suffer from generalized anxiety syndrome, 40% of all patients need at least two medications simultaneously, bipolar disorder is the pathology that demands the highest monthly cost, with more than US $ 112 with three medications for simultaneous use, which represents 29% of their income if you earn a unified minimum remuneration in Ecuador, to 2017. (AU)

Acceso de las personas con VIH al sistema de salud colombiano y sus costos relacionados desde una perspectiva individual y familiar, Bogotá, 2010 / Acesso das pessoas com VIH ao sistema de saúde colombiano e custos relacionados desde uma perspectiva individual e familiar, Bogotá, 2010 / Access of people with HIV to the Colombian healthcare system and its related costs from an individual and family perspective, Bogotá, 2010

Con el objetivo de explorar el acceso a los servicios de salud para la población con VIH en Bogotá y los costos asociados se diseñó un protocolo mixto. Éste incluyó una fase cuantitativa, de corte transversal, con una muestra por conveniencia de 540 adultos con VIH, y una fase cualitativa, con perspectiva fenomenológica con 20 pacientes. El 95% de la muestra estaba afiliada al SGSSS; sin embargo, se encontraron fallas estructurales y operativas que constituyen barreras a la atención integral, así como procesos dispendiosos para la exigibilidad de los derechos. Los costos directos mensuales asumidos por las personas con VIH o sus familias eran de $65.000, lo que representa entre el 11 y el 16% de sus ingresos. Los costos indirectos eran 2,2 veces mayores. El acceso a los servicios de salud inciden en el impacto psicofísico y aumentan la carga de enfermedad en términos de costos directos e indirectos...

To determine the access to healthcare for HIV patients and the associated costs in Bogotá, we developed a protocol using a mixed design. The quantitative phase comprised a cross-sectional study with a convenience sample of 540 adults with HIV. For the qualitative phase,a phenomenological study with 20 individuals was undertaken. 95% of participants had health insurance, but we found many structural, operative and human failures that imposed barriers to comprehensive treatment, as well as a complicated process to guarantee the rights for health. The direct cost assumed by individuals with HIV or their families was 65,000 COP monthly, representing 11-16% of their income. Indirect costs were 2.2 times higher. Access to healthcare influenced their medical condition as well as the burden of illness in terms of direct and indirect costs...

Com o objetivo de explorar o acesso aos serviços de saúde para população com VIH em Bogotá e os custos associados desenhou-se um protocolo misto. Este incluiu uma fase quantitativa, de corte transversal, com amostra por conveniência de 540 adultos com VIH e uma fase qualitativa com perspectiva fenomenológica com 20 pacientes. Amostra estava conformada por 95% de afiliados ao SGSSS (Sistema Geral de Segurança Social em Saúde), no entanto, falhas estruturais e operativas que constituem barreiras à atenção integral foram encontradas, mesmo que processos chatos para a exigibilidade dos direitos. Custos diretos mensais assumidos pelas pessoas com VIH ou suas famílias foram de $ 65.000 (US $35,5, aproximadamente) o que representa entre 11% e 16% das rendas. Custos indiretos foram 2,2 vezes mais. O ingresso aos serviços de saúde incide no impacto psicofísico e aumenta a carrega de doença em termos de custos diretos e indiretos...