Out-of-pocket expenditures associated with congenital zika syndrome in Brazil: an analysis of household health spending / Gastos out-of-pocket associados à síndrome congênita do vírus Zika no Brasil: uma análise dos gastos domiciliares em saúde

Objective: The study aims to estimate catastrophic health expenditures associated with the diagnosis and follow-up treatment of Congenital Zika Syndrome (CZS) in children affected during the 2015-2016 epidemic in Brazil. Catastrophic health expenditures are defined as health spending that exceeds a predefined proportion of the household's total expenditures, exposing family members to financial vulnerability. Methods: Ninety-six interviews were held in the cities of Fortaleza and Rio de Janeiro in a convenience sample, using a questionnaire on sociodemographic characteristics and private household expenditures associated with the syndrome, which also allowed estimating catastrophic expenditures resulting from care for CZS. Results: Most of the mothers interviewed in the study were brown, under 34 years of age, unemployed, and reported a monthly family income of two minimum wages or less. Spending on medicines accounted for 77.6% of the medical expenditures, while transportation and food were the main components of nonmedical expenditures, accounting for 79% of this total. The affected households were largely low-income and suffered catastrophic expenditures due to the disease. Considering the family income metric, in 41.7% of the households, expenses with the child's disease exceeded 10% of the household income. Conclusion: Public policies should consider the financial and healthcare needs of these families to ensure adequate support for individuals affected by CZS.

Objetivo: O estudo tem como objetivo estimar os gastos catastróficos em saúde associados ao diagnóstico e acompanhamento do tratamento da síndrome congênita do Zika (SCZ) em crianças afetadas durante a epidemia de 2015-2016 no Brasil. Gastos catastróficos em saúde são definidos como gastos com saúde que excedem uma proporção predefinida dos gastos totais do domicílio, expondo os membros da família à vulnerabilidade financeira. Métodos: Foram realizadas 96 entrevistas nas cidades de Fortaleza e Rio de Janeiro numa amostra de conveniência, por meio de questionário sobre características sociodemográficas e gastos privados domiciliares associados à síndrome, o que também permitiu estimar gastos catastróficos decorrentes do cuidado à SCZ. Resultados: A maioria das mães entrevistadas no estudo era parda, com menos de 34 anos, desempregada e com renda familiar mensal igual ou inferior a dois salários mínimos. Os gastos com medicamentos representaram 77,6% dos gastos médicos, enquanto transporte e alimentação foram os principais componentes dos gastos não médicos, respondendo por 79% desse total. Os domicílios afetados eram, em grande parte, de baixa renda e sofreram gastos catastróficos devido à doença. Considerando a métrica de renda familiar, em 41,7% dos domicílios, os gastos com a doença da criança ultrapassaram 10% da renda familiar. Conclusão: As políticas públicas devem considerar as necessidades financeiras e de saúde dessas famílias para garantir o suporte adequado aos indivíduos acometidos pela SCZ.

Gasto catastrófico y empobrecedor en salud: Un estudio para Argentina / Catastrophic and Impoverishing Expenditure: a study for Argentina

INTRODUCCIÓN: La protección financiera en salud implica que todas las personas accedan a los servicios de salud que necesiten sin sufrir dificultades financieras para pagarlos. Dicha protección se estima mediante indicadores como el gasto catastrófico y empobrecedor en salud. El trabajo tuvo por objetivo estimar esos indicadores para Argentina en el período 2017-2018. MÉTODOS: Se construyeron y analizaron las variables del gasto en salud y los indicadores de gasto catastrófico y empobrecedor en salud a través del procesamiento de la Encuesta Nacional de Gastos de los Hogares (ENGHo) de 2017-2018. Asimismo, se realizó una comparación con la ENGHo 2004-2005. RESULTADOS: Los hogares destinaron un 6,4% del gasto total a bienes y servicios de salud, y un 4,9% del ingreso total. Según la ENGHo 2017-2018, el 11,4% y el 3,3% de los hogares del país incurrió en gasto catastrófico en salud para umbrales del 10% y 25% del gasto total del hogar, respectivamente. Respecto al período 2004- 2005, el indicador cayó con cualquier umbral utilizado. Por su parte, como consecuencia del gasto de bolsillo en salud, los hogares considerados pobres aumentaron en 1,8 puntos porcentuales. DISCUSIÓN: La caída del gasto catastrófico entre los dos períodos en análisis podría exponer un avance en la protección financiera del país. El análisis revela la importancia de contar con datos sobre necesidad, utilización y gasto en servicios de salud de manera simultánea para lograr una mejor comprensión de esta problemática.

Catastrophic Health Expenditure and Impoverishment from NonCommunicable Diseases: A comparison of Private and Public Health Facilities in Ekiti State, Southwest Nigeria

Catastrophic health expenditure and impoverishment are the outcomes of poor financing mechanisms. Little is known about the prevalence and predictors of these outcomes among non-communicable disease patients in private and public health facilities. METHODS: A health facility-based comparative cross-sectional study was conducted among 360 patients with non-communicable diseases (180 per group) selected through multistage sampling. Data were collected with a semi-structured, interviewer administered questionnaire and analyzed with IBM SPSS for Windows, Version 22.0. Two prevalences of catastrophic health expenditure were calculated utilizing both the World Bank (CHE1) and the WHO (CHE2) methodological thresholds. RESULTS: The prevalence of CHE1 (Private:42.2%, Public:21.7%, p<0.001) and CHE2 (Private:46.8%, Public:28.0%, p<0.001) were higher in private health facilities. However, there was no significant difference between the proportion of impoverishment (Private: 24.3%, Public:30.9%, p=0.170). The identified predictors were occupation, number of complications and clinic visits for catastrophic health expenditure and socioeconomic status for impoverishment in private health facilities. Level of education, occupation, socioeconomic status, number of complications and alcohol predicted catastrophic health expenditure while the level of education, socioeconomic status andthe number of admissions predicted impoverishment in public health facilities. CONCLUSION: Catastrophic health expenditure and impoverishment were high among the patients, with the former more prevalent in private health facilities. Therefore, we recommend expanding the coverage and scope of national health insurance among these patients to provide them with financial risk protection. Identified predictors should be taken into account by the government and other stakeholders when designing policies to limit catastrophic health expenditure and impoverishment among them