Search Results (124)

Background/Objectives: Many Medicare beneficiaries often face substantial financial strain due to healthcare costs. This study examined out-of-pocket expenditures for healthcare services by demographics among Medicare beneficiaries in 2019 and 2021. Methods: A repeated cross-sectional study analyzed the 2019 and 2021 Medicare Current Beneficiary Survey Cost Files of beneficiaries aged ≥65 years (2019, n = 6895; 2021, n = 6094). Survey-weighted generalized linear models with a log link and gamma distribution with a three-way interaction of sex (male, female), age (65–74, ≥75), and race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, and Other), adjusted for covariates, and to 2021 USD, were conducted to estimate per capita annual out-of-pocket expenditures for healthcare services, excluding premiums. Results: Estimated average per capita annual out-of-pocket expenditures for healthcare services were $2511 in 2019 and $2641 in 2021. Differences in out-of-pocket expenditures were observed among various demographic groups in 2019 and 2021. Non-Hispanic Blacks had lower out-of-pocket expenditures than non-Hispanic Whites in both years (in 2021, $2139 [1761–2517] vs. $2730 [2580–2879]). Beneficiaries aged 65–74 years who were non-Hispanic Black had lower out-of-pocket expenditures than non-Hispanic Whites in the same age group for both years. A significant proportion of non-Hispanic Blacks had lower incomes (in 2021, income < $25,000, 46.1% vs. 17.0%) and more comorbidities (in 2021, comorbidities ≥ 4, 55.6% vs. 44.7%), compared to non-Hispanic Whites in both years. Similar differences in incomes and comorbidities were observed among those aged 65–74 years of both groups. Conclusions: Medicare beneficiaries face substantial out-of-pocket burdens for healthcare services, with persistent demographic disparities. Understanding contributing factors and implementing effective policies/practices are essential to reduce/mitigate high out-of-pocket expenditures for beneficiaries. Full article

Sustainable rural development requires households to move beyond defensive medical spending and emergency borrowing toward more productive, forward-looking resource allocation. This study uses panel data from the China Household Finance Survey (CHFS), covering the 2017, 2019, and 2021 waves plus a newly released 2023 green-channel wave. We examine whether improvements in safe drinking water, clean cooking energy, and sanitation are associated with lower rural household economic vulnerability. We employ a staggered difference-in-differences design with household and year fixed effects, complemented by event–study tests, mediation analysis, and robustness checks. Environmental infrastructure improvements are significantly associated with lower child hospitalization and out-of-pocket medical expenditure, reduced reliance on high-cost informal credit, and higher income-generating asset shares. Mechanism analysis supports a “health–credit–income” channel, in which environmental improvements reduce preventable health shocks, ease emergency borrowing, and relax liquidity constraints on productive asset allocation. Threshold results further show that these financial-resilience benefits are strongest among households with the lowest baseline resource endowments. The study focuses on rural China, yet the identified health–credit–income mechanism offers a broader, scalable framework. Environmental infrastructure first reduces preventable disease burden, then eases emergency informal borrowing, and finally frees liquidity for income-generating assets. This sequence helps explain how environmental investment can create the financial preconditions for sustainable consumption and investment across developing economies. These findings offer micro-level evidence for integrating environmental infrastructure, rural financial resilience, and ESG social-value assessment. Full article

Objective: To evaluate the impact of urban–rural health insurance integration on the health outcomes and financial burden of rural older adults. Methods: Utilizing panel data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2013 to 2018, we employed a staggered difference-in-differences model coupled with propensity score matching (PSM-DID) for rigorous causal identification. Results: The policy significantly reduced out-of-pocket medical expenditures for rural households by approximately 5.6% (p = 0.034). Concurrently, significant improvements were observed in both physical health (a 0.092-point reduction in ADL impairment scores) and mental health (a 0.725-point reduction in CES-D depression scores). Mechanism analyses revealed that the integration did not significantly increase the probability of outpatient or inpatient visits—thereby ruling out supplier-induced demand and moral hazard—while effectively reducing the incidence of catastrophic health expenditure by 1.9% (p = 0.004). Heterogeneity analyses indicated that while the financial relief was universally distributed across varying educational levels, the policy dividends were predominantly captured by the younger-old demographic. Notably, the reduction in financial burden was not statistically significant for the oldest-old cohort (aged 75 and older). Conclusions: The urban–rural health insurance integration has achieved a dual dividend of financial protection and health enhancement without triggering the overutilization of medical services. Nevertheless, the unmet care expenses for older adults with severe disabilities underscore the urgent necessity for a secondary safety net, such as long-term care insurance. Full article

Background/Objectives: Because the numbers of middle-aged and older adults living alone in Korea have substantially increased, which warrants greater attention to their health-related quality of life. Therefore, we aimed to develop a predictive model for the health-related quality of life among community-dwelling middle-aged and older adults living alone. Methods: Using 2022 Korea Health Panel Survey data, 1313 participants with complete EQ-5D component data were analyzed. All candidate predictors were entered into benchmarked models without pre-model feature selection. Preprocessing and 5-fold cross-validated hyperparameter tuning were conducted within the training data. Final performance was evaluated on a held-out test set, and the selected model was interpreted using SHAP. Results: XGBoost had the lowest training cross-validated RMSE and was selected as the final explainable model. On the test set, it showed moderate performance (R² = 0.373, MAE = 0.070, RMSE = 0.096), outperforming the mean baseline model (RMSE = 0.121) but remaining comparable with other top-performing models. Predictions were within absolute errors of 0.05 and 0.10 for 45.6% and 76.4% of participants, respectively. SHAP ranked subjective health, age, walking time, need for care, and monthly household income as the five highest-ranked predictors. Other highly ranked predictors included unmet medical needs, total annual out-of-pocket expenditure, disability, anxiety, and regular exercise. Conclusions: These findings may inform targeted interventions and support strategies, although external validation and longitudinal studies are needed to confirm generalizability and causal relationships. Full article

Introduction: Musculoskeletal conditions impose a substantial economic burden on the United States (U.S.) healthcare system, but contemporary national estimates of condition-specific spending for common orthopaedic conditions remain limited. This study utilized the 2023 Medical Expenditure Panel Survey (MEPS) to estimate the national prevalence, condition-specific expenditures, and payer distribution for treated knee injuries and shoulder disorders. Methods: Adults with treated knee injuries or shoulder disorders were identified using ICD-10-CM codes from the MEPS Medical Conditions File. Condition-specific expenditures were estimated by linking diagnoses to medical events and payments using the MEPS Condition–Event Link File. Expenditures were aggregated across inpatient, outpatient, office-based, emergency, home health, and prescribed medicine categories. Survey-weighted analyses were used to estimate national prevalence, mean expenditures, service-level spending patterns, and payer distributions. Survey-weighted Gamma generalized linear models with log link were used to examine patient characteristics associated with expenditures among the U.S. civilian noninstitutionalized population with positive condition-specific spending. Results: The analysis identified 2.55 million adults with treated knee injuries and 2.58 million adults with treated shoulder disorders. Mean annual condition-specific expenditures per person were higher for knee injuries ($10,552; 95% CI: $6128–$14,975) than for shoulder disorders ($4310; 95% CI: $3337–$5283). Knee injury expenditures were concentrated in inpatient and home health care, whereas shoulder disorder expenditures were concentrated in outpatient and office-based care. Private insurance, Medicare, out-of-pocket payments, and Worker’s Compensation each contributed to the financial burden, with payer distributions varying by condition. In adjusted models, fair/poor self-rated health and female sex were associated with higher knee injury expenditures, while no covariates were statistically significant for shoulder disorder expenditures. Conclusions: Treated knee injuries and shoulder disorders showed distinct condition-specific expenditure profiles across care settings and payer sources. These findings provide contemporary national benchmarks for orthopaedic spending and may support future research, utilization monitoring, and value-based reimbursement planning. Full article

Background and Objectives: Access to medicines is a fundamental determinant of health equity and a core pillar of universal health coverage, encompassing the timely availability, affordability, and appropriate use of essential medicines. Socioeconomic disparities may limit actual and timely access to pharmacological treatment, particularly in healthcare systems characterized by mixed public–private financing and significant out-of-pocket expenditures. This study aimed to evaluate socioeconomic determinants of access to medicines among Romanian patients with chronic diseases, focusing on income level, prescription reimbursement, perceived affordability, and substitution behavior during medicine shortages. Materials and Methods: A cross-sectional study was conducted between October and December 2024 using a structured online questionnaire administered to 200 adult patients diagnosed with cardiovascular diseases, diabetes mellitus, chronic hepatitis B and C, or oncological conditions, recruited at the “Prof. Dr. D. Hociotă” Institute of Phonoaudiology and Functional ENT Surgery, Bucharest, Romania. Associations between income and access-related variables were assessed using Spearman’s rank correlation coefficients with 95% confidence intervals. Binary logistic regression identified independent predictors of perceived difficulty in accessing medicines (p < 0.05). Results: Lower income was significantly associated with greater reliance on reimbursed prescriptions (r_s = −0.241, 95% CI: −0.37 to −0.10, p = 0.001) and fully reimbursed prescriptions (r_s = −0.305, 95% CI: −0.43 to −0.17, p < 0.001). Income was strongly correlated with perceived affordability of treatment (r_s = 0.601, 95% CI: 0.50–0.69, p < 0.001). In multivariate logistic regression analysis, income below 3000 RON/month (adjusted OR = 1.94, 95% CI: 1.05–3.58, p = 0.034) and insufficient affordability (adjusted OR = 4.12, 95% CI: 2.15–7.89, p < 0.001) were independently associated with perceived difficult access to treatment. Additionally, 80% of respondents reported purchasing substitute medicines when prescribed medicines were unavailable. Conclusions: This cross-sectional study indicates that socioeconomic status and perceived affordability are significant determinants of access to medicines among Romanian patients with chronic diseases attending a tertiary ENT centre. Financial vulnerability remains a major barrier despite existing reimbursement mechanisms. Policy interventions aimed at strengthening income-sensitive reimbursement strategies and ensuring consistent pharmaceutical availability may improve equitable access and therapeutic continuity. Full article

Background: PPPs are central to Saudi Arabia’s Vision 2030 healthcare transformation, yet evidence on their impact on accessibility, quality, and sustainability remains limited. The purpose of this study was to evaluate the perceived associations between PPP implementation under Vision 2030 and three healthcare system outcomes—service accessibility (geographical, financial, technological), care quality (clinical outcomes, patient satisfaction, efficiency), and reform sustainability (economic, operational, adaptive)—from the perspectives of healthcare professionals and patients in Saudi Arabia. Methods: A cross-sectional, mixed-methods design was employed. Surveys were administered to 150 healthcare professionals and 210 patients at PPP-operated facilities (response rates of 61.2% and 65.6%, respectively). Descriptive and inferential statistics—including t-tests, ANOVA, chi-square tests, and multiple regression analysis adjusted for age, sex, education, household income, comorbidities, and facility type were used to assess associations between PPP initiatives and outcomes. Instrument reliability was confirmed (Cronbach’s α ≥ 0.7), and content validity was supported by an expert-panel content validity index of 0.91. Thematic analysis of open-ended responses captured stakeholder perceptions and challenges (inter-coder κ = 0.83). Results: Among professionals, 56.6% reported improved accessibility following the implementation of PPP, with 60.6% endorsing telemedicine as a key facilitator. However, 64.6% indicated financial access remained unchanged or worsened due to persistent out-of-pocket expenditures, and a statistically significant urban–rural gap was observed (p = 0.008). Quality indicators showed positive trends, including improved patient outcomes (52%), reduced waiting times (60.6%), and high satisfaction with hygiene and safety (74%). Sustainability assessments were cautiously favorable (mean financial viability = 3.4/5), though subsidy dependence remained a concern. Adjusted regression analysis identified financial accessibility (β = 0.31, p < 0.001) and reduced waiting times (β = 0.23, p = 0.005) as variables significantly associated with patient-reported outcomes. Conclusions: PPPs were associated with measurable improvements in healthcare accessibility, quality, and efficiency in Saudi Arabia. However, achieving the Vision 2030 objectives requires reforms that address financial equity, service distribution, workforce nationalization, and governance. Full article

An updated understanding of the U.S. oral health care system is essential for addressing the burden of oral disease, high dental expenditures, and persistent inequities in access. This narrative review synthesizes current evidence on the prevalence of major oral diseases, dental care delivery, financing, dental workforce, and public health initiatives, and highlights the challenges and future opportunities in the U.S. A comprehensive search of PubMed, Google Scholar, and reports from U.S. federal agencies and professional organizations was conducted between September 2025 and March 2026. Following the latest National Health and Nutrition Examination Survey, untreated caries remains widespread, affecting 11% of children (ages 2–5), 10% of adolescents (ages 12–19), 21% of adults (ages 35–49), and 12% of older adults (ages 65–74). Periodontal diseases are common, with 42% of adults aged 30 years or older having periodontitis. Oral cancer incidence stands at 11.5 per 100,000 and increases sharply with advancing age. Edentulism among older adults (ages 65–74) was approximately 11%. The U.S. dental workforce includes over 200,000 dentists, yet shortages affect rural and low-income areas, with 62 million Americans living in Dental Health Professional Shortage Areas. Dental care is primarily delivered through private practices, supplemented by community health centers. Financing relies mostly on private insurance and out-of-pocket payments, while the coverage of public programs like Medicaid varies across states, and Medicare generally excludes routine dental care for older adults. Water fluoridation remains widespread, yet ongoing debates highlight persistent challenges. School-based dental sealants and topical fluoride programs are widely recognized as cost-effective and scalable, offering substantial benefits at the population level. Nevertheless, community-based preventive measures are often hindered by resource constraints, inequitable access, and in some cases political conflicts. In summary, oral diseases remain prevalent in the U.S. Limited public coverage, workforce shortages in rural or underserved areas, and uneven access to dental care highlight the need for systemic reforms to improve oral health equity. These findings point to the importance of strengthening dental public health research and coordinated policy action to reduce structural barriers and expand access to dental care. Full article

Background/Objectives: Financial toxicity (FT) is increasingly recognised as a critical dimension of the cancer care continuum, reflecting both objective financial burden and subjective financial distress arising from cancer-related care. Head and neck cancers (HNC) may be particularly vulnerable to FT because treatment often involves multimodal care, functional morbidity, prolonged rehabilitation, and disruption to employment. This scoping review mapped and synthesised the literature on FT in a focused subset of head and neck cancers (HNC), namely malignancies of the oral cavity, oropharynx, nasopharynx, sinonasal tract, and major and minor salivary glands. Methods: A scoping review was conducted in accordance with the methodological guidance of the Joanna Briggs Institute for scoping reviews to identify and synthesise studies addressing FT in the selected HNC subsites. Searches were undertaken in MEDLINE, Embase, Scopus, Web of Science, CINAHL, EconLit, and Global Index Medicus for English-language studies published between 1 January 2015 and 1 January 2025. The search window was restricted to this period to capture the more contemporary evolution of FT as a distinct research construct in oncology. Eligible studies included adult patients and reported patient-level FT outcomes, including direct costs, indirect costs, out-of-pocket expenditure, financial hardship, financial distress, employment disruption, or related economic strain. Findings were synthesised narratively and organised thematically. Results: Twenty-five studies published between 2015 and 2025 were included. The evidence base was dominated by cross-sectional and retrospective designs, with limited prospective follow-up and very little intervention-focused research. FT was conceptualised heterogeneously across studies, spanning direct expenditure, indirect and non-medical costs, subjective financial distress, and coping-related consequences. Questionnaire-based approaches were used in 13 studies, but only a smaller subset employed FT-specific instruments such as COST. Across the literature, FT was most commonly associated with lower income, weaker financial protection, employment disruption, rural residence in some settings, and more intensive treatment. Reported downstream associations included poorer quality of life, psychological distress, care alteration, and work-related burden, although evidence for treatment delay or survival effects was more limited and should be interpreted cautiously. Conclusions: In this focused HNC subset, FT appears multidimensional, socially patterned, and clinically relevant. However, the literature remains methodologically fragmented, with inconsistent measurement and sparse longitudinal evidence. Future work should prioritise validated and tumour-specific assessment strategies, prospective study designs, and evaluation of mitigation interventions that address both direct and indirect burden across the cancer continuum. Full article

Objectives: This study examines how different benefit payment modes under China’s long-term care insurance (LTCI) program influence healthcare utilization and medical expenditures among middle-aged and older adults. Specifically, it compares the effects of in-kind benefits and mixed benefits on healthcare service use and financial burden. Methods: This study uses data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018, focusing on middle-aged and older adults with functional limitations. Exploiting the staggered implementation of LTCI pilot programs across 14 cities, a difference-in-differences (DID) approach is employed to estimate the causal effects of different benefit payment modes on healthcare utilization and expenditures. Heterogeneity analyses are conducted to explore differences between rural and urban populations. Results: The results indicate that the in-kind benefit mode significantly reduces inpatient visits, total medical costs, and out-of-pocket expenditures. By contrast, the mixed benefit mode shows only a modest reduction observed mainly in outpatient visits. Heterogeneity analysis further reveals that in-kind benefits are particularly effective in reducing healthcare utilization and medical expenditures among rural residents, while urban residents experience higher reductions in out-of-pocket spending. Conclusions: These findings highlight the importance of benefit design in shaping the effectiveness of LTCI policies. Prioritizing service-based benefits may improve healthcare system efficiency and reduce financial burdens among older adults. The results provide policy-relevant insights for optimizing LTCI benefit design in China and other aging societies. Full article

Pediatric pneumonia remains a major cause of morbidity and mortality in low- and middle-income countries (LMICs), imposing both health and financial burdens. While the clinical aspects of pediatric pneumonia are well-studied, less attention has been paid to its economic implications for households, particularly regarding out-of-pocket (OOP) expenditure. This paper synthesizes current evidence from Kenya, India, Bangladesh, and Vietnam and introduces a proposed econometric framework designed to identify cost determinants and model policy interventions. The framework integrates microeconomic data, identifies cost determinants, and models the effects of clinical and policy factors (e.g., intensive care, vaccination, insurance coverage) on household expenditures. Simulated results illustrate potential findings from such an approach. Existing studies show substantial variability in hospitalization costs, with OOP payments ranging from US$30 to US$250 per episode, often exceeding 20% of monthly household income. Econometric modeling using generalized linear models (GLMs) and difference-in-differences (DiD) can disentangle the impact of hospital practices, disease severity, and policy interventions. Simulated regression results demonstrate that length of stay, intensive care admission, and absence of insurance significantly increase household costs, while pneumococcal conjugate vaccine (PCV) introduction reduces both admissions and financial burden. Hospitalization for pediatric pneumonia imposes significant OOP costs on households in LMICs. An econometric framework provides rigorous tools to estimate cost drivers, evaluate policy impacts, and guide equitable health financing reforms. Full article

Background/Objectives: This study examines gender differences in healthcare utilization and financial burden across family structures under Korea’s near-universal health insurance system. Methods: Using 2010–2018 Korea Health Panel data, we applied a two-part model to estimate initiation of care, conditional utilization, and expected out-of-pocket expenditures. Results: Single fathers were less likely to initiate care, whereas single mothers had higher unmet needs and substantially greater conditional and expected out-of-pocket spending, with expected expenditures approximately 46% higher than those of two-parent households. Conclusions: We document stage-specific disparities in healthcare utilization and financial burden across family structures even under near-universal coverage, indicating the need for policies that strengthen both access and financial protection for single-parent households. Full article

National legislative frameworks governing prescribing, pricing, reimbursement, and dispensing play a decisive role in shaping access to medicines. This study examines the financial availability of medicines in Bulgaria and North Macedonia through a comparative review of national pharmaceutical legislation, pricing mechanisms, reimbursement models, and digitalisation policies, assessed in relation to European Union standards. The findings indicate that access to medicines in both countries is shaped by the combined effects of multiple regulatory and financial instruments rather than by individual policy measures. Both systems apply strict control of prescribing and dispensing, external reference pricing, and positive reimbursement lists, reflecting alignment with international recommendations. However, significant differences in policy design lead to divergent access outcomes. Bulgaria’s more advanced digitalisation of prescribing and reimbursement, including mandatory electronic prescribing for selected therapeutic groups, enhances regulatory oversight and expenditure control but is associated with higher patient out-of-pocket expenditure, partly due to the application of the standard value-added tax on medicines. In contrast, North Macedonia combines lower taxation with capped patient co-payments, higher regulated pharmacy margins, and fixed pharmacy remuneration per prescription, contributing to improved financial affordability for patients while supporting pharmacy sustainability. Additional instruments, such as the Generics without Co-Payment List, further strengthen patient financial protection. The study provides comparative evidence relevant to pharmaceutical policy reforms and highlights the importance of balanced regulatory approaches that promote affordability, system sustainability, and equitable access to medicines. Full article

Background: Surgical care is being increasingly recognized as a critical component of universal health coverage (UHC), with unmet surgical needs contributing substantially to morbidity, mortality, and financial hardship in low- and middle-income countries. In India, out-of-pocket expenditure (OOPE) remains the dominant mechanism for financing surgical care, raising concerns regarding financial risk protection. Publicly financed health insurance schemes such as the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) have been introduced to reduce OOPE for inpatient services. Methods: A hospital-based single-center case study with a cross-sectional analytical design was conducted in a tertiary care teaching hospital in coastal Karnataka, India. A total of 150 patients undergoing common general surgical procedures (laparoscopic cholecystectomy, laparoscopic appendicectomy, inguinofemoral hernia repair, and umbilical hernia repair) were enrolled. Patients were categorized into three groups: uninsured, privately insured, and AB-PMJAY beneficiaries. Direct medical expenditure components were captured, and OOPE was compared across groups. Post hoc comparisons were performed following one-way ANOVA. Results: OOPE varied substantially across insurance categories. Uninsured patients incurred the highest mean OOPE, followed by privately insured patients, while AB-PMJAY beneficiaries reported negligible OOPE. Differences across groups were statistically significant (p < 0.001). Conclusions: Uninsured patients incurred a high financial burden for common surgical procedures, while private health insurance offered partial financial protection compared to no insurance. AB-PMJAY substantially reduced point-of-care expenditure for eligible beneficiaries. Expanding financial risk protection for surgical care may be essential for advancing equitable access and achieving UHC in India. Full article