Results from some studies in rural area of Vietnam have shown that poor people are likely tend to sell assets while non poor people are able to pay for health care services. This makes poor people fall into poverty trap. Objectives: To identify the average household health expenditure during a year and sources of borrowing money and average amount of borrowing as well for health care services. Methods: 621 households were selected randomly from the Filabavi, Bavi District, Ha Tay Province. A longitudinal descriptive study was conducted for one year from July 2001 to June 2002. All selected households were interviewed one time per month. Results and conslusion: average payment household for health care services for one year was VND 519.000 (6.4% of total annual household income). Annual household income of poor group was VND 6,576,000, among this 8.4% was paid for health care services. There was 16.9% household had to borrow money for health care services average1y, while 23.1% of poor household had to borrow money for health care services. Borrowing sources included relatives (85%), neighbours (50%), Bank (26%), friends (15%), community organizations (9%) and private organizations with some interest (18%).
Health Expenditures, Rural Health

This study was conducted to determine how the regional health insurance program, put into effect nation- wide, might affect paterns and extent of medical care utilization in rural areas. The study employed a "onegroup, before-after design" and the data were collected from two sampling surveys conducted in Kangwha County, based on "multi-stage, stratified cluster sampling. "Changes in ambulatory care utilization, as measured in terms of the number of visits per 100 persons during the two-week survey period, varied with the type of facility. Out-of-pocket expenses for medical care connected with all forms of facilities were found to have decreased during the time interval due to insurance coverage. Before insurance, when a person sought medical help at a drugstore, it was more often because it was conveniently close and he or she was old and believed himself or herself to not be seriously ill; when a person sought medical help at a clinic or hospital, it was because he or she believed himself or herself to be seriously ill(i.e. only morbidity condition was a significant factor). After insuranc, when a person sought help at a drugstore, it was mainly because he or she was old and the drugstore was conveniently located. when a person sought help at a clinic or hospital, it was because he or she believed himself or herself to be seriously ill and, in addition, because the facility was conveniently located (i.e. geographical accessibility became an added factor of significance). Furthermore, knowledge of benefit coverage increased as residents gained more experience with the program during the interval between surveys.
Health Expenditures ; Health Services/utilization* ; Human ; Insurance, Health* ; Korea ; Rural Population*

Finances of health insurance can be explained by factors determining benefit expense and premium collection. This study was conducted to analyze factors contributing to the financial status of rural health insurance. Nationwide 134 health insurance associations except the six pilot project counties were analyzed and obtained the followings. 1. In univariate analysis, statistically significant variables that explain 1) outpatient benefit expenditures include public health center utilization, proportion of pregnant women, premium and collection rate of premium 2) inpatient benefit expenditures include public health center utilization, proportion of old age, proportion of pregnant women, premium and collection rate of premium 3) profits include public health center utilization, proportion of old age, proportion of pregnant women and collection rate of premium. 2. In multiple regression analysis, statistically significant determinants in 1) outpatient benefit include premium and public health utilization 2) inpatient benefit include premium 3) profit include public health center utilization, premium and collection rate of premium.
Female ; Health Expenditures ; Humans ; Inpatients ; Insurance ; Insurance, Health* ; Outpatients ; Pilot Projects ; Pregnant Women ; Public Health ; Regression Analysis ; Rural Health

Demand for high quality medical care has recently been increasing in step with high level of income and education. Patients prefer the use of large general hospitals to small community hospitals. Large hospitals, usually located at urban area, expand their capacities to cope with the increasing demand, therefore, they easily secure revenue necessary for growth and development of hospitals. However, small community hospitals are facing with serious financial difficulties caused from the reduction of patients in one hand and the inflation of cost in another. If small rural hospitals were closed, the closure would have negative impacts on local economies in addition to the decrease in access to medical care. Community leaders should have an insight on the contribution of community hospitals to local economies. They could make a rational decision on the hospital closure only with the understanding of hospital's contribution to the community. This study is designed to develop an economic model to estimate the contribution of rural hospital to local economies, and also to apply this model with a specific hospital. The contribution of a hospital to local economies consists of two elements, direct effect and multiplier effects. The direct impacts include hospital's local purchasing power, employee's local purchasing power, and the consumption of patients coming from outside the community. The direct impact induces multiplication effect in the local economy. The seed money invested to other industries grows through economic activities in the economy. The seed money invested to other industries grows through economic activities in the region. This study estimated the direct effect with the data of expenditure of the case hospital. The total effect was calculated by multiplied the direct effect with a multiplier. The multiplier was drown from the ratio of marginal propensity of income and expenditure. Beside the estimation of the total impacts, the economic effect from the external resources was also analyzed by the use of the ratio of patients coming outside the region. The results are as follows. 1. The direct economic contribution of the hospital to the local economy is 1,104 million won. 2. The value of multiplier in the region is 2.976. 3. The total economic effect is 3,286 million won, and the multiplication effect is 2,182 million won. 4. The economic contribution from the external resources is 245 million won which is 7.5% of the total economic effect.
Education ; Growth and Development ; Hand ; Health Expenditures ; Health Facility Closure ; Hospitals, Community ; Hospitals, General ; Hospitals, Rural* ; Humans ; Inflation, Economic ; Models, Economic

OBJECTIVETo explore the situation of equity in health service delivery in the experimental region of new rural cooperative medical scheme (NRCMS).

METHODSA household questionnaire survey was conducted to 2112 residents in the experimental county of NRCMS in Yuexi county with a stratified-cluster sampling on the situation of health service delivery, from July 1-15,2005. Data was analyzed with Epi Info 6.04 and SPSS 11.0 software and indices as rate, ratio, Gini coefficient, concentration index (CI) and chi-square test etc.

RESULTSThere was no significante difference of the treatment-seeking rate during two weeks among five groups economic condition residents (chi2 = 5.52, P > 0.05) and the rates were 48.14 per thousand, 82.90 per thousand, 65.88 per thousand, 48.72 per thousand and 50.66 per thousand respectively with CI = -0.026. Similarly, the hospitalization rates were 59.08 per thousand, 67.36 per thousand, 51.76 per thousand, 58.97 per thousand and 52.86 per thousand respectively in the last year and the CI = - 0.017. But there was a significante difference of rates on chronic disease among the five groups of residents with different economic conditions in the last six months (chi2 = 18.42, P < 0.01) and the rates were 295.40 per thousand, 243.52 per thousand, 230.59 per thousand, 225.64 per thousand and 176.21 per thousand and the CI = -0.055. When income reduced, the prevalence had been increasing among residents. Meanwhile, the collection funds showed unfair in residents with various income and the compensating fund of new rural cooperative medical scheme had not reduced the gap between rich and poor.

CONCLUSIONThere was an unequity of medicine expenditure and compensating fund in residents with various income in the experimental region. The low income residents had a high health service need and the government should improve NRCMS greatly to change the situation.

China ; Data Collection ; Delivery of Health Care ; Health Expenditures ; Health Services Needs and Demand ; Healthcare Disparities ; Humans ; Income ; Rural Health Services ; economics ; utilization

BACKGROUNDThe New Rural Cooperative Medical Scheme (NCMS) has been further adjusted and optimized to reduce the financial burden of rural residents and to achieve universal coverage for them. In this study, we aimed to explore the impact of NCMS on medical service utilization and medical expense of inpatients in recent years.

METHODSThe research data of Hainan Province were extracted from the Chinese NCMS platform from 2012 to 2014. Detailed information included total expenditure, average inpatients costs, average out-of-pocket payments, actual reimbursement rate, and average annual growth rate of the above indicators. Descriptive analysis was used to gauge the effects of NCMS.

RESULTSIn the utilization of medical services, NCMS inpatients in tertiary hospital decreased from 25.49% in 2012 to 20.39% in 2014, inpatients in county hospitals increased from 39.49% to 55.92%, simultaneously. The total expenditure in county hospitals rose steadily from 28.46% to 46.66%, meanwhile, the total expenditure in tertiary hospitals fell from 60.44% to 44.51%.The average out-of-pocket costs of rural inpatients remained stable over the years. Furthermore, the compensation fund of NCMS inpatients grew significantly. The actual inpatient reimbursement rate at township health centers increased from 76.93% to 84.04%. Meanwhile, the rate at county hospitals and tertiary hospitals increased slightly from 59.37% and 46.10% to 61.25% and 47.71%, respectively.

CONCLUSIONSWith the improvement of the reimbursement ability, especially after the new health care reform in 2009, the NCMS have been playing a prominent role in alleviating the economic burden of farmers' medical treatment. Meanwhile, more patients go to primary hospitals than tertiary hospitals, and the capability of primary hospitals has been greatly improved.

China ; Female ; Health Expenditures ; statistics & numerical data ; Hospitalization ; statistics & numerical data ; Humans ; Inpatients ; statistics & numerical data ; Insurance, Health ; economics ; Male ; Rural Population

BACKGROUND: Depression is prevalent and a serious disorder in the elderly that interferes with social and physical function. It is associated with significant morbidity and a high mortality rate from suicide. Depression is highly treatable disease, but it remain largely unrecognized and untreated among the elderly. This study evaluate the factors related to depression of elderly, to be used as basic reference for management program in the community. METHODS: The cross-sectional study evaluates the depression of community-living elderly, aged 60 and older, in a Korean rural community. The subject were selected from a two stage cluster sampling. Questionnaire contained demographics, Geriatric Depression Scale (GDS), Mini-Nutritional Assessment (MNA), Mini-Mental Status Exam-Korean (MMSE-K), IADL, Social support network. T-test and multiple stepwise regression were constructed to explore the factors related to depression. RESULTS: Mean age was 71.22+/-7.1 with 101 male subjects and 200 female subjects. The mean GDS score was 6.9+/-3.7 and 56.5% of subjects were suggested depression (above 5 point on GDS). The mean score from the GDS showed significant differences in terms of following factors: gender, age, education, marital status, income, expenditures, type of residency, cognitive function, presence of disease, number of medications, stress, subjective self perception of health, IADL, nutrition, emotional support, social activity support, instrumental support (p<0.05). In the multiple stepwise regression analysis on depression, nutrition, IADL, education, presence of disease were selected as highly correlated variables (p<0.05), and religion, cognitive function, subjective self perception of health, stress were also selected (p>0.05). These variables explained 34.2% of depression. CONCLUSION: Nutritional status, cognitive function, physical state, functional state, social support network demographic characteristics were related to depression in the elderly.
Aged* ; Cross-Sectional Studies ; Demography ; Depression* ; Education ; Female ; Health Expenditures ; Humans ; Internship and Residency ; Male ; Marital Status ; Mortality ; Nutritional Status ; Surveys and Questionnaires ; Rural Population* ; Self Concept ; Suicide

BACKGROUND: Nutrition is closely related to morbidity and mortality, and active intervention is known to be effective in their prevention. This study evaluates the factors related to nutritional status of elderly, to be used as a basic reference for effective prevention program. METHODS: The cross-sectional study evaluates the nutritional status of community-living elderly, aged 60 and older, in a Korean rural community. The subject were selected from a two stage cluster sampling. Questionnaire contained demographics, the Mini-Nutritional Assessment(MNA), Mini-Mental Status Exam-Korean(MMSE-K), Geriatric Depression Scale(GDS), IADL, Social support network, and dietary patters. T-test and hierarchical regression models were constructed to explore the factors related to nutritional status. RESULTS: Mean age was 72+/-7.1 with 101 male subjects and 200 female subject. The MNA score revealed 41.5% of subjects who were at risk of malnutrition. The mean MNA score showed significant differences in terms of following factors: gender, age, education, marital status, income, expenditures, MMSE-K, GDS, social support, instrumental support, regularity of meal, changes in taste, satisfaction in food, unbalanced dietary habit, number of family members sharing the meal, IADL, presence of disease, number of medications(p<0.05). Multiple regression analysis revealed that demographic characteristics explained 7.5% of nutritional status, social support network 6.7%, mental disease 25.3%, dietary pattern 23.8% , and physical disease 22.2% correspondingly. Whole model explained 45.1% of nutritional status. The significant variables were the number of medications, presence of stress, unbalanced dietary habit, regularity of meal, instrumental support, depression, cognition, and satisfaction in food(p<0.05). CONCLUSION: Mental and physical state, dietary pattern, social support network, demographic characteristics were related to nutritional status.
Aged* ; Cognition ; Cross-Sectional Studies ; Demography ; Depression ; Education ; Female ; Food Habits ; Health Expenditures ; Humans ; Male ; Malnutrition ; Marital Status ; Meals ; Mortality ; Nutritional Status* ; Surveys and Questionnaires ; Rural Population

This cross-sectional study assessed household food insecurity among low-income rural communities and examined its association with demographic and socioeconomic factors as well as coping strategies to minimize food insecurity. Demographic, socioeconomic, expenditure and coping strategy data were collected from 200 women of poor households in a rural community in Malaysia. Households were categorized as either food secure (n=84) or food insecure (n=116) using the Radimer/Cornell Hunger and Food Insecurity instrument. T-test, Chi-square and logistic regression were utilized for comparison of factors between food secure and food insecure households and determination of factors associated with household food insecurity, respectively. More of the food insecure households were living below the poverty line, had a larger household size, more children and school-going children and mothers as housewives. As food insecure households had more school-going children, reducing expenditures on the children's education is an important strategy to reduce household expenditures. Borrowing money to buy foods, receiving foods from family members, relatives and neighbors and reducing the number of meals seemed to cushion the food insecure households from experiencing food insufficiency. Most of the food insecure households adopted the strategy on cooking whatever is available at home for their meals. The logistic regression model indicates that food insecure households were likely to have more children (OR=1.71; p<0.05) and non-working mothers (OR=6.15; p<0.05), did not own any land (OR=3.18; p<0.05) and adopted the strategy of food preparation based on whatever is available at their homes (OR=4.33; p<0.05). However, mothers who reported to borrow money to purchase food (OR=0.84; p<0.05) and households with higher incomes of fathers (OR=0.99; p<0.05) were more likely to be food secure. Understanding the factors that contribute to household food insecurity is imperative so that effective strategies could be developed and implemented.
Child ; Cooking ; Cross-Sectional Studies ; Family Characteristics ; Fathers ; Female ; Food Supply ; Health Expenditures ; Humans ; Hunger ; Logistic Models ; Malaysia ; Meals ; Mothers ; Poverty ; Rural Population ; Socioeconomic Factors