169 lines
5.6 KiB
YAML
169 lines
5.6 KiB
YAML
abstract: 'STUDY QUESTION: How do households recover financially from direct
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out-of-pocket payment for government subsidized ART?
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SUMMARY ANSWER: After a mean of 3.8 years, there was poor recovery from
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initiated financial coping strategies with the poorest households being
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disproportionatley affected.
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WHAT IS KNOWN ALREADY: Out-of-pocket payment for health services can
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create financial burdens for households and inequities in access to
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care. A previous study conducted at a public-academic institution in
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South Africa documented that patient co-payment for one cycle of ART
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resulted in catastrophic expenditure for one in five households, and
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more frequently among the poorest, requiring diverse financial coping
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strategies to offset costs.
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STUDY DESIGN, SIZE, DURATION: An observational follow-up study was
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conducted similar to 4 years later to assess financial recovery among
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the 135 couples who had participated in this previous study. Data were
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collected over 12 months from 73 informants.
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PARTICIPANTS/MATERIALS, SETTING, METHOD: The study was conducted at a
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level three referral hospital in the publicacademic health sector of
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South Africa. At this institution ART is subsidized but requires patient
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co-payments. A purpose-built questionnaire capturing socio-economic
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information and recovery from financial coping strategies which had been
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activated was administered to all informants. Financial recovery was
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defined as the resolution of strategies initiated for the specific
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purpose of covering the original ART cycle. Results were analysed by
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strategy and household with the latter including analysis by tertiles
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based on socio-economic status at the time of the original expenditure.
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In addition to descriptive statistics, the Pearson Chi squared test was
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used to determine differences between socioeconomic tertiles and
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associations between recovery and other variables.
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MAIN RESULTS AND THE ROLE OF CHANCE: The participation rate in this
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follow-up study was 54.1\% with equal representation from the three
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socio-economic tertiles. The average duration of follow-up was 46.1
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months (+/- 9.78 SD) and respondents'' mean age was 42 years (range
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31-52). The recovery rate was below 50\% for four of five strategies
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evaluated: 23.1\% of households had re-purchased a sold asset; 23.5\%
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had normalized a previous reduction in household spending, 33.8\% had
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regained their savings, and 48.7\% were no longer bolstering income
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through additional work. Two-thirds of households (60.0\%) had repaid
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all loans and debts. The poorest households showed lower rates of
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recovery when compared to households in the richest tertile. Complete
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recovery from all strategies initiated was reported by only 10
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households (13.7\%): 1 of 19 in the lowest tertile, 3 of 30 in the
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middle and by 6 of 24 households in the richest tertile (P > 0.05). No
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association was found between the degree of financial recovery and
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additional cost burdens incurred, including related to babies born; or
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between the degree of recovery and ongoing pursuit of ART.
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LIMITATIONS, REASONS FOR CAUTION: The sample size was limited. The
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participation rate was just over 50\%. Results were dependent on
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participants'' narrative and recall.
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WIDER IMPLICATIONS OF THE FINDINGS: The willingness of patients to pay
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for ART does not necessarily imply the ability to pay. As a result, the
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lack of comprehensive third-party funding for ART can create immediate
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and long-term financial hardship which is more pronounced among poorer
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households. While more data on the impact of out-of-pocket payment for
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ART are needed to illustrate the problem in other low resource settings,
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the results from South Africa provide useful information for similar
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developing countries. The current absence of more extensive data should
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therefore not be a barrier to the promotion of financial risk protection
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for infertile couples, especially the poorest, in need of ART.'
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affiliation: 'Dyer, SJ (Corresponding Author), Groote Schuur Hosp, Dept Obstet \&
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Gynaecol, Main Rd, ZA-7925 Observatory, South Africa.
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Dyer, Silke J.; Vinoos, Latiefa, Univ Cape Town, Groote Schuur Hosp, Dept Obstet
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\& Gynaecol, Main Rd, ZA-7925 Cape Town, South Africa.
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Dyer, Silke J.; Vinoos, Latiefa, Univ Cape Town, Fac Hlth Sci, Main Rd, ZA-7925
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Cape Town, South Africa.
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Ataguba, John E., Univ Cape Town, Fac Hlth Sci, Hlth Econ Unit, Anzio Rd, ZA-7925
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Cape Town, South Africa.'
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author: Dyer, Silke J. and Vinoos, Latiefa and Ataguba, John E.
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author-email: silke.dyer@uct.ac.za
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author_list:
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- family: Dyer
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given: Silke J.
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- family: Vinoos
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given: Latiefa
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- family: Ataguba
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given: John E.
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da: '2023-09-28'
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doi: 10.1093/humrep/dex315
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eissn: 1460-2350
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files: []
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issn: 0268-1161
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journal: HUMAN REPRODUCTION
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keywords: 'assisted reproductive technology; out-of-pocket payment; infertility;
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health economics; Africa; health expenditures; income; developing
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countries'
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keywords-plus: 'DEVELOPING-COUNTRIES; COPING STRATEGIES; ECONOMIC-IMPACT; HEALTH-CARE;
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INFERTILITY; CONSEQUENCES; PATIENT; SECTOR; COSTS; INDIA'
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language: English
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month: DEC
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number: '12'
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number-of-cited-references: '24'
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orcid-numbers: Ataguba, John Ele-Ojo/0000-0002-7746-3826
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pages: 2431-2436
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papis_id: e26809c535eaccc1443b0d3896d625b1
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ref: Dyer2017poorrecovery
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times-cited: '8'
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title: Poor recovery of households from out-of-pocket payment for assisted reproductive
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technology
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type: article
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unique-id: WOS:000417055700009
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usage-count-last-180-days: '0'
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usage-count-since-2013: '7'
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volume: '32'
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web-of-science-categories: Obstetrics \& Gynecology; Reproductive Biology
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year: '2017'
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