PHP37 THE IMPACT OF UNIVERSAL COVERAGE ON EQUITY IN HEALTH CARE FINANCE AND FINANCIAL RISK PROTECTION IN THAILAND

Abstract Background: Monitoring progress towards Universal Health Coverage (UHC) requires an assessment of progress in coverage of health services and protection of households from the impact of direct out-of-pocket payments (i.e. financial risk protection). Although Uganda has expressed aspirations for attaining UHC, out-of-pocket payments remain a major contributor to total health expenditure. This study aims to monitor progress in financial risk protection in Uganda. Methods: This study uses data from the Uganda National Household Surveys for 2005/06, 2009/10, 2012/13 and 2016/17. We measure financial risk protection using catastrophic health care payments and impoverishment indicators. Health care payments are catastrophic if they exceed a set threshold (i.e. 10% and 25%) of the total household consumption expenditure. Health payments are impoverishing if they push the household below the poverty line (the US$1.90/day and Uganda’s national poverty lines). A logistic regression model is used to assess the factors associated with household financial risk.Results: The results show that while progress has been made in reducing financial risk, this progress remains minimal, and there is still a risk of a reversal of this trend. We find that although catastrophic health payments at the 10% threshold decreased from 22.4% in 2005/06 to 13.8% in 2012/13, it increased to 14.2% in 2016/17. The percentage of Ugandans pushed below the national poverty line (US$1.90/day) has decreased from 5.2% in 2005/06 to 2.7% in 2016/17. The distribution of both catastrophic health payments and impoverishment varies across socio-economic status, location and residence. In addition, certain household characteristics (poverty, having a child below 5 years and an adult above 60 years) are more associated with the lack of financial risk protection. Conclusion: There is a need for targeted interventions to reduce OOP payments, especially among those most affected to increase financial risk protection. In the short-term, it is important to ensure that public health services are funded adequately to enable effective coverage with quality health care. In the medium-term, increased reliance on mandatory prepayment will reduce the burden of OOP health spending further.

Download Full-text

What has been the progress in addressing financial risk in Uganda? Analysis of catastrophe and impoverishment due to health payments

10.21203/rs.2.20134/v2 ◽

2020 ◽

Author(s):

Brendan Kwesiga ◽

Tom Aliti ◽

Pamela Nabukhonzo Kakande ◽

Peter Byawaka ◽

Susan Najjuko ◽

...

Keyword(s):

Health Care ◽

Health Services ◽

Financial Risk ◽

Poverty Line ◽

Financial Risk Protection ◽

Quality Health Care ◽

Targeted Interventions ◽

Out Of Pocket Payments ◽

Risk Protection ◽

The Impact

Abstract Background: Monitoring progress towards Universal Health Coverage (UHC) requires an assessment of progress in coverage of health services and protection of households from the impact of direct out-of-pocket payments (i.e. financial risk protection). Although Uganda has expressed aspirations for attaining UHC, out-of-pocket payments remain a major contributor to total health expenditure. This study aims to monitor progress in financial risk protection in Uganda. Methods: This study uses data from the Uganda National Household Surveys for 2005/06, 2009/10, 2012/13 and 2016/17. We measure financial risk protection using catastrophic health care payments and impoverishment indicators. Health care payments are catastrophic if they exceed a set threshold (i.e. 10% and 25%) of the total household consumption expenditure. Health payments are impoverishing if they push the household below the poverty line (the US$1.90/day and Uganda’s national poverty lines). A logistic regression model is used to assess the factors associated with household financial risk.Results: The results show that while progress has been made in reducing financial risk, this progress remains minimal, and there is still a risk of a reversal of this trend. We find that although catastrophic health payments at the 10% threshold decreased from 22.4% in 2005/06 to 13.8% in 2012/13, it increased to 14.2% in 2016/17. The percentage of Ugandans pushed below the poverty line (US$1.90/day) has decreased from 5.2% in 2005/06 to 2.7% in 2016/17. The distribution of both catastrophic health payments and impoverishment varies across socio-economic status, location and residence. In addition, certain household characteristics (poverty, having a child below 5 years and an adult above 60 years) are more associated with the lack of financial risk protection. Conclusion: There is a need for targeted interventions to reduce OOP payments, especially among those most affected to increase financial risk protection. In the short-term, it is important to ensure that public health services are funded adequately to enable effective coverage with quality health care. In the medium-term, mandatory prepayment through health insurance will be needed to reduce the burden of OOP health spending further.

Download Full-text

What has been the progress in addressing financial risk in Uganda? Analysis of catastrophe and impoverishment due to health payments

BMC Health Services Research ◽

10.1186/s12913-020-05500-2 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Brendan Kwesiga ◽

Tom Aliti ◽

Pamela Nabukhonzo ◽

Susan Najuko ◽

Peter Byawaka ◽

...

Keyword(s):

Health Care ◽

Health Services ◽

Financial Risk ◽

Poverty Line ◽

Financial Risk Protection ◽

Quality Health Care ◽

Targeted Interventions ◽

Out Of Pocket Payments ◽

Risk Protection ◽

The Impact

Abstract Background Monitoring progress towards Universal Health Coverage (UHC) requires an assessment of progress in coverage of health services and protection of households from the impact of direct out-of-pocket payments (i.e. financial risk protection). Although Uganda has expressed aspirations for attaining UHC, out-of-pocket payments remain a major contributor to total health expenditure. The aim of this study is to monitor progress in financial risk protection in Uganda. Methods This study uses data from the Uganda National Household Surveys for 2005/06, 2009/10, 2012/13 and 2016/17. We measure financial risk protection using catastrophic health care payments and impoverishment indicators. Health care payments are catastrophic if they exceed a set threshold (i.e. 10 and 25%) of the total household consumption expenditure. Health payments are impoverishing if they push the household below the poverty line (the US$1.90/day and Uganda’s national poverty lines). A logistic regression model is used to assess the factors associated with household financial risk. Results The results show that while progress has been made in reducing financial risk, this progress remains minimal, and there is still a risk of a reversal of this trend. We find that although catastrophic health payments at the 10% threshold decreased from 22.4% in 2005/06 to 13.8% in 2012/13, it increased to 14.2% in 2016/17. The percentage of Ugandans pushed below the national poverty line (US$1.90/day) has decreased from 5.2% in 2005/06 to 2.7% in 2016/17. The distribution of both catastrophic health payments and impoverishment varies across socio-economic status, location and residence. In addition, certain household characteristics (poverty, having a child below 5 years and an adult above 60 years) are more associated with the lack of financial risk protection. Conclusion There is need for targeted interventions to reduce OOP, especially among those affected so as to increase financial risk protection. In the short-term, it is important to ensure that public health services are funded adequately to enable effective coverage with quality health care. In the medium-term, increased reliance on mandatory prepayment will reduce the burden of OOP health spending further.

Download Full-text

What has been the progress in addressing financial risk in Uganda? Analysis of catastrophe and impoverishment due to health payments

10.21203/rs.2.20134/v1 ◽

2020 ◽

Author(s):

Brendan Kwesiga ◽

Tom Aliti ◽

Pamela Nabukhonzo Kakande ◽

Peter Byawaka ◽

Susan Najjuko ◽

...

Keyword(s):

Health Care ◽

Financial Risk ◽

Economic Status ◽

Poverty Line ◽

Health Coverage ◽

Financial Risk Protection ◽

Quality Health Care ◽

Out Of Pocket Payments ◽

Risk Protection ◽

The Impact

Abstract Background: Monitoring progress towards Universal Health Coverage (UHC) requires an assessment of progress in coverage of health services and protection of households from the impact of direct out-of-pocket payments (i.e. financial risk protection). Although Uganda has expressed aspirations for attaining UHC, out-of-pocket payments remain a major contributor to total health expenditure. The aim of this study is to monitor progress in financial risk protection in Uganda. Methods: This study uses data from the Uganda National Household Surveys for 2005/06, 2009/10, 2012/13 and 2016/17. We measure financial risk protection using catastrophic health care payments and impoverishment indicators. Health care payments are catastrophic if they exceed a set threshold (i.e. 10% and 25%) of the budget share of total household consumption expenditure. Health payments are impoverishing if they push the household below; the poverty line (using the US$1.90/day and Uganda’s national poverty lines). Logistic regression model is used to assess factors associated with household financial risk.Results: The results show that while progress has been made in reducing financial risk, this progress remains minimal and there is still a risk of reversal of this trend. We find that although catastrophic health payments at the 10% threshold decreased from 22.4% in 2005/06 to 13.8% in 2012/13, it increased to 14.2% in 2016/17. The percentage of Ugandans pushed below the poverty line (US$1.90/day) has decreased from 5.2% in 2005/06 to 2.7% in 2016/17. We show that the distribution of both catastrophic health payments and impoverishment varies across socio-economic status, location and residence. In addition, household characteristics (poverty, having a child below 5 years and an adult above 60 years) are more associated with households lacking financial risk protection. Conclusion: To address the lack of financial risk protection, there is need for interventions aimed at reducing out-of-pocket payments especially among those most affected. In short term, it is important to ensure that there is increased funding for publicly financed services to enable effective coverage with quality health care. In the medium term, introducing mandatory prepayment through health insurance will further reduce the burden due to household expenditure.

Download Full-text

Treatment as insurance: HIV antiretroviral therapy offers financial risk protection in Malawi

Health Policy and Planning ◽

10.1093/heapol/czaa023 ◽

2020 ◽

Vol 35 (6) ◽

pp. 676-683

Author(s):

Sarah Dickerson ◽

Victoria Baranov ◽

Jacob Bor ◽

Jeremy Barofsky

Keyword(s):

Health Expenditure ◽

Financial Risk ◽

Health Expenditures ◽

Catastrophic Health Expenditure ◽

Hiv Treatment ◽

Financial Risk Protection ◽

Urban Households ◽

Medical Spending ◽

Risk Protection ◽

The Impact

Abstract Many countries have expanded insurance programmes in an effort to achieve universal health coverage (UHC). We assess a complementary path toward financial risk protection: increased access to technologies that improve health and reduce the risk of large health expenditures. Malawi has provided free HIV treatment since 2004 with significant US Government support. We investigate the impact of treatment access on medical spending, capacity to pay and catastrophic health expenditures at the population level, exploiting the phased rollout of HIV treatment in a difference-in-differences design. We find that increased access to HIV treatment generated a 10% decline in medical spending for urban households, a 7% increase in capacity to pay for rural households and a 3-percentage point decrease in the likelihood of catastrophic health expenditure among urban households. These risk protection benefits are comparable to that found from broad-based insurance coverage in other contexts. Our findings show that targeted treatment programmes that provide free care for high burden causes of death can provide substantial financial risk protection against catastrophic health expenditure, while moving developing nations toward UHC.

Download Full-text