scholarly journals Assessing medical impoverishment and associated factors in health care in Ethiopia

2020 ◽  
Author(s):  
Amarech Guda Obse ◽  
John E. Ataguba
Keyword(s):  
Rural Areas ◽  
Health Expenditure ◽  
Addis Ababa ◽  
Significant Proportion ◽  
Health Spending ◽  
Sub Saharan Africa ◽  
Financial Protection ◽  
Health Coverage ◽  
Current Health ◽  
Out Of Pocket Payments

Abstract Background: About5% of the global population, predominantly in low- and middle-income countries, is forced into poverty because of out-of-pocket (OOP) health spending. In most countries in sub-Saharan Africa, the share of OOP health spending in current health expenditure exceeds 35%, increasing the likelihood of impoverishment. In Ethiopia, OOP payments remained high at 37% of current health expenditure in 2016. This study aims to assess impoverishment resulting from OOP health spending in Ethiopia and examine the factors associated with this impoverishment. Methods: This paper uses data from the Ethiopian Household Consumption Expenditure Survey (HCES) 2010/11. The HCES covered 10,368 rural and 17,664 urban households. OOP health spending includes spending on various outpatient and inpatient services. Impoverishing impact of OOP health spending was estimated by comparing poverty estimates before and after OOP health spending. A probit model was used to assess factors that are associated with impoverishment. Results: Using the Ethiopian national poverty line of Birr 3,781 per person per year (equivalent to US$2.10 per day), OOP health spending pushed about 1.19% of the population (i.e. over 957,169 individuals) into poverty. At regional level, impoverishment ranged between 2.35% in Harari and 0.35% in Addis Ababa. Living in rural areas (highland, moderate, or lowland) increased the likelihood of impoverishment compared to residing in an urban area. Households headed by males and adults with formal education are less likely to be impoverished by OOP health spending, compared to their counterparts. Conclusion:In Ethiopia, OOP health spending impoverishes a significant number of the population. Although the country had piloted and initiated many reforms, e.g. the fee waiver system and community-based health insurance, a significant proportion of the population still lacks financial protection. The estimates of impoverishment from out-of-pocket payments reported in this paper do not consider individuals that are already poor before paying out-of-pocket for health services. It is important to note that this population may either face deepening poverty or forgo healthcare services if a need arises. More is therefore required to provide financial protection to achieve universal health coverage in Ethiopia, where the informal sector is relatively large.

scholarly journals Assessing medical impoverishment and associated factors in health care in Ethiopia

2019 ◽  
Author(s):  
Amarech Guda Obse ◽  
John E. Ataguba
Keyword(s):  
Rural Areas ◽  
Health Expenditure ◽  
Significant Proportion ◽  
Health Spending ◽  
Healthcare Services ◽  
Sub Saharan Africa ◽  
Financial Protection ◽  
Health Coverage ◽  
Current Health ◽  
Out Of Pocket Payments

Abstract Background About 5% of the global population, predominantly in low- and middle-income countries, is forced into poverty because of out-of-pocket (OOP) health spending. In most countries in sub-Saharan Africa, the share of OOP health spending in current health expenditure exceeds 35%, increasing the likelihood of impoverishment. In Ethiopia, OOP payments remained high at 37% of current health expenditure in 2016. This study aims to assess impoverishment resulting from OOP health spending in Ethiopia and examine the factors associated with this impoverishment.Methods This paper uses data from the Ethiopian Household Consumption Expenditure Survey (HCES) 2010/11. The HCES covered 10,368 rural and 17,664 urban households. OOP health spending includes spending on various outpatient and inpatient services. Impoverishing impact of OOP health spending was estimated by comparing poverty estimates before and after OOP health spending. A probit model was used to assess factors that are associated with impoverishment.Results Using the Ethiopian national poverty line of Birr 3,781 per person per year (equivalent to US$2.10 per day), OOP health spending pushed about 1.19% of the population (i.e. over 957,169 individuals) into poverty. Living in rural areas (highland, moderate, or lowland) increased the likelihood of impoverishment compared to residing in an urban area. Households headed by males and adults with formal education are less likely to be impoverished by OOP health spending, compared to their counterparts.Conclusion In Ethiopia, OOP health spending impoverishes a significant number of the population. Although the country had piloted and initiated many reforms, e.g. the fee waiver system and community-based health insurance, a significant proportion of the population still lacks financial protection. The estimates of impoverishment from out-of-pocket payments reported in this paper do not consider individuals that are already poor before paying out-of-pocket for health services. It is important to note that this population may either face deepening poverty or forgo healthcare services if a need arises. More is therefore required to provide financial protection to achieve universal health coverage in Ethiopia, where the informal sector is relatively large.

scholarly journals Assessing medical impoverishment and associated factors in health care in Ethiopia

2019 ◽  
Author(s):  
Amarech Guda Obse ◽  
John E. Ataguba
Keyword(s):  
Rural Areas ◽  
Health Expenditure ◽  
Formal Education ◽  
Significant Proportion ◽  
Health Spending ◽  
Poverty Line ◽  
Sub Saharan Africa ◽  
Financial Protection ◽  
Health Coverage ◽  
Current Health

Abstract Background About 5% of the global population, predominantly in low-and-middle income countries, is forced into poverty because of out-of-pocket (OOP) health spending. In most countries in sub-Saharan Africa, the share of OOP health spending in current health expenditure exceeds 35%, increasing the likelihood of impoverishment. In Ethiopia, OOP payments remained high at 37% of current health expenditure in 2016. This study aims to assess impoverishment resulting from OOP health spending in Ethiopia, and examine the factors associated with this impoverishment. Methods This paper uses data from the Ethiopian Household Consumption Expenditure Survey (HCES) 2010/11. The HCES covered 10,368 rural and 17,664 urban households. OOP health spending includes spending on various out-patient and inpatient services. Impoverishing impact of OOP health spending was estimated by comparing poverty estimates before and after OOP health spending. A probit model was used to assess factors that are associated with impoverishment. Results Using the Ethiopian national poverty line of Birr 3,781 per person per year (equivalent to US$2.10 per day), OOP health spending pushed about 1.19% of the population (i.e. over 877,000 individuals) into poverty. Living in rural areas (highland, moderate, or lowland) increased the likelihood of impoverishment compared to an urban residence. On the other hand, the households headed by males, and adults with a formal education decreased the likelihood of impoverishment, compared to their counterparts. Conclusion In Ethiopia, OOP health spending impoverishes a significant number of the population. Although the country had piloted and initiated many reforms, e.g. the fee waiver system and community-based health insurance, a significant proportion of the population still lack financial protection. More is required to provide financial protection to achieve universal health coverage in Ethiopia, where the informal sector is relatively large.

Challenges in Financing Universal Health Coverage in Sub-Saharan Africa

2018 ◽  
Author(s):  
Diane McIntyre ◽  
Amarech G. Obse ◽  
Edwine W. Barasa ◽  
John E. Ataguba
Keyword(s):  
Health Expenditure ◽  
Sub Saharan Africa ◽  
Health Coverage ◽  
Healthcare Financing ◽  
Current Health ◽  
Out Of Pocket Payments ◽  
The World ◽  
Sub Saharan ◽  
Ssa Countries ◽  
Universal Health

Within the context of the Sustainable Development Goals, it is important to critically review research on healthcare financing in sub-Saharan Africa (SSA) from the perspective of the universal health coverage (UHC) goals of financial protection and access to quality health services for all. There is a concerning reliance on direct out-of-pocket payments in many SSA countries, accounting for an average of 36% of current health expenditure compared to only 22% in the rest of the world. Contributions to health insurance schemes, whether voluntary or mandatory, contribute a small share of current health expenditure. While domestic mandatory prepayment mechanisms (tax and mandatory insurance) is the next largest category of healthcare financing in SSA (35%), a relatively large share of funding in SSA (14% compared to <1% in the rest of the world) is attributable to, sometimes unstable, external funding sources. There is a growing recognition of the need to reduce out-of-pocket payments and increase domestic mandatory prepayment financing to move towards UHC. Many SSA countries have declared a preference for achieving this through contributory health insurance schemes, particularly for formal sector workers, with service entitlements tied to contributions. Policy debates about whether a contributory approach is the most efficient, equitable and sustainable means of financing progress to UHC are emotive and infused with “conventional wisdom.” A range of research questions must be addressed to provide a more comprehensive empirical evidence base for these debates and to support progress to UHC.

scholarly journals Financial protection against out-of-pocket health expenditure in Poland

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Tambor ◽  
M Pavlova
Keyword(s):  
European Union ◽  
Low Income ◽  
Health Spending ◽  
Financial Hardship ◽  
Financial Protection ◽  
Health Coverage ◽  
Over The Counter ◽  
Catastrophic Health Spending ◽  
Out Of Pocket Payments ◽  
European Union Countries

Abstract Background Protecting people against financial hardship associated with using health care, is crucial for achieving universal health coverage. Despite the significant improvement happening in the last two decades, household out-of-pocket payments in Poland account for 23% of current spending on health, which is more than in many European Union countries. This implies an incased risk of financial hardship for Polish households. Methods The aim of this study was to assess the extent to which people in Poland experience financial hardship when they use health services. The analysis draws on household budget survey data collected annually by the Central Statistical Office of Poland between 2005 and 2014. It focuses on two indicators of financial protection: catastrophic health spending and impoverishing health spending. The study is a part of WHO country-based studies generating new evidence on financial protection in European health systems. Results In 2014, 8.6% of Polish households experienced catastrophic health spending, while 3.8% of households were impoverished or further impoverished due to health spending. Financial hardship is heavily concentrated among the poorest households for whom the incidence of catastrophic spending is 30%. Outpatient medicines are the largest single driver of catastrophic health spending across all consumption quintiles except the richest. For the richest households, payments for medical products and dental care are the main causes of financial hardship. Although financial protection improved between 2005 and 2014, the improvement among the poorest was marginal. Conclusions Policy attention should focus on protecting households against high spending on outpatient medicines, e.g. revising patient cost-sharing for prescribed medicines and strengthen regulation for over-the-counter medicines. The protection mechanisms should be targeted at low-income households (people living on social benefits, disability or survivor's pensioners). Key messages Financial protection is fairly weak in Poland compared to many European Union countries. Out-of-pocket payments for medicines (prescribed and over-the-counter) are the main cause of financial hardship for Polish households.

scholarly journals The catastrophic and impoverishing effects of out-of-pocket healthcare payments in Kenya, 2018

2019 ◽  
Vol 4 (6) ◽  
pp. e001809
Author(s):  
Paola Salari ◽  
Laura Di Giorgio ◽  
Stefania Ilinca ◽  
Jane Chuma
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Health Expenditure ◽  
Scale Up ◽  
Two Dimensions ◽  
Poor People ◽  
Financial Protection ◽  
Health Coverage ◽  
Catastrophic Payments ◽  
The Impact

IntroductionProgress towards effective service coverage and financial protection—the two dimensions of Universal Health Coverage (UHC)—has been limited in Kenya in the last decade. The government of Kenya has embarked on a highly ambitious reform programme currently being piloted in four Kenyan counties and aiming at national rollout by 2022. This study provides an updated assessment of the performance of the Kenyan health system in terms of financial protection allowing to monitor trends over time. In light of the UHC initiative, the study provides a baseline to assess the impact of the UHC pilot programme and inform scale-up plans. It also investigates household characteristics associated with catastrophic payments.MethodsUsing data from the Kenya Household Health Expenditure and Utilization Survey (KHHEUS) 2018, we investigated the incidence and intensity of catastrophic and impoverishing health expenditure. We used a logistic regression analysis to assess households’ characteristics associated with the probability of incurring catastrophic health expenditures.ResultsThe results show that the incidence of catastrophic payments is more severe for the poorest households and in the rural areas and mainly due to outpatient services. Results for the impoverishing effect suggest that after accounting for out-of-pocket(OOP) payments, the proportion of poor people increases by 2.2 percentage points in both rural and urban areas. Thus, between 1 and 1.1 million individuals are pushed into poverty due to OOP payments. Among the characteristics associated with the probability of incurring OOP expenditures, socioeconomic conditions, the presence of elderly and of people affected by chronic conditions showed significant results.ConclusionKenya is still lagging behind in terms of protecting its citizens against financial risks associated with ill health and healthcare seeking behaviour. More effort is needed to protect the most vulnerable population groups from the high costs of illness.

scholarly journals Do Political Factors affect Government Health Spending? Empirical Evidence from Sub-Sahara African Countries

2020 ◽  
Vol 3 (2) ◽  
pp. p57
Author(s):  
Issa Dianda
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Expenditure ◽  
Public Spending ◽  
Health Spending ◽  
Political Stability ◽  
Sub Saharan Africa ◽  
Political Factors ◽  
Government Health ◽  
Out Of Pocket Payments

In Sub-Saharan Africa (SSA), access to essential health care services remains problematic. The financing of health care is mainly provided by private sources, mainly out-of-pocket payments which represent respectively 53.12% and 36.73% of total health expenditure in 2016. As for public health expenditure, essential for ensuring universal health coverage, it represents only about 35% of health expenditure. Thus, the increase in public spending on health from domestically sources proves to be a major challenge for the countries of the region in the prospect of reaching the SDG relating to health by 2030. This paper aims to analyse the determinants of domestic government health spending in SSA by focusing on political factors. We use data from 39 SSA countries covering the period 2010-2016 and panel-corrected standard errors method for empirical investigation. The results show that democracy favours an increase in government health spending. Furthermore, a political competitive environment, the guarantee and the protection of civil liberties and political right, accountability, government effectiveness and political stability are decisive for increasing government health spending. The results also showed that political participation does not affect public health spending. These results indicate that improving political factors is essential to increase public spending in SSA.

scholarly journals Predictors of catastrophic out-of-pocket health expenditure in rural Egypt: application of the heteroskedastic probit model

2021 ◽  
Vol 96 (1) ◽  
Author(s):  
Suzan Abdel-Rahman ◽  
Farouk Shoaeb ◽  
Mohamed Naguib Abdel Fattah ◽  
Mohamed R. Abonazel
Keyword(s):  
Private Sector ◽  
Rural Areas ◽  
Health Expenditure ◽  
Health Spending ◽  
Probit Model ◽  
Chronically Ill ◽  
Catastrophic Health Expenditure ◽  
Health Coverage ◽  
Household Heads ◽  
The Impact

Abstract Background Out-of-pocket (OOP) health expenditure is a pressing issue in Egypt and far exceeds half of Egypt’s total health spending, threatening the economic viability, and long-term sustainability of Egyptian households. Targeting households at risk of catastrophic health payments based on their characteristics is an obvious pathway to mitigate the impoverishing impacts of OOP health payments on livelihoods. This study was conducted to identify the risk factors of incurring catastrophic health payments hoping to formulate appropriate policies to protect households against financial catastrophes. Methods Using data derived from the Egyptian Household Income, Expenditure, and Consumption Survey (HIECS), a multiplicative heteroskedastic probit model is applied to account for heteroskedasticity and avoid biased and inconsistent estimates. Results Accounting for heteroskedasticity induces notable differences in marginal effects and demonstrates that the impact of some core variables is underestimated and insignificant and in the opposite direction in the homoscedastic probit model. Moreover, our results demonstrate the principal factors besides health status and socioeconomic characteristics responsible for incurring catastrophic health expenditure, such as the use of health services provided by the private sector, which has a dramatic effect on encountering catastrophic health payments. Conclusions The marked differences between estimates of probit and heteroskedastic probit models emphasize the importance of investigating homoscedasticity assumption to avoid policies based on incorrect evidence. Many policies can be built upon our findings, such as enhancing the role of social health insurances in rural areas, expanding health coverage for poor households and chronically ill household heads, and providing adequate financial coverage for households with a high proportion of elderly, sick members, and females. Also, there is an urgent need to limit OOP health payments absorbed by private sector to achieve an acceptable level of fair financing.

scholarly journals Achieving SDG 3.8.2: Financial Protection Against Catastrophic Health Expenditure in Malaysia

2020 ◽  
Author(s):  
Surianti Sukeri ◽  
Muaz Sayuti
Keyword(s):  
At Risk ◽  
Universal Health Coverage ◽  
Health Expenditure ◽  
Health Spending ◽  
Safety Net ◽  
Catastrophic Health Expenditure ◽  
P Value ◽  
Financial Protection ◽  
Health Coverage ◽  
Universal Health

Abstract Background: The Sustainable Development Goal (SDG) 3.8.2 is one of the two indicators to monitor a country's progress towards universal health coverage. It concerns the financial protection against catastrophic spending on health based on the budget share approach. The purpose of this study is twofold: 1) to measure SDG 3.8.2 on the proportion of households with catastrophic health expenditure (CHE), and 2) to determine households at risk of CHEMethods: A cross-sectional study was conducted using secondary data from the 2015/2016 Household Expenditure Survey. The inclusion criterion was Malaysian households with some health spending in the past 12 months before the date of the survey. The World Health Organization method of calculating CHE was applied in the calculation, and a threshold of 10% out-of-pocket health spending from total household expenditures was used to determine CHE. Data were analysed descriptively, and multiple logistic regression was used to determine factors associated with CHE.Results: A total of 13015 households were involved in the study. The proportion of CHE was 2.8%. Four associated factors that were statistically significant were female-headed household (Adjusted OR 1.6; CI 1.25, 2.03; p-value <0.001), household that lived in rural area (Adjusted OR 1.29; 95% CI 1.04, 1.61; p-value =0.022), small household size (Adjusted OR 2.4; 95% CI 1.81, 3.18; p-value <0.001) and head of household aged below 60 years old (Adjusted OR2.34; 95% CI 1.81, 3.18; p-value <0.001).Conclusions: The low proportion of CHE revealed that Malaysia is on the right track towards achieving SDG 3.8 on universal health coverage status by 2030. However there is an increasing trend in the proportion of CHE. Households at risk of CHE require financial protection to afford healthcare and safety net measures to prevent from spiralling further into the vicious cycle of illness and poverty.

Recognition and Analysis of the Drivers and Key Factors Affecting Exposure Households with Catastrophic and Impoverishing Health Expenditure in Iran with the Futures Study Approach Protocol (Preprint)

2021 ◽  
Author(s):  
Maryam Hedayati ◽  
Iravan Masoudi Asl ◽  
Mohammad Reza Maleki ◽  
Salime Goharinezhad ◽  
Ali Akbar Fazaeli
Keyword(s):  
Health Care ◽  
Health Expenditure ◽  
Financial Protection ◽  
Key Factors ◽  
Healthcare Expenditures ◽  
Financial Barriers ◽  
Out Of Pocket Payments ◽  
The Future ◽  
Key Drivers ◽  
Hierarchy Process

BACKGROUND Health expenditure is a vital issue for policymakers not as it were due to the health outcome significance, but moreover since of the gradual total health expenditure rises that has ended up a major concern. To survey the financial related burden due to out-of-pocket payments, two commonly elite approaches have been utilized: catastrophic and impoverishing health expenditures. Catastrophic healthcare expenditures and impoverishment both can prevent individuals from accessing effective healthcare services. In Iran, the high out-of-pocket and increase in the share of the population experiencing catastrophic healthcare expenditures and poor financial protection of households against catastrophic healthcare expenditures are among the major public health concerns. To identify the drivers, key factors, and the trends of catastrophic and impoverishing healthcare expenditures among Iranian households, this study will be conducted by futures studies approach. OBJECTIVE - To identify the key drivers affecting the future of catastrophic and impoverishing healthcare expenditure in Iran. - To assess the trend in the incidence and intensity of CHE in Iran. - To categorize the key drivers - To prioritize main promoter factors in terms of importance, effectiveness and lack of uncertainty. METHODS This study will conduct in four steps. The drivers of the future of Exposure Households with Catastrophic and Impoverishing Health Expenditure will be listed by analyzing the results of a scoping review and then semi-structured interviews with health financial experts. Afterward, key drivers will be categorized using Porter's five forces (social, technical, economic, environmental, and political) for the macro environment and prioritized using the Fuzzy Analytical Hierarchy Process (FAHP) formulated in excel software. Further, cross-impact analysis of promoter factors and analytic hierarchy process will be used to determine main promoter factors in terms of importance, effectiveness, and lack of uncertainty. RESULTS We anticipate that the results of this protocol study will provide a comprehensive overview of the evidence on the determinants of unfairness and payments that expose the Iranian households to catastrophic and impoverishing health care expenditures and identify research gaps. CONCLUSIONS In our study, we will examine the rates of catastrophic health expenditure and impoverishment from medical expenses and its drivers in Iran. This will provide insight into the level of financial protection that a healthcare financing system provides for its citizens. It reflects the financial burden shouldered by families and the financial barriers that reduce their access to health care.

scholarly journals The COVID-19 Pandemic and Non-communicable Diseases—A Wake-up Call for Primary Health Care System Strengthening in Sub-Saharan Africa

2020 ◽  
Vol 11 ◽  
pp. 215013272094694
Author(s):  
Christian Kraef ◽  
Pamela Juma ◽  
Per Kallestrup ◽  
Joseph Mucumbitsi ◽  
Kaushik Ramaiya ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Care Systems ◽  
Health Spending ◽  
Communicable Diseases ◽  
Sub Saharan Africa ◽  
Primary Health Care System ◽  
Health Coverage ◽  
Non Communicable Diseases ◽  
Primary Health

Strengthening Primary Health Care Systems is the most effective policy response in low-and middle-income countries to protect against health emergencies, achieve universal health coverage, and promote health and wellbeing. Despite the Astana declaration on primary health care, respective investment is still insufficient in Sub-Sahara Africa. The SARS-CoV-2019 pandemic is a reminder that non-communicable diseases (NCDs), which are increasingly prevalent in Sub-Sahara Africa, are closely interlinked to the burden of communicable diseases, exacerbating morbidity and mortality. Governments and donors should use the momentum created by the pandemic in a sustainable and effective way by pivoting health spending towards primary health care.

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