scholarly journals Redistributive Effects of Health Care Out-of-Pocket Payments in Cameroon

2021 ◽  
Author(s):  
Augustin Ntembe Ntembe ◽  
Regina Tawah ◽  
Elkanah Faux
Keyword(s):  
Health Care ◽  
Health Care Financing ◽  
Household Survey ◽  
Poverty Line ◽  
Horizontal Inequity ◽  
Tax Progressivity ◽  
Goods And Services ◽  
Out Of Pocket Payments ◽  
Redistributive Effects ◽  
Redistributive Effect

Abstract Background: The bulk of health care financing in Cameroon is derived from out-of-pocket payments. Given that poverty is pervasive with a third of the population living below the poverty line, health care financing from out-of-pocket payments is likely to have redistributive and equity effects. Out-of-pocket payments on health care limit the ability of households to afford non-healthcare goods and services.Method: The study uses data from the 2014 Cameroon Household Survey to estimate the Kwakwani index for analyzing tax progressivity and the model developed by Aronson, Johnson, and Lambert (1994) to measure the redistributive effect of out-of-pocket payments for health care. The estimated indexes measure the extent of the progressivity of health care payments and the reranking that results from the payments.Results: The results indicate that out-of-pocket payments for health care in Cameroon in 2014 represented a significant share of household prepayment income. The estimates also show that the redistributive effect is positive implying that health care payments are weakly progressive and will weakly enhance equity and post-payment reranking is low. Conclusion: The study concludes that out-of-pocket payments on health care in Cameroon are progressive (income redistributive effect = 0.00144). A positive redistributive effect suggests that out-of-pocket payments on health care exert an equalizing effect on the distribution of post-payment incomes. However, the existence of some horizontal inequity and re-ranking implying that people in the same income band are treated unequally depending on the burden of ill-health.

scholarly journals Redistributive effects of health care out-of-pocket payments in Cameroon

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Augustin Ntembe ◽  
Regina Tawah ◽  
Elkanah Faux
Keyword(s):  
Health Care ◽  
Low Income ◽  
Health Care Financing ◽  
Household Survey ◽  
Poverty Line ◽  
Goods And Services ◽  
Income Groups ◽  
Out Of Pocket Payments ◽  
Redistributive Effects ◽  
Using Data

Abstract Background The bulk of health care financing in Cameroon is derived from out-of-pocket payments. Given that poverty is pervasive, with a third of the population living below the poverty line, health care financing from out-of-pocket payments is likely to have redistributive and equity effects. In addition, out-of-pocket payments on health care can limit the ability of households to afford non-healthcare goods and services. Method The study estimates the Kakwani index for analyzing tax progressivity and applies the model developed by Aronson, Johnson, and Lambert (1994) to measure the redistributive effects of health care financing using data from the 2014 Cameroon Household Survey. The estimated indexes measure the extent of the progressivity of health care payments and the reranking that results from the payments. Results The results indicate that out-of-pocket payments for health care in Cameroon in 2014 represented a significant share of household prepayment income. The results also show some evidence of inequity as few people change ranks after payment despite the slight progressivity of health care out-of-pocket payments. Conclusion The existence of some disparities among income groups implies that the burdens of ill-health and out-of-pocket payments are unequal. The detected disparities within income groups can be reduced by targeting low-income groups through increases in government expenditures on health care and pro-poor prioritization of the expenditures.

Health care financing and income inequality in Nigeria

2020 ◽  
Vol 47 (11) ◽  
pp. 1419-1431
Author(s):  
Chukwuedo Susan Oburota ◽  
Olanrewaju Olaniyan
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Income Inequality ◽  
Health Care Financing ◽  
Social Health Insurance ◽  
Household Survey ◽  
Study Data ◽  
Horizontal Inequity ◽  
Content Type ◽  
High Level

PurposeThe purpose of this paper is to decompose the inequities induced by the Nigerian health care financing sources and their effect on the income distribution. Inequities in health care financing sources are of immense policy concern particularly in developing countries such as Nigeria, where high-level income inequality exists, and the cost of medical care is generally financed out-of-pocket (OOP) due to limited access to health insurance.Design/methodology/approachThe Duclos et al. decomposition model provided the theoretical framework for the study. Data were obtained from two waves of the Nigeria General Household Survey (GHS) panel, 2012–13 and 2015–16. The analysis covered 3,999 households in 2012–13 and 4,051 households in 2015–16. Two measures of health care financing: OOP payment and health insurance contribution (HIC) were used. The ability to pay measure was household consumption expenditure.FindingsThe major inequity issue induced by the OOP payments was vertical inequity. HICs created the problems of vertical inequity, horizontal inequity and reranking among households. Overall both health care financing options were associated with the worsening of income inequality both at the national and sectorial levels in the country. The operations of the NHIS need to be improved to ensuring improved health care coverage for the poor.Originality/valueThis paper fulfills an identified need to determine the income redistributive effects (REs) of the social health insurance (SHI) contribution at the national, urban and rural locations overtime.

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

2020 ◽  
Author(s):  
Brendan Kwesiga ◽  
Tom Aliti ◽  
Pamela Nabukhonzo ◽  
Susan Najjuko ◽  
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. 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.

The Redistributive Effect of Direct Taxes: A Comparison of Six LIS Countries

1996 ◽  
Author(s):  
John A. Bishop ◽  
K. Victor Chow ◽  
John P. Formby
Keyword(s):  
United States ◽  
United Kingdom ◽  
Statistical Inference ◽  
The United States ◽  
West Germany ◽  
Lorenz Curves ◽  
Tax Progressivity ◽  
The United Kingdom ◽  
Redistributive Effects ◽  
Redistributive Effect

The Luxembourg Income Study (LIS) is used to investigate the redistributive effects of direct taxes in six countries, Australia, Canada, Sweden, West Germany, the United States and the United Kingdom. Two periods are considered and comparisons are made among countries at different points in time and within countries across time. Lorenz curves are adapted and used to make ordinal comparisons of two very general measures of tax progressivity- so called “residual” and “liability” progression. Newly developed statistical inference procedures allow us to take the sampling variability inherent in the LIS data into account.

Umverteilungseffekte in der Finanzierung von Gesundheitsleistungen / Redistribution Effects of Health Care Financing

2007 ◽  
Vol 227 (5-6) ◽  
Author(s):  
Florian Buchner ◽  
Rebecca Deppisch ◽  
Jürgen Wasem
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Systems ◽  
Health Care Financing ◽  
Social Health Insurance ◽  
Health Care Expenditures ◽  
Social Health ◽  
Financing System ◽  
Out Of Pocket Payments ◽  
Care Systems

SummaryHealth care systems are financed through a mixture of different components: taxes, contributions to social health insurance, premiums to private health insurance, out of pocket payments by patients. These components can be combined differently leading to specific effects of interpersonal redistribution. This can be compared between different countries. In such a comparison the redistributional impact of the German health care systems is rather regressive - which is basically caused by the opportunity for people with high income to leave social health insurance. In comparison to a health insurance system with risk rated premiums, financing of the German social health insurance leads to interpersonal redistribution from higher to lower income, from the young to the elderly, from healthy to sick and from singles to families with children. The pay-as-you-go character of the system leads especially in combination with an aging population and technological change to burden for future generations. In comparison to a system in which each region finances its own health care expenditures, there are also considerable interregional redistributions. The financing system in Germany is not conceptually consistent. Reform proposals (unified health insurance for all; flat rate premiums) tackle these inconsistencies.

scholarly journals The Role of Private Health Care Financing in the Central and Eastern European Countries

Ekonomika ◽  
2008 ◽  
Vol 83 ◽  
Author(s):  
Marta Borda
Keyword(s):  
Health Care ◽  
Health Expenditure ◽  
Health Care Services ◽  
Health Care Systems ◽  
Health Care Financing ◽  
Economic Transformation ◽  
Eastern European ◽  
Private Health Care ◽  
Out Of Pocket Payments ◽  
Care Systems

The economic transformation process in the central and Eastern European (CEE) countries has included, among others, a thorough reform of the previous, centrally planned health care systems. Consequently, the contemporary health care systems functioning in these countries, despite common directions of changes, vary in the area of detailed aspects. The purpose of the paper is to provide an overview of private sources of the health care financing (including out-of-pocket payments and prepaid plans), which are considered to be an important component of each health care system. In the first part of the paper, the results of comparative analysis of total health expenditure incurred by the CEE countries between 2000 and 2004 are presented in order to indicate the main trends, problems and differences among the analysed states. Next, the main types of private health expenditure are described and their contribution to the health care financing is presented. Finally, voluntary health insurance offered in the Polish market, considered as an additional method of health care financing. is characterized.The obtained results allow to compare and evaluate the range of using private health care funds in the analysed countries during the last few years. Moreover, the results indicate a need for the further development of private methods of health care financing. which in practice can supplement or duplicate health care services delivered by the public sector.

scholarly journals Effect of Payments for Disease Specific Care on Poverty Estimates in Nepal

2018 ◽  
pp. 18-34
Author(s):  
Shiva Raj Adhikari
Keyword(s):  
Health Care ◽  
Health Care Cost ◽  
Estimation Method ◽  
Basic Needs ◽  
Poverty Line ◽  
Living Standard ◽  
Care Needs ◽  
Basic Health ◽  
Basic Health Care ◽  
Out Of Pocket Payments

The popular poverty estimation method follows the cost of basic needs approach through estimation of poverty line. Health care is a basic necessity of life, as important as food, shelter, and clothing; however, current practice of estimating poverty indicators in Nepal does not capture the basic health care cost. Not accounted of out of pocket payment for health care into the poverty estimation could give a misleading picture of trends in poverty over time. Ignoring health care costs altogether can result in misclassifying which households or individuals are in the greatest need. Therefore, the paper estimated the revised poverty statistics with explicitly accounting for basic health care needs along with other basic needs such as food, clothing, and shelter by utilizing the Nepal living standard surveys(2010/11) data. The paper used the Foster, Greer and Thorbecke (FGT) poverty estimation method to estimate hidden or underestimated poverty before and after accounting health care payment. The results show that official poverty statistics are significantly underestimated while incorporating basic health care cost in the estimation of poverty statistics in Nepal. Out of pocket payments for health care of different diseases have different impoverishment impacts in terms of incidence and intensity of poverty. Higher average costs of health care cause higher impoverishment impacts. This paper indicates that incidence of poverty is underestimated by almost 4 percentage point and intensity of poverty is underestimated by 0.29 percent based on official estimation of poverty. Economic Journal of Development Issues Vol. 23 & 24 No. 1-2 (2017) Combined Issue, Page : 18-34

scholarly journals Equity of health care financing in South Korea: 1990–2016

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tae-Jin Lee ◽  
Inuk Hwang ◽  
Hea-Lim Kim
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Financing ◽  
Social Health Insurance ◽  
Vertical Equity ◽  
Health Coverage ◽  
Policy Reforms ◽  
Study Results ◽  
Out Of Pocket Payments ◽  
Kakwani Index

Abstract Background The National Health Insurance in Korea has been in operation for more than 30 years since having achieved universal health coverage in 1989 and has gone through several policy reforms. Despite its achievements, the Korean health insurance has some shortfalls, one of which concerns the fairness of paying for health care. Method Using the population representative Household Income and Expenditure Survey data in Korea, this study examined the yearly changes in the vertical equity of paying for health care between 1990 and 2016 by the source of financing using the Kakwani index, considering health insurance and other related policy reforms in Korea during this period. Results The study results suggest that direct tax was the most progressive mode of health care financing in all years, whereas indirect tax was proportional. The out-of-pocket payments were weakly regressive in all years. The Kakwani index for health insurance contributions was regressive but now is proportional to the ability to pay, whereas the Kakwani index for private health insurance premiums turned from progressive to weakly regressive. The Kakwani index for overall health care financing showed a weak regressivity during the study period. Discussion The overall health care financing in Korea has transformed from a slight regressivity to proportional over time between 1990 and 2016. It is expected that these changes were closely related to the improved equity of health insurance contributions from 1998 to 2008, which was the result of a merger of the health insurance societies and an amendment in the health insurance contribution structure. These results suggest that standardizing insurance managing organizations and financing rules potentially has positive implications for the equity of healthcare financing in a country where the major method of health care financing is social health insurance.

scholarly journals Determinants of out of pocket healthcare expenditures: The case of Mugla province in Turkey

2019 ◽  
Vol 9 (2) ◽  
pp. 76-83
Author(s):  
Bilge Senturk ◽  
Aysun Danisman Isik ◽  
Cisel Ekiz Gokmen
Keyword(s):  
Health Care ◽  
Health Care Financing ◽  
Health Expenditures ◽  
Least Square Method ◽  
Health Care Expenditures ◽  
Least Square ◽  
Health Coverage ◽  
Ordinary Least Square ◽  
Income Status ◽  
Out Of Pocket Payments

As the share of health care financing from public funds was increasing in Turkey, the utilization of the health care services has also increased, dramatically. Despite of universal health coverage, the result of this trend causes to increase the incidence of making out of pocket expenditures. The aim of this study is to evaluate the determinants of households’ health expenditures in Mugla province of Turkey. A total of 204 households living in the central district of Mugla were surveyed and questioned both for their total consumption and health expenditures, as well as their health status, demographic and socio-economic characteristics. Ordinary least square method was used for the multiple regression analysis to identify the factors that affect the out of pocket health care expenditures. In addition to other empirical studies in Turkey, the effects of relative poverty and types of income and occupation on oop expenditures were estimated. Results identify that consumption expenditure of the household, poverty, wage/income status, education, household size, having chronic disease and having elderly in the households have significant effects on the amount of out of pocket (oop) health expenditure of the households. Keywords: Health care financing; Out of pocket payments; Ordinary least square method; Turkey

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

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.

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