Assessing catastrophic and impoverishing effects of health care payments in Uganda

Kwesiga, Brendan; Zikusooka, Charlotte Muheki; Ataguba, John E.

doi:10.1186/s12913-015-0682-x

Cited by 61 publications

(79 citation statements)

References 33 publications

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“…However, our results are similar in pattern to those reported for other developing countries. In Uganda, using rank-dependent thresholds, at the 5% and 25% initial threshold levels of total household expenditure, the incidence of catastrophic health expenditure stood at 38.0% and 6.7%, respectively [26]. In Rwanda at the 10.0% and 40.0% uniform threshold levels of household non-food expenditure, the incidence of catastrophe was estimated at 16.2% and 2.9%, respectively [29].…”

Section: Discussionmentioning

confidence: 99%

“…This methodology has the advantage of explicitly recognising the diminishing marginal utility of income and it incorporates the principle of vertical equity, which is fundamental in the assessment of fairness in health financing system. Importantly, studies using the variable threshold approach have reported higher estimates compared to those obtained with the uniformed threshold [19,26]; signifying an understatement of financial catastrophe.…”

Section: Discussionmentioning

confidence: 99%

“…This method has also been recently applied in Uganda [26]. Briefly, this is a generalized method that can be used to report results based on the uniform threshold and rank-dependent thresholds that are dependent on household income.…”

Section: Methodsmentioning

confidence: 99%

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An assessment of financial catastrophe and impoverishment from out-of-pocket health care payments in Swaziland

Ngcamphalala

Ataguba

2018

Global Health Action

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Background: As the drive towards universal coverage is gaining momentum globally, the need for assessing levels of financial health protection in countries, particularity the developing world, has increasingly become important. In Swaziland, the level of financial health protection is not clearly understood. Objective: To assess financial catastrophe and impoverishment from out-of-pocket payments for health services in Swaziland. Methods: The nationally representative Swaziland Household Income and Expenditure Survey (2009/2010) dataset is used for the analyses. Data are collected by the Central Statistics Office in Swaziland. The final dataset contains information on 3,167 households (i.e. about 14,145 individuals) out of the anticipated 3,750 households. Financial catastrophe is assessed using an initial threshold that is adjusted to increase with household income (i.e. rank-dependent). Payment for health services is considered catastrophic when they exceed the threshold. Impoverishment is assessed using a national poverty line and an international poverty line ($1.25/day). Results: Using an initial threshold of 10.0% of household expenditure, 9.7% of Swazi households experience financial catastrophe while the proportion is estimated at 2.7% using an initial threshold of 40.0% of non-food expenditure. Between 1.0% and 1.6% of the Swazi population, representing between 10,000 and 16,000 people are pushed below the poverty line because of out-of-pocket payments. These findings indicate that financial health protection is not adequate in Swaziland. Conclusion: If Swaziland is to move towards achieving universal health coverage, there is a need to address the burden created by direct out-of-pocket payments. Among other things, this means that the country needs to consider financing mechanisms that guarantee equitable access to needed quality health services, which do not place undue hardship on the poor and vulnerable.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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An assessment of financial catastrophe and impoverishment from out-of-pocket health care payments in Swaziland

Ngcamphalala

Ataguba

2018

Global Health Action

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“…In practice, in line with previous studies [14, 35–37], we used food expenditure as a proxy of a household’s basic subsistence needs. Also in line with prior research [36], we set the threshold levels in this study were set at 10 %, 25 %, and 40 %.…”

Section: Methodsmentioning

confidence: 99%

The economic burden of chronic non-communicable diseases in rural Malawi: an observational study

Wang

Brenner

Kalmus

et al. 2016

BMC Health Serv Res

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BackgroundEvidence from population-based studies on the economic burden imposed by chronic non-communicable diseases (CNCDs) is still sparse in Sub-Saharan Africa. Our study aimed to fill this existing gap in knowledge by estimating both the household direct, indirect, and total costs incurred due to CNCDs and the economic burden households bear as a result of these costs in Malawi.MethodsThe study used data from the first round of a longitudinal household health survey conducted in 2012 in three rural districts in Malawi. A cost-of-illness method was applied to estimate the economic burden of CNCDs. Indicators of catastrophic spending and impoverishment were used to estimate the economic burden imposed by CNCDs on households.ResultsA total 475 out of 5643 interviewed individuals reported suffering from CNCDs. Mean total costs of all reported CNCDs were 1,040.82 MWK, of which 56.8 % was contributed by direct costs. Individuals affected by chronic cardiovascular conditions and chronic neuropsychiatric conditions bore the highest levels of direct, indirect, and total costs. Using a threshold of 10 % of household non-food expenditure, 21.3 % of all households with at least one household member reporting a CNCD and seeking care for such a condition incurred catastrophic spending due to CNCDs. The poorest households were more likely to incur catastrophic spending due to CNCDs. An additional 1.7 % of households reporting a CNCD fell under the international poverty line once considering direct costs due to CNCDs.ConclusionOur study showed that the economic burden of CNCDs is high, causes catastrophic spending, and aggravates poverty in rural Malawi, a country where in principle basic care for CNCDs should be offered free of charge at point of use through the provision of an Essential Health Package (EHP). Our findings further indicated that particularly high direct, indirect, and total costs were linked to specific diagnoses, although costs were high even for conditions targeted by the EHP. Our findings point at clear gaps in coverage in the current Malawian health system and call for further investments to ensure adequate affordable care for people suffering from CNCDs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1716-8) contains supplementary material, which is available to authorized users.

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“…Retrieved February 7, 2018, from https://www.unicef.org/infobycountry/trinidad_tobago_statistics.html#0. 16 Trinidad and Tobago: Motor Vehicles. Tradingeconomics.com.…”

Section: Roadwaysmentioning

confidence: 99%

Health Equity and Access to Health Care in Trinidad and Tobago

Bahall¹

2018

WJPH

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Health inequity persists, particularly in developing countries. This study explores access to public health care and equity. This descriptive study was conducted using a review of the literature, print media, health reports, and patient experiences. Health accessibility links to equity were analysed, focusing on inequity in healthcare access, challenges in accessing services (long waiting times, non-available pharmaceuticals), poor public health (murder, rape, and other crimes, traffic accidents, traffic congestion, divorce, and unemployment), and misrepresentations of health guidelines. The necessary out-of-pocket spending disfavours the poor and favours the rich who, by purchasing basic health services, have greater access to public health services. The negative public health environment increases the health burden and imposes healthcare requirements which further disfavour the poor in particular, while informal networks favour the rich. Shortfalls in health services and public health necessitate out-of-pocket spending, which also dis-favours the poor and favours the rich.

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Assessing catastrophic and impoverishing effects of health care payments in Uganda

Cited by 61 publications

References 33 publications

An assessment of financial catastrophe and impoverishment from out-of-pocket health care payments in Swaziland

An assessment of financial catastrophe and impoverishment from out-of-pocket health care payments in Swaziland

The economic burden of chronic non-communicable diseases in rural Malawi: an observational study

Health Equity and Access to Health Care in Trinidad and Tobago

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