Catastrophic healthcare expenditure and impoverishment in tropical deltas: evidence from the Mekong Delta region

Ahmed, Sayem; Szabo, Sylvia; Nilsen, Kristine

doi:10.1186/s12939-018-0757-5

Cited by 36 publications

(46 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Among household characteristics that are associated with a lower probability of impoverishment are living in households headed by a male and/or educated persons. Other studies from China, India, Nigeria, and Vietnam [44][45][46][47] reported similar results. This is an indication of genderbased differences in the burden and impact of OOP health spending to the disadvantage of women.…”

Section: Discussionsupporting

confidence: 64%

“…Based on this study, age and having older people in a household were not related to impoverishment. However, K Koch, C Pedraza and A Schmid [46] and S Ahmed, S Szabo and K Nilsen [47] found that having older adults and a household headed by older persons increase the likelihood of impoverishment from OOP health spending. It remains unclear why these variables were not significant in the Ethiopian case.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Assessing medical impoverishment and associated factors in health care in Ethiopia

Obse

Ataguba

2020

BMC Int Health Hum Rights

View full text Add to dashboard Cite

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 assesses the impoverishment resulting from OOP health spending in Ethiopia and the associated factors. 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 3781 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 the 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-ofpocket 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.

show abstract

Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Assessing medical impoverishment and associated factors in health care in Ethiopia

Obse

Ataguba

2020

BMC Int Health Hum Rights

View full text Add to dashboard Cite

show abstract

“…Among household characteristics that are associated with a lower probability of impoverishment are living in households headed by a male and/or educated persons. Other studies from China, India, Nigeria, and Vietnam [46][47][48][49] reported similar results. This is an indication of gender-based differences in the burden and impact of OOP health spending to the disadvantage of women.…”

Section: Discussionsupporting

confidence: 64%

“…Based on this study, age and having older people in a household were not related to impoverishment. However, K Koch, C Pedraza and A Schmid [48] and S Ahmed, S Szabo and K Nilsen [49] found that having older adults and a household headed by older persons increase the likelihood of impoverishment from OOP health spending. It remains unclear why these variables were not significant in the Ethiopian case.…”

Section: Discussionmentioning

confidence: 99%

Assessing medical impoverishment and associated factors in health care in Ethiopia

Obse

Ataguba

2019

Preprint

View full text Add to dashboard Cite

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.

show abstract

“…A possible explanation is that they have higher capacity to pay and might replace low quality public healthcare service with private healthcare. On the other, it re ects the inability of less-endowed households to divert resources from other basic needs which hinder them to seek care, thereby relying on low quality or no care [48][49][50]. Also, the lesser likelihood among the poorer economic groups to not face CHE might be explained by the lack of rigour to seek healthcare if their illness is not perceived to be severe.…”

Section: Discussionmentioning

confidence: 99%

Mapping the Multidimensionality of Medical Care related Catastrophe on Households: A Study of Four Blocks in Birbhum District, West Bengal

Dasgupta

Mukherjee

2020

Preprint

View full text Add to dashboard Cite

Background Medical care related catastrophe is generally identified by healthcare expenses crossing a certain percentage of household’s resources (Wagstaff and van Doorslaer, 2003). This paper attempts to examine medical care related ‘catastrophe’ by going beyond the threshold-oriented approach of catastrophic medical expenditure and include multiple indicators which seeks to explore the catastrophe from a multidimensional perspective. Methods Drawing from multidimensional vulnerability to poverty approach (Alkire and Forster, 2008), we provide a measure which incorporates multiple indicators that might put households in medical care related catastrophic situation. Our study uses data from a cross-sectional household survey conducted by the Society for Health and Demographic Surveillance (SHDS) of the Government of West Bengal in 2012. Using negative binomial and logistic regression, the study also attempts to find the correlates of healthcare utilization, incurring catastrophic health expenditure for both 10 per cent of household consumption expenditure and 40 per cent of non-food expenditure as well as resorting to distress financing and availing low quality/ no care despite chronic illness. Results Estimates show that illness, presence of elderly members, hospitalization and outpatient visits increases the risk of incurring catastrophic health expenditure and healthcare utilization counts. In addition, households belonging to backward socio-religious categories and having members engaged as casual labourers face higher odds of distressed financing and availing informal/ no healthcare. In contrast to Wagstaff and van Doorslaer’s measure of catastrophic medical expenses, the multidimensional measure shows a lower medical care catastrophe for the upper economic classes and forward caste groups and vice versa which is more realistic and convincing. Conclusions The evidence generated from the multidimensional analysis presents a more convincing and reliable picture of vulnerability imparted due to health shocks as compared to identifying households with catastrophic medical expenditure by Wagstaff and van Doorslaer’s method. However, this study has its limitations as it has given equal weightage to all the dimensions and restricted itself to headcount measures. However, extension and refinement of this approach can provide more insightful findings.

show abstract

Catastrophic healthcare expenditure and impoverishment in tropical deltas: evidence from the Mekong Delta region

Cited by 36 publications

References 26 publications

Assessing medical impoverishment and associated factors in health care in Ethiopia

Assessing medical impoverishment and associated factors in health care in Ethiopia

Assessing medical impoverishment and associated factors in health care in Ethiopia

Mapping the Multidimensionality of Medical Care related Catastrophe on Households: A Study of Four Blocks in Birbhum District, West Bengal

Contact Info

Product

Resources

About