Estimating Catastrophic Health Expenditures from Household Surveys: Evidence from Living Standard Measurement Surveys (LSMS)-Integrated Surveys on Agriculture (ISA) from Sub-Saharan Africa

Ssewanyana, Sarah; Ibrahim, Kamarulzaman

doi:10.1007/s40258-020-00609-1

Cited by 21 publications

(24 citation statements)

References 15 publications

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“…However, other non-health expenditures (rent, utilities and education) are financed with the same household resources as healthcare, and if substantial, can reduce resources ‘available’ for health expenditure. 45 We did not collect information to assess the magnitude of non-health expenses incurred by households. But having other young children or productivity losses are circumstances that can reduce resources available to households explaining their association with reduced odds of CHE.…”

Section: Discussionmentioning

confidence: 99%

The cost of illness for childhood clinical pneumonia and invasive pneumococcal disease in Nigeria

et al. 2022

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BackgroundPneumococcal disease contributes significantly to childhood morbidity and mortality and treatment is costly. Nigeria recently introduced the pneumococcal conjugate vaccine (PCV) to prevent pneumococcal disease. The aim of this study is to estimate health provider and household costs for the treatment of pneumococcal disease in children aged <5 years (U5s), and to assess the impact of these costs on household income.MethodsWe recruited U5s with clinical pneumonia, pneumococcal meningitis or pneumococcal septicaemia from a tertiary level hospital and a secondary level hospital in Kano, Nigeria. We obtained resource utilisation data from medical records to estimate costs of treatment to provider, and household expenses and income loss data from caregiver interviews to estimate costs of treatment to households. We defined catastrophic health expenditure (CHE) as household costs exceeding 25% of monthly household income and estimated the proportion of households that experienced it. We compared CHE across tertiles of household income (from the poorest to least poor).ResultsOf 480 participants recruited, 244 had outpatient pneumonia, and 236 were hospitalised with pneumonia (117), septicaemia (66) and meningitis (53). Median (IQR) provider costs were US$17 (US$14–22) for outpatients and US$272 (US$271–360) for inpatients. Median household cost was US$51 (US$40–69). Overall, 33% of households experienced CHE, while 53% and 4% of the poorest and least poor households, experienced CHE, respectively. The odds of CHE increased with admission at the secondary hospital, a diagnosis of meningitis or septicaemia, higher provider costs and caregiver having a non-salaried job.ConclusionProvider costs are substantial, and households incur treatment expenses that considerably impact on their income and this is particularly so for the poorest households. Sustaining the PCV programme and ensuring high and equitable coverage to lower disease burden will reduce the economic burden of pneumococcal disease to the healthcare provider and households.

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Section: Discussionmentioning

confidence: 99%

The cost of illness for childhood clinical pneumonia and invasive pneumococcal disease in Nigeria

et al. 2022

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“…Although several studies analysed nationally-representative surveys, their findings differ from ours because they do not address a specific illness, target chronic conditions, and may have limited applicability to our study setting due to subnational differences in healthcare seeking behaviour. [18,41,42] At CHE 10 , the cost of treatment costs had significant burden on households regardless of their income. At higher thresholds, our results are similar to others including those that used household income as a measure of available resources like we did.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The cost of illness for childhood clinical pneumonia and invasive pneumococcal disease in Nigeria

Adamu

Karia

Bello

et al. 2021

Preprint

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Background: Pneumococcal disease contributes significantly to childhood morbidity and mortality and treatment is costly. Nigeria recently introduced the Pneumococcal Conjugate Vaccine (PCV) to prevent pneumococcal disease. The aim of this study is to estimate health provider and household costs for the treatment of pneumococcal disease in children aged <5 years (U5s), and to assess the impact of these costs on household income. Methods: We recruited U5s with clinical pneumonia, pneumococcal meningitis or pneumococcal septicaemia from a tertiary and a secondary level hospital in Kano, Nigeria. We obtained resource utilisation data from medical records to estimate costs of treatment to provider, and household expenses and income loss data from caregiver interviews to estimate costs of treatment to households. We defined catastrophic health expenditure (CHE) as household costs exceeding 25% of monthly household income and estimated the proportion of households that experienced it. We compared CHE across tertiles of household income (from the poorest to least poor). Results: Of 480 participants recruited, 244 had outpatient pneumonia, and 236 were hospitalised with pneumonia (117), septicaemia (66) and meningitis (53). Median (IQR) provider costs were US$17 (US$14-22) for outpatients and US$272 (US$271-360) for inpatients. Median household cost was US$51 (US$40-69). Overall, 33% of households experienced CHE, while 53% and 4% of the poorest and least poor households, experienced CHE respectively. The odds of CHE increased with admission at the secondary hospital, a diagnosis of meningitis or septicaemia, higher provider costs, and caregiver having a non-salaried job. Conclusion: Provider costs are substantial, and households incur treatment expenses that considerably impact on their income and this is particularly so for the poorest households. Sustaining the PCV programme and ensuring high and equitable coverage to lower disease burden will reduce the economic burden of pneumococcal disease to the healthcare provider and households.

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“…High OOP payments, low government health spending, and lack of policy clarity around purchasing of healthcare from private providers by public purchasers are among the challenges identified in the papers in this special issue. The persistently high OOP expenditures in SSA raise concerns about the prospect of achieving the goal of UHC in the region, especially given that it is primarily the poor who make these catastrophic payments [26]. It highlights the extent of financial protection across the continent and the need to do more to protect the most vulnerable.…”

Section: Discussionmentioning

confidence: 99%

“…The next batch of papers (three in total) undertakes empirical analyses of specific health financing issues in SSA. Ssewanyana and Kasirye [26] estimate catastrophic health expenditures from household surveys in five countries: Ethiopia, Malawi, Nigeria, Tanzania and Uganda. They note that the burden of catastrophic health expenditures remains substantial in SSA and call for renewed attention to the expansion of public revenues to finance health expenditures.…”

Section: Content Of This Special Issuementioning

confidence: 99%

Health Financing in Sub-Saharan Africa: From Analytical Frameworks to Empirical Evaluation

Asante

Wasike

Ataguba

2020

Appl Health Econ Health Policy

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Estimating Catastrophic Health Expenditures from Household Surveys: Evidence from Living Standard Measurement Surveys (LSMS)-Integrated Surveys on Agriculture (ISA) from Sub-Saharan Africa

Cited by 21 publications

References 15 publications

The cost of illness for childhood clinical pneumonia and invasive pneumococcal disease in Nigeria

The cost of illness for childhood clinical pneumonia and invasive pneumococcal disease in Nigeria

The cost of illness for childhood clinical pneumonia and invasive pneumococcal disease in Nigeria

Health Financing in Sub-Saharan Africa: From Analytical Frameworks to Empirical Evaluation

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