Impoverishing effects of catastrophic health expenditures in Malawi

Mchenga, Martina; Chirwa, Gowokani Chijere; Chiwaula, Levison

doi:10.1186/s12939-017-0515-0

Cited by 76 publications

(89 citation statements)

References 19 publications

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“…We identified several determinants of CHE in this review, but it is worthy to note that household poverty/low socio‐economic status was the most common factor that increased CHE in six out of the eight studies that assessed determinants of CHE. Similarly, poverty has also been recognized as a determinant of CHE in other studies . This is especially so given that even small costs for common illnesses can be financially disastrous for poor households with no insurance cover .…”

Section: Discussionmentioning

confidence: 91%

“…There was conflicting evidence on the role of place of residence on CHE with some studies reporting increased CHE among rural dwellers while others reported CHE to be more among urban residents; however, both views can be explained. Some studies have also documented that rural residence increased the risk of CHE while others have found similar effects with urban residence . Rural dwellers are usually poorer, less educated, and without access to expensive/sophisticated health care services, which are commonly available in the urban areas.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, a study conducted using the Kenya Household Health Expenditures and Utilization Survey data of 2007 found that 11.7% of households experienced catastrophic expenditures and 4% were impoverished by health care payments . Additionally, studies conducted in Burkina Faso, Kenya, China, Malawi for different health conditions have found CHE incidence to range between 0.73% and 66.8% . Such high rates of CHE are often inequitable and unsuitable for the achievement of UHC as it inhibits access especially for poor households, who must often choose between paying for health and paying for other necessities such as food or rent.…”

Section: Discussionmentioning

confidence: 99%

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A review of the incidence and determinants of catastrophic health expenditure in Nigeria: Implications for universal health coverage

Okedo‐Alex

Akamike

Ezeanosike

et al. 2019

Health Planning & Management

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Summary Background In the Nigerian context, preconditions for financial catastrophe are operational as there is high out‐of‐pocket spending (OOPS) on health with low capacity to pay, presence of user fees, and poor prepayment insurance coverage. We reviewed the incidence and determinants of catastrophic health expenditure (CHE) in Nigeria. Methods Databases including PubMed, OVID, EMBASE, CINAHL, and Web of Science were searched for primary research studies on the incidence and determinants of CHE in Nigeria published between 2003 and 2018. Search terms used include household, out‐of‐pocket expenditure, catastrophic health expenditure, and Nigeria. Results Twenty studies that met the inclusion criteria were included in the review. At 10% of total household and nonfood expenditure, the incidence of CHE was 8.2% to 50%, while 3.2% to 100% households incurred CHE at 40% of nonfood expenditure. The incidence of CHE was higher among inpatients and studies with lower threshold definitions. Outpatient CHE was highest for type 2 diabetes and tuberculosis while human immunodeficiency virus (HIV) care incurred the most CHE among inpatients. Determinants of CHE include wealth status, age, gender, place of residence/geographical location, household size/composition, educational status, health insurance status, illness, and health provider types. Conclusion There is a high incidence of CHE across various common health conditions in Nigeria. CHE was more among the poor, elderly, rural dwellers, private facility utilization, female gender, and noninsured among others. We recommend expansion of the National Health Insurance Scheme via informal social and financing networks platforms. Increased budgetary allocation to health and intersectoral collaboration will also play a significant role in CHE reduction.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A review of the incidence and determinants of catastrophic health expenditure in Nigeria: Implications for universal health coverage

Okedo‐Alex

Akamike

Ezeanosike

et al. 2019

Health Planning & Management

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“…When the income gap between rich and poor groups in rural and urban households increased, inequality rate in the exposure to catastrophic health expenditures became higher. Mchenga et al in a study in Malawi concluded that there was a considerable gap between households' economic levels in this country and the risk of exposure to catastrophic health expenditures …”

Section: Discussionmentioning

confidence: 99%

Decomposing inequality in financial protection situation in Iran after implementing the health reform plan: What does the evidence show based on national survey of households' budget?

Moradi

Naghdi

Brown

et al. 2018

Health Planning & Management

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The headcount ratio of the exposure to catastrophic health expenditures in urban and rural households was 2.5% (2.43% - 2.64%) and 3.6% (3.48% - 3.76%), respectively. The difference in households' income levels was the main contributor in explaining the inequality in facing catastrophic health expenditures between poor and nonpoor households. [Correction added on 02 June 2018, after first online publication: The "Results" section of the Abstract of the published article has been correctly updated on this version.] CONCLUSION: Even after implementing the HTP, the headcount ratios of catastrophic health expenditure are still considerable. The results show that income is the greatest determinant of inequality in facing catastrophic health expenditure and in urban households.

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“…Only four papers reported income quintiles for impoverishment expenditures, and there was no clear pattern of concentration of impoverishment among the income quintiles. [20][21][22] [23] Due to the few studies, which used concentration indexes to assess whether the poor are more likely than the rich to incur financial catastrophe, it is not possible to determine whether catastrophic spending among the different income groups is sensitive to certain thresholds and methods in the African region.…”

Section: Analysis Of Financial Protection By Equity Stratfiersmentioning

confidence: 99%

What do we know about financial protection in health in Africa? A systematic review

Kabaniha

Afriyie

Mandalia³

et al. 2020

Preprint

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Background Financial protection is one of the main indicators to assess progress towards Universal Health Coverage. Efforts have been made globally to monitor financial protection. However, progress in the African Region is limited. Methods A systematic review was conducted to assess financial protection in health in Africa. The search of five databases was conducted between March and May 2019. Studies were included if they conducted empirical analyses on one or two dimensions of financial protection—catastrophic and impoverishing health expenditures, at the national or subnational levels. The review included peer-review articles, grey literature and reports. Data extraction included study characteristics, the dimension of financial protection, including methods and data sources, and the type of analysis (incidence, equity analysis, determinants, trends over time) of financial protection. Results Fifty-one studies met the inclusion criteria of the review with at least one study in 41 out of the 47 countries in the WHO African Region. The analyses of the included studies showed that catastrophic and impoverishing health spending occurs in all the countries in the region, albeit at different levels. Various national household surveys were used as data sources. Also, the studies used different methods to assess financial protection. The incidence ranged from 0.29% in Zambia in 2010 to 16.4% in Nigeria in 2009 at a 10% threshold. Due to the wide range of data sources and methods, comparison of findings within and across countries was difficult. Furthermore, the majority of the studies focused on in-depth analysis of catastrophic health spending than impoverishing. Trends over time of both catastrophic and impoverishing health expenditures were even limited in single-country analysis. Conclusion This review provides evidence that generally, financial protection is being monitored at the national level in the African Region, and the incidence of financial protection has increased generally in the Region. Further research on financial protection should explore methods to harmonize the estimation of OOP from different surveys In addition, analyses should go beyond measuring the incidence of financial protection and also focus on equity analysis, looking at the drivers and trends of both dimensions of financial protection.

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Impoverishing effects of catastrophic health expenditures in Malawi

Cited by 76 publications

References 19 publications

A review of the incidence and determinants of catastrophic health expenditure in Nigeria: Implications for universal health coverage

A review of the incidence and determinants of catastrophic health expenditure in Nigeria: Implications for universal health coverage

Decomposing inequality in financial protection situation in Iran after implementing the health reform plan: What does the evidence show based on national survey of households' budget?

What do we know about financial protection in health in Africa? A systematic review

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