The impact of out‐of‐pocket health expenditure on household impoverishment: Evidence from Morocco

Oudmane, Meriem; Mourji, Fouzi; Ezzrari, Abdeljaouad

doi:10.1002/hpm.2848

Cited by 20 publications

(21 citation statements)

References 16 publications

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“…Our finding that hospitalizations increased the incidence of catastrophic health expenditures is consistent with findings from other studies [5,20,21,41,42]. Households with hospitalized members may sell assets, use savings and hire external labor as coping mechanisms.…”

Section: Discussionsupporting

confidence: 92%

Examining the incidence of catastrophic health expenditures and its determinants using multilevel logistic regression in Malawi

2021

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Background Despite a free access to public health services policy in most sub-Saharan African countries, households still contribute to total health expenditures through out-of-pocket expenditures. This reliance on out-of-pocket expenditures places households at a risk of catastrophic health expenditures and impoverishment. This study examined the incidence of catastrophic health expenditures, impoverishing effects of out-of-pocket expenditures on households and factors associated with catastrophic expenditures in Malawi. Methods We conducted a secondary analysis of the most recent nationally representative integrated household survey conducted by the National Statistical Office between April 2016 to 2017 in Malawi with a sample size of 12447 households. Catastrophic health expenditures were estimated based on household annual nonfood expenditures and total household annual expenditures. We estimated incidence of catastrophic health expenditures as the proportion of households whose out-of-pocket expenditures exceed 40% threshold level of non-food expenditures and 10% of total annual expenditures. Impoverishing effect of out-of-pocket health expenditures on households was estimated as the difference between poverty head count before and after accounting for household health payments. We used a multilevel binary logistic regression model to assess factors associated with catastrophic health expenditures. Results A total of 167 households (1.37%) incurred catastrophic health expenditures. These households on average spend over 52% of household nonfood expenditures on health care. 1.6% of Malawians are impoverished due to out-of-pocket health expenditures. Visiting a religious health facility (AOR = 2.27,95% CI:1.24–4.15), hospitalization (AOR = 6.03,95% CI:4.08–8.90), larger household size (AOR = 1.20,95% CI:1.24–1.34), higher socioeconomic status (AOR = 2.94,95% CI:1.39–6.19), living in central region (AOR = 3.54,95% CI:1.79–6.97) and rural areas (AOR = 5.13,95% CI:2.14–12.29) increased the odds of incurring catastrophic expenditures. Conclusion The risk of catastrophic health expenditures and impoverishment persists in Malawi. This calls for government to improve the challenges faced by the free public health services and design better prepayment mechanisms to protect more vulnerable groups of the population from the burden of out-of-pocket payments.

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Section: Discussionsupporting

confidence: 92%

Examining the incidence of catastrophic health expenditures and its determinants using multilevel logistic regression in Malawi

2021

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“…This nancial catastrophe is not without social and economic consequences because those who can pay spend their savings or reduce their basic needs. However, for households that cannot pay, the mothers and babies are held at the point of care, sometimes without treatment, since they cannot afford care.This study aligns with several other studies within the DRC [6,8,9] and elsewhere [32,[45][46][47] revealing that even the lowest healthcare costs are out of reach for many people. As a result, several social and economic consequences arise at the household level: exclusion from health care, indebtedness and high use of the informal sector [15,39,48].It is true that the presence of quali ed personnel during all deliveries is considered to be one of the most important interventions for safer births because it reduces maternal deaths and increases successful delivery of infants [41,[49][50][51].…”

Section: Discussionsupporting

confidence: 92%

Social and Economic Consequences of the Cost of Obstetric and Neonatal Care in Lubumbashi, in the Democratic Republic of Congo: Mixed Study

Musau¹,

Ntambue²,

Omewatu³

et al. 2020

Preprint

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Background: The aim of this study was to explore and measure the social and economic consequences of the cost of obstetric and neonatal care in Lubumbashi, the Democratic Republic of Congo.Methods: We conducted a mixed qualitative and quantitative study in the maternity departments of health facilities in Lubumbashi. The qualitative results were based on a case study conducted in 2018 that included 14 respondents (8 parturients, 2 accompanying family members and 4 health care providers). A quantitative cross-sectional analytical study was carried out in 2019 with 411 women who gave birth at 10 referral hospitals. Data were collected for one month at each hospital, and selected parturients were included in the study only if they paid out-of-pocket and at the point of care for costs related to obstetric and neonatal care.Results: Costs for obstetric and neonatal care averaged US $77, US $207 and US $338 for simple, complicated vaginal and cesarean deliveries, respectively. These health expenditures were greater than or equal to 40% of the ability to pay for 58.4% of households. At the time of delivery, 14.1% of women in childbirth did not have enough money to pay for care. Of those who did, 76.5% spent their savings. When households did not pay for care, mothers and their babies were held for a long time at the place of care. This resulted in prolonged absence of the mother from the household, reduced household income, family conflicts, and the abandonment of the home by the spouse. At the health facility level, the length of stay increased without generating any additional financial benefits. Disrespectful care and the deterioration of the relationships between caregivers and parturients were also recorded.Conclusion: To reduce the social and economic consequences of care, the government of the DRC should implement a mechanism for subsidizing care and should associate it with a cost-sharing system. This would result in achieving universal health coverage and improving the physical, mental and social health of mothers, their babies and their households.

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“…The Kenyan health insurance programme also promotes access to maternal healthcare in private hospitals90 and reduces out-of-pocket health expenditures 91. In Morocco, the only impact study we included in this review found a significant impact of insurance on catastrophic health expenditure 92. In Nigeria, the public health insurance scheme is also reported to have an impact on access to care and financial protection for beneficiaries,93 except for the poor 93.…”

Section: Resultsmentioning

confidence: 95%

“…91 In Morocco, the only impact study we included in this review found a significant impact of insurance on catastrophic health expenditure. 92 In Nigeria, the public health insurance scheme is also reported to have an impact on access to care and financial protection for beneficiaries, 93 except for the poor. 93 Such a lack of equity was also observed in Rwanda, where policyholders in the poorest quintiles used less care than other policyholders and were more exposed than the latter to catastrophic health expenditure.…”

Section: Resultsmentioning

confidence: 99%

Universal health insurance in Africa: a narrative review of the literature on institutional models

Bassoum

Faye

2022

BMJ Glob Health

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IntroductionSeveral African countries have introduced universal health insurance (UHI) programmes. These programmes aim to extend health insurance to groups that are usually excluded, namely informal workers and the indigent. Countries use different approaches. The purpose of this article is to study their institutional characteristics and their contribution to the achievement of universal health coverage (UHC) goals.MethodThis study is a narrative review. It focused on African countries with a UHI programme for at least 4 years. We identified 16 countries. We then compared how these UHI schemes mobilise, pool and use funds to purchase healthcare. Finally, we synthesised how all these aspects contribute to achieving the main objectives of UHC (access to care and financial protection).ResultsNinety-two studies were selected. They found that government-run health insurance was the dominant model in Africa and that it produced better results than community-based health insurance (CBHI). They also showed that private health insurance was marginal. In a context with a large informal sector and a substantial number of people with low contributory capacity, the review also confirmed the limitations of contribution-based financing and the need to strengthen tax-based financing. It also showed that high fragmentation and voluntary enrolment, which are considered irreconcilable with universal insurance, characterise most UHI systems in Africa.ConclusionPublic health insurance is more likely to contribute to the achievement of UHC goals than CBHI, as it ensures better management and promotes the pooling of resources on a larger scale.

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The impact of out‐of‐pocket health expenditure on household impoverishment: Evidence from Morocco

Cited by 20 publications

References 16 publications

Examining the incidence of catastrophic health expenditures and its determinants using multilevel logistic regression in Malawi

Examining the incidence of catastrophic health expenditures and its determinants using multilevel logistic regression in Malawi

Social and Economic Consequences of the Cost of Obstetric and Neonatal Care in Lubumbashi, in the Democratic Republic of Congo: Mixed Study

Universal health insurance in Africa: a narrative review of the literature on institutional models

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