Utilization of Health Care and Burden of Out-of-Pocket Health Expenditure in Zimbabwe: Results from a National Household Survey

Abstract

In the last decade, Zimbabwe has undertaken substantial changes and implemented new initiatives to improve health system performance and services delivery, including results-based financing in rural health facilities. This study aims to examine the utilization of health services and level of financial risk protection of Zimbabwe's health system. Using a multistage sampling approach, 7,135 households with a total of 32,294 individuals were surveyed in early 2016 on utilization of health services, out-of-pocket (OOP) health expenditure, and household consumption (as a measure of living standards) in 2015. The study found that the outpatient visits were favorable to the poor but the poorest had less access to inpatient care. In 2015, household OOP expenditure accounted for about one quarter of total health expenditure in Zimbabwe and 7.6% of households incurred catastrophic health expenditure (CHE). The incidence of CHE was 13.4% in the poorest quintile in comparison with 2.8% in the richest. Additionally, 1.29% of households fell into poverty due to health care-related expenditures. The study suggests that there are inequalities in utilization of health services among different population groups. The poor seeking inpatient care are the most vulnerable to CHE.

Financial risk of seeking maternal and neonatal healthcare in southern Ethiopia: a cohort study of rural households

“…This was evidenced by OOP healthcare payments resulting in an additional 2% of households falling into poverty. This finding was consistent with other studies from Zimbabwe [43], as poverty was associated with low utilisation of healthcare services. The poorest households suffered from high OOP healthcare payments, which resulted in a higher incidence of CHE.…”

Improving the Allocative Efficiency of the HIV Response Across the Care Cascade in Zimbabwe

“…[6] High out-of-pocket spending on health is putting many Zimbabweans at risk of poverty or is deepening their poverty level. [6], [9] Despite recent improvements, purchasing power parity (adjusted per capita gross national income) was 27% lower in 2017, compared with 1990. [6] Still, with international funding and other general development gains, consistent improvements in life expectancy have been observed in Zimbabwe.…”

“…6 Accordingly, in 2015 8% of Zimbabweans experienced increased risk of poverty due to household paying out-of-pocket health costs. [9] In the same year, only 34% of total health spending was publicly funded, suggesting heavy reliance on donor funding and the private sector. [3] In contrast to overall health budgets, the HIV response is less reliant on out-of-pocket funding, subject in larger part to a targeted tax instrument paid for by formal sector employment.…”

“…Individuals are assigned to a given population group based on their dominant risk. 9 HIV infections occur through the interaction between different populations by regular, casual, or commercial (including transactional) sexual partnerships, through sharing of injecting equipment or through mother-to-child transmission. The forceof-infection is the rate at which uninfected individuals become infected, and it depends on the number and type of risk events to which individuals are exposed in a given period (either within their population groups or through interaction with other population groups) and the infection probability of each event.…”

Targeted subsidy plan and Kakwani index in Iran health system

“…OOPP is considered as a barrier to –health-care utilization and has negative effects on society's health, especially for people with low-income and poor families. [ 6 ] Moreover, it will increase the probability of being stuck in poverty trap for households. [ 7 ]…”