Variation in financial protection and its association with health expenditure indicators: an analysis of low- and middle-income countries

Abstract

Background An insight into variation in financial protection among countries and the underpinning factors associated with the variations observed will help to inform public health policy and practice. Method Secondary datasets from Global Health Expenditure Database and World Bank Development Indicators collected between 2000 and 2016 were used. Financial protection was measured in 75 low- and middle-income countries (LMICs) using the sustainable development goals framework. Funnel plot charts were used to explore the variation, and regression models were used to measure associations. Result Fifty-three (67%) countries were within the 99% control limits indicating common-cause variation; 11 countries were above the upper control limit and 15 countries were below the lower control limit. In the fully adjusted model, country, spending on health relative to their economy had the strongest association with the variation in catastrophic spending. Every 1% increase in health spending relative to gross domestic product (GDP) was found to be associated with a reduction of 0.13% in the number of people that incurred catastrophic health spending. Conclusion There is substantial variation in financial protection, as measured by the number of people that incurred catastrophic health spending, in LMICs; a proportion of this could be explained by the difference in GDP and external health expenditure.

Equity of national publicly funded health insurance schemes under the universal health coverage agenda: a systematic review of studies conducted in Africa

“…This alone exposes families to catastrophic health spending through high out-of-pocket payment to access health services, constitute barriers to disadvantaged groups, thus widening the inequity gap. 26,74,75,76 Also, a large percentage of the population in African countries are employed in the informal sector and reside in rural settings. 71,77 This has posed serious challenges to implementing effective health insurance schemes that will cover the whole population.…”