Browsing by Subject "Financial protection"

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    Open Access
    Assessing medical impoverishment and associated factors in health care in Ethiopia
    (2020-03-30) Obse, Amarech G; Ataguba, John E
    Abstract Background About 5% of the global population, predominantly in low- and middle-income countries, is forced into poverty because of out-of-pocket (OOP) health spending. In most countries in sub-Saharan Africa, the share of OOP health spending in current health expenditure exceeds 35%, increasing the likelihood of impoverishment. In Ethiopia, OOP payments remained high at 37% of current health expenditure in 2016. This study assesses the impoverishment resulting from OOP health spending in Ethiopia and the associated factors. Methods This paper uses data from the Ethiopian Household Consumption Expenditure Survey (HCES) 2010/11. The HCES covered 10,368 rural and 17,664 urban households. OOP health spending includes spending on various outpatient and inpatient services. Impoverishing impact of OOP health spending was estimated by comparing poverty estimates before and after OOP health spending. A probit model was used to assess factors that are associated with impoverishment. Results Using the Ethiopian national poverty line of Birr 3781 per person per year (equivalent to US$2.10 per day), OOP health spending pushed about 1.19% of the population (i.e. over 957,169 individuals) into poverty. At the regional level, impoverishment ranged between 2.35% in Harari and 0.35% in Addis Ababa. Living in rural areas (highland, moderate, or lowland) increased the likelihood of impoverishment compared to residing in an urban area. Households headed by males and adults with formal education are less likely to be impoverished by OOP health spending, compared to their counterparts. Conclusion In Ethiopia, OOP health spending impoverishes a significant number of the population. Although the country had piloted and initiated many reforms, e.g. the fee waiver system and community-based health insurance, a significant proportion of the population still lacks financial protection. The estimates of impoverishment from out-of-pocket payments reported in this paper do not consider individuals that are already poor before paying out-of-pocket for health services. It is important to note that this population may either face deepening poverty or forgo healthcare services if a need arises. More is therefore required to provide financial protection to achieve universal health coverage in Ethiopia, where the informal sector is relatively large.
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    Open Access
    Catastrophic health expenditure and financial coping strategies among patients with colorectal cancer (crc) and stomas: a cross-sectional study at Groote Schuur Hospital, Western Cape, South Africa
    (2026) Gokool, Kairav; Cunnama, Lucy; Okova, Denis
    Background: Colorectal cancer (CRC) is the second leading cause of cancer mortality globally, with an increasing burden in low- and middle-income countries (LMICs) like South Africa. CRC, often accompanied by stoma formation, imposes significant out-of-pocket (OOP) expenses for patients. However, limited research exists on the financial and socio-economic impacts of CRC and CRC-related stoma care in LMIC contexts. This exploratory study investigated the extent of catastrophic health expenditure (CHE) among CRC patients with stomas and the financial coping strategies they employ. Methods: A cross-sectional observational study was conducted at Groote Schuur Hospital in Cape Town, South Africa, from October to November 2024. A questionnaire was administered to 21 patients with CRC and stomas to gather data on demographics, direct and indirect costs, and coping mechanisms. Statistical analysis included descriptive statistics, computing CHE and penalised logistic regression models to identify determinants of CHE. Cost-coping strategies were also examined. Results: Transportation costs accounted for the largest share of OOP expenditure (48.9%) and followed by medicines (27.8%). CHE, defined as annual OOP costs exceeding 10% of household expenditure, affected 38% of participants, with a disproportionate burden on poorer households and patients with late-stage CRC. Among the poorest households, 60% experienced CHE compared with 50% of poor households, similarly 50% of stage 3 and 33.33% of stage 4 CRC households reported CHE. Financial coping strategies were reported by 81% of households, most commonly reducing household expenditures (47.7%) and taking on additional work (19%). A notable proportion (19%) reported employing no coping mechanisms. Conclusion: This study highlights the significant financial burden faced by CRC patients with stomas. To mitigate this burden, policymakers should prioritize expanding financial protection measures, such as subsidies for essential medications and transport assistance programs. Integrating CRC care into existing universal health coverage (UHC) frameworks can also enhance affordability and accessibility. Adopting early screening initiatives may also play a crucial role in alleviating late-stage disease burdens and the accompanying likelihood of financial catastrophe.
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    Open Access
    Promoting universal financial protection: evidence from seven low- and middle-income countries on factors facilitating or hindering progress
    (BioMed Central Ltd, 2013) McIntyre, Di; Ranson, Michael; Aulakh, Bhupinder; Honda, Ayako
    Although universal health coverage (UHC) is a global health policy priority, there remains limited evidence on UHC reforms in low- and middle-income countries (LMICs). This paper provides an overview of key insights from case studies in this thematic series, undertaken in seven LMICs (Costa Rica, Georgia, India, Malawi, Nigeria, Tanzania, and Thailand) at very different stages in the transition to UHC.These studies highlight the importance of increasing pre-payment funding through tax funding and sometimes mandatory insurance contributions when trying to improve financial protection by reducing out-of-pocket payments. Increased tax funding is particularly important if efforts are being made to extend financial protection to those outside formal-sector employment, raising questions about the value of pursuing contributory insurance schemes for this group. The prioritisation of insurance scheme coverage for civil servants in the first instance in some LMICs also raises questions about the most appropriate use of limited government funds.The diverse reforms in these countries provide some insights into experiences with policies targeted at the poor compared with universalist reform approaches. Countries that have made the greatest progress to UHC, such as Costa Rica and Thailand, made an explicit commitment to ensuring financial protection and access to needed care for the entire population as soon as possible, while this was not necessarily the case in countries adopting targeted reforms. There also tends to be less fragmentation in funding pools in countries adopting a universalist rather than targeting approach. Apart from limiting cross-subsidies, fragmentation of pools has contributed to differential benefit packages, leading to inequities in access to needed care and financial protection across population groups; once such differentials are entrenched, they are difficult to overcome. Capacity constraints, particularly in purchasing organisations, are a pervasive problem in LMICs. The case studies also highlighted the critical role of high-level political leadership in pursuing UHC policies and citizen support in sustaining these policies.This series demonstrates the value of promoting greater sharing of experiences on UHC reforms across LMICs. It also identifies key areas of future research on health care financing in LMICs that would support progress towards UHC.