On the Measurement of Financial Protection: An Assessment of the Usefulness of the Catastrophic Health Expenditure Indicator to Monitor Progress Towards Universal Health Coverage

Grépin, Karen A; Irwin, Bridget R.; Trakinsky, Benjamin Sas

doi:10.1080/23288604.2020.1744988

Cited by 25 publications

(21 citation statements)

References 48 publications

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“…We opted to focus our analysis of UHC solely on elements of service coverage, rather than financial risk protection, given the ongoing debate on the measurement challenges associated with current thresholds used in the calculation of the official SDG indicator on financial protection as a component of UHC. [36][37][38] We removed the service capacity and access component as it is conceptually meant to measure the health system functionality component and thus may introduce predictable collinearity. We calculated values for spearman's rho between the emerging functionality scores and the UHC index, postulating that a strong correlation would confer face validity of the emerging index as a good predictor of UHC attainment.…”

Section: Construct Validitymentioning

confidence: 99%

Towards universal health coverage in the WHO African Region: assessing health system functionality, incorporating lessons from COVID-19

Karamagi

Tumusiime²,

Titi-Ofei

et al. 2021

BMJ Glob Health

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The move towards universal health coverage is premised on having well-functioning health systems, which can assure provision of the essential health and related services people need. Efforts to define ways to assess functionality of health systems have however varied, with many not translating into concrete policy action and influence on system development. We present an approach to provide countries with information on the functionality of their systems in a manner that will facilitate movement towards universal health coverage. We conceptualise functionality of a health system as being a construct of four capacities: access to, quality of, demand for essential services and its resilience to external shocks. We test and confirm the validity of these capacities as appropriate measures of system functionality. We thus provide results for functionality of the 47 countries of the WHO African Region based on this. The functionality of health systems ranges from 34.4 to 75.8 on a 0–100 scale. Access to essential services represents the lowest capacity in most countries of the region, specifically due to poor physical access to services. Funding levels from public and out-of-pocket sources represent the strongest predictors of system functionality, compared with other sources. By focusing on the assessment on the capacities that define system functionality, each country has concrete information on where it needs to focus, in order to improve the functionality of its health system to enable it respond to current needs including achieving universal health coverage, while responding to shocks from challenges such as the 2019 coronavirus disease. This systematic and replicable approach for assessing health system functionality can provide the guidance needed for investing in country health systems to attain universal health coverage goals.

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Section: Construct Validitymentioning

confidence: 99%

Towards universal health coverage in the WHO African Region: assessing health system functionality, incorporating lessons from COVID-19

Karamagi

Tumusiime²,

Titi-Ofei

et al. 2021

BMJ Glob Health

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“…Su et al (2006) reported that as much as 14.6-25.7% of the households from the lowest quartile in the general population in Nouna incurred catastrophic healthcare expenditure before the implementation of community-based health insurance [21]. None of these studies measured the extent to which ultra-poor are exposed to financial hardship through the use of health services, despite researchers have highlighted the importance of monitoring such outcome to secure the achievement of the sustainable development goals (SDGs), in particular SDG3, targeting specifically health for all [22]. The lack of evidence on the financial risk protection for the ultra-poor in Burkina Faso is comparable with other low-and middle income countries.…”

Section: Introductionmentioning

confidence: 99%

Factors related to excessive out-of-pocket expenditures among the ultra-poor after discontinuity of PBF: a cross-sectional study in Burkina Faso

et al. 2020

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Background Measuring progress towards financial risk protection for the poorest is essential within the framework of Universal Health Coverage. The study assessed the level of out-of-pocket expenditure and factors associated with excessive out-of-pocket expenditure among the ultra-poor who had been targeted and exempted within the context of the performance-based financing intervention in Burkina Faso. Ultra-poor were selected based on a community-based approach and provided with an exemption card allowing them to access healthcare services free of charge. Methods We performed a descriptive analysis of the level of out-of-pocket expenditure on formal healthcare services using data from a cross-sectional study conducted in Diébougou district. Multivariate logistic regression was performed to investigate the factors related to excessive out-of-pocket expenditure among the ultra-poor. The analysis was restricted to individuals who reported formal health service utilisation for an illness-episode within the last six months. Excessive spending was defined as having expenditure greater than or equal to two times the median out-of-pocket expenditure. Results Exemption card ownership was reported by 83.64% of the respondents. With an average of FCFA 23051.62 (USD 39.18), the ultra-poor had to supplement a significant amount of out-of-pocket expenditure to receive formal healthcare services at public health facilities which were supposed to be free. The probability of incurring excessive out-of-pocket expenditure was negatively associated with being female (β = − 2.072, p = 0.00, ME = − 0.324; p = 0.000) and having an exemption card (β = − 1.787, p = 0.025; ME = − 0.279, p = 0.014). Conclusions User fee exemptions are associated with reduced out-of-pocket expenditure for the ultra-poor. Our results demonstrate the importance of free care and better implementation of existing exemption policies. The ultra-poor’s elevated risk due to multi-morbidities and severity of illness need to be considered when allocating resources to better address existing inequalities and improve financial risk protection.

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“…This is most significant when patients self-treat since cost rose by about US $7 between 2012 and 2018. The increase in OOPPs and incidence of CHEs can be attributed to the successful implementation of components of these health reforms since studies have suggested that when health reforms improve access to healthcare but does not adequately protect users from OOPPs, the incidence of OOPPs and CHE tend to increase [37,38]. A review of the performance of health systems reforms in the Kyrgyz Republic from independence to 2010 by Ibraimova et.…”

Section: Discussionmentioning

confidence: 99%

Trends in out of pocket payments and catastrophic health expenditure in the Kyrgyz Republic post “Manas Taalimi” and “Den Sooluk” health reforms, 2012–2018

Iamshchikova

Mogilevskii

Onah

2021

Int J Equity Health

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Background Over the years, the Kyrgyz Republic has implemented health reforms that target health financing with the aim of removing financial barriers to healthcare including out-of-pocket health payments (OOPPs). This study examines the trends in OOPPs, and the incidence of catastrophic health expenditure (CHE) post the “Manas Taalimi” and “Den Sooluk” health reforms. Methods We used data from the Kyrgyzstan Integrated Household Surveys (2012–2018). Population-weighted descriptive statistics were used to examine the trends in OOPPs and CHE at three thresholds; 10 percent of total household consumption expenditure (Cata10), 25 percent of total household consumption expenditure (Cata25) and 40 percent of total household non-food consumption expenditure (Cata40). Panel and cross-sectional logistic regression with marginal effects were used to examine the predictors of Cata10 and Cata40. Findings Between 2012 and 2018, OOPPs increased by about US $6 and inpatient costs placed the highest cost burden on users (US $13.6), followed by self-treatment (US $10.7), and outpatient costs (US $9). Medication continues to predominantly drive inpatient, outpatient, and self-treatment OOPPs. About 0.378 to 2.084 million people (6 – 33 percent) of the population incurred catastrophic health expenditure at the three thresholds between 2012 and 2018. Residing in households headed by a widowed or single head, or residing in rural regions, increases the likelihood of incurring catastrophic health expenditure. Conclusions The initial gains in the reduction of OOPPs and catastrophic health expenditure appear to gradually erode since costs continue to increase after an initial decline and catastrophic health expenditure continues to rise unabated. This implies that households are increasingly incurring economic hardship from seeking healthcare. Considering that this could result to forgone expenditure on essential items including food and education, efforts should target the sustainability of these health reforms to maintain and grow the reduction of catastrophic health payments and its dire consequences.

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On the Measurement of Financial Protection: An Assessment of the Usefulness of the Catastrophic Health Expenditure Indicator to Monitor Progress Towards Universal Health Coverage

Cited by 25 publications

References 48 publications

Towards universal health coverage in the WHO African Region: assessing health system functionality, incorporating lessons from COVID-19

Towards universal health coverage in the WHO African Region: assessing health system functionality, incorporating lessons from COVID-19

Factors related to excessive out-of-pocket expenditures among the ultra-poor after discontinuity of PBF: a cross-sectional study in Burkina Faso

Trends in out of pocket payments and catastrophic health expenditure in the Kyrgyz Republic post “Manas Taalimi” and “Den Sooluk” health reforms, 2012–2018

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