Porous safety net: catastrophic health expenditure and its determinants among insured households in Togo

Abstract

BackgroundIn Togo, about half of health care costs are paid at the point of service, which reduces access to health care and exposes households to catastrophic health expenditure (CHE). To address this situation, the Togolese government introduced a National Health Insurance Scheme (NHIS) in 2011. This insurance currently covers only employees and retirees of the State as well as their dependents, although plans for extension exist. This study is the first attempt to examine the extent to which Togo’s NHIS protects its members financially against the consequences of ill-health.MethodsData was obtained from a cross-sectional representative households’ survey involving 1180 insured households that had reported illness in the household in the 4 weeks preceding the survey or hospitalization in the 12 months preceding the survey. The incidence and intensity of CHE were measured by the catastrophic health payment method. A logistic regression was used to analyse determinants of CHE.ResultsThe results indicate that the proportion of insured households with CHE varies widely between 3.94% and 75.60%, depending on the method and the threshold used. At the 40% threshold, health care cost represents 60.95% of insured households’ total monthly non-food expenditure. This study showed that the socioeconomic status, the type of health facility used, hospitalization and household size were the highest predictors of CHE. Whatever the chosen threshold, care in referral and district hospitals significantly increases the likelihood of CHE. In addition, the proportion of households facing CHE is higher in the lowest income groups. The behaviour of health care providers, poor quality of care and long waiting time were the main factors leading to CHE.ConclusionA sizable proportion of insured households face CHE, suggesting gaps in the coverage. To limit the impoverishment of insured households with low income, policies for free or heavily subsidized hospital services should be considered. The results call for an equitable health insurance scheme, which is affordable for all insured households.

Effect of Critical Illness Insurance on Household Catastrophic Health Expenditure: The Latest Evidence from the National Health Service Survey in China

“…Therefore, it is necessary to further focus policy efforts on elderly and impoverished households, such as increasing welfare subsidies or extending medical assistance programs to enhance financial protection and reduce CHE. Previous reports described significant associations between the type of healthcare facility and CHE [28,35]. Our study also found that seeking inpatient services in second-level hospitals or above increased CHE incidence and intensity, which suggests that higher medical costs of high-level hospitals and hospitalization may result in more catastrophic health expenses.…”

A review of the incidence and determinants of catastrophic health expenditure in Nigeria: Implications for universal health coverage

“…This finding was however conflicting as one of the studies found a lower odds of CHE among households that utilized health services from private facilities. Also, use of public health facilities has been associated with increased odds of CHE from other studies . This may be related to the high cost of specialized services especially in public tertiary hospitals compared with their private counterparts; hence, households tend to pay more at public health care facilities than private facilities .…”

“…All (100%) of households that received inpatient care incurred catastrophic spending in one of the studies . Hospitalization for such medical conditions are usually as emergencies and are associated with high costing diagnostic tests, treatment, and nonmedical costs such as food in addition to the low‐income level and lost earnings of the primary income earner who may be the patient or caregiver . Given the chronicity of HIV and epilepsy care, such CHE could affect continuity of care and increase mortality from these diseases.…”

“…Also, use of public health facilities has been associated with increased odds of CHE from other studies. 55 This may be related to the high cost of specialized services especially in public tertiary hospitals compared with their private counterparts; hence, households tend to pay more at public health care facilities than private facilities. 40 Regarding educational status, this review found that both the educated and uneducated were more likely to incur CHE.…”

Analysis of the Effect of Rural Residents Serious Illness Medical Insurance on Relieving the Economic Burden of Rural Residents in China:A Case Study in Jinzhai County

“…Meanwhile, relevant research showed that the economic condition of migrant workers was relatively good, which may also lead to more patients choose to go to different places for medical treatment [14]. Therefore, it could be considered that people with better economic conditions were more likely to enjoy the SIMIS, while patients with poor economic conditions may choose not to see a doctor, which also causes unfairness to some extent [15,16].…”