Distribution of out of pocket health expenditures in a sub-Saharan Africa country: evidence from the national survey of household standard of living, Cote d'Ivoire.
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ABSTRACT: Objective
The purpose and objective of our research is to identify the determinants of the out of pocket (OOP) health expenditures in the population of Ivory Coast and the ratios across three different area; Abidjan, the rural and urban area. We used data from the 2015 standard households living survey conducted by the National Institute of Statistic.Results
About 6315 (13.3%) of the participants had experienced OOP health expenditure. There was significant differences in the self-reported OOP between these three areas (p?
SUBMITTER: Attia-Konan AR
PROVIDER: S-EPMC6332523 | biostudies-literature | 2019 Jan
REPOSITORIES: biostudies-literature
Publications
Distribution of out of pocket health expenditures in a sub-Saharan Africa country: evidence from the national survey of household standard of living, Côte d'Ivoire.
Attia-Konan Akissi Régine AR Oga Agbaya Stéphane Serge ASS Touré Amadou A Kouadio Kouakou Luc KL
BMC research notes 20190115 1
<h4>Objective</h4>The purpose and objective of our research is to identify the determinants of the out of pocket (OOP) health expenditures in the population of Ivory Coast and the ratios across three different area; Abidjan, the rural and urban area. We used data from the 2015 standard households living survey conducted by the National Institute of Statistic.<h4>Results</h4>About 6315 (13.3%) of the participants had experienced OOP health expenditure. There was significant differences in the sel ...[more]
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Project description:Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. In Cote d'Ivoire, high BP is the first risk factor for stroke and myocardial infarction. May Measurement Month (MMM) is a global initiative of the International Society of Hypertension aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programmes worldwide. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2017. BP measurement, the definition of hypertension and statistical analysis followed the standard MMM17 protocol. A Coordinators Team was created. All doctors in cardiology training of Abidjan Institute of Cardiology (N = 72) were briefed to carry out the MMM study as investigators, and 55 sites were created. These were major urban transport stations, supermarkets and markets, and churches. BP was calculated from the mean of the 2nd and 3rd readings, and hypertension was defined as a systolic BP of at least 140 mmHg and/or a diastolic BP of at least 90 mmHg or being on BP-lowering treatment. We screened 24 563 individuals during MMM17, with mean age of 37 years. After multiple imputations, 5015 (20.4%) had hypertension. Of individuals not receiving anti-hypertensive medication, 3943 (16.8%) were hypertensive. Of individuals receiving anti-hypertensive medication, 583 (54.4%) had uncontrolled BP. MMM17 was the largest BP screening campaign undertaken in Cote d'Ivoire. MMM allowed us to identify many undiagnosed and inadequately treated hypertension cases and could usefully lower the burden attributed to increased BP. MMM should be continued.
| S-EPMC6479434 | biostudies-literature
Project description:BackgroundIn Ethiopia, household Out-Of-Pocket healthcare expenditure accounts for one-third of total healthcare expenditure, is one of the highest in the world, and still creates barriers and difficulties for households to healthcare access and may delay or forgo needed healthcare use. Despite the presence of a few highly dispersed and inconsistent studies, no comprehensive study was conducted. Therefore, in this systematic review and meta-analysis, we aimed at estimating the pooled estimates of the burden of household Out-Of-Pocket healthcare expenditures among Ethiopian households and identifying its determinants.MethodsWe systematically searched articles from PubMed / Medline and Google scholar databases and direct Google search engine without restriction on publication period. Cross-sectional and cohort articles and grey literature published in English were included. Data were extracted using Microsoft Excel. Two reviewers screened the titles, reviewed the articles for inclusion, extracted the data, and conducted a quality assessment. The third reviewer commented on the review. Articles with no abstracts or full texts, editorials, and qualitative in design were excluded. To assess quality, Joanna Briggs Critical Appraisal Tools was used. A Forest plot was used to present summary information on each article and pooled common effects. Potential heterogeneity was checked using Cochrane's Q test and I-squared statistic. We checked publication bias using a Funnel plot. Moreover, subgroup and sensitivity analyses were performed. Meta-analysis was used for the pooled estimates using RevMan statistical software Version 5.4.1.ResultsIn this review, a total of 27 primary articles were included (with a total sample size of 331,537 participants). Because of the presence of heterogeneity, we employed a random-effects model; therefore, the pooled burden household Out-Of-Pocket / catastrophic healthcare expenditure in Ethiopia was strongly positively associated with household economic status. The odds of facing Out-Of-Pocket / catastrophic healthcare expenditures among the poorest quintile was about three times that of the richest (AOR = 3.09, 95% CI: 1.63, 5.86) p-value < 0.001. In addition, on pooled analysis, the mean direct Out-Of-Pocket healthcare expenditures were $32 per month (95%CI: $11, $52) (SD = $45), and the mean indirect Out-of-Pocket healthcare expenditures were $15 per month (95%CI: $3, $28) (SD = $17). The mean catastrophic healthcare expenditure at 10% of threshold was also disproportionately higher: 40% (95%CI: 28, 52%) (SD = 20%). Moreover, the common coping mechanisms were a sale of household assets, support from family, or loan: 40% (95%CI: 28, 52%) (SD = 20%).ConclusionOur study revealed the evidence of inequity in financial hardship that the burden of household Out-Of-Pocket / catastrophic healthcare expenditures gap persists among Ethiopian households that is unfair and unjust. To reduce the detected disparities in seeking healthcare among Ethiopian households, national healthcare priorities should target poor households. This calls for the Ministry of Health to improve the challenges and their impact on equity and design better prepayment policies and strengthen financial protection strategies to protect more vulnerable Ethiopian households.Protocol registrationThe details of this protocol have been registered on the PROSPERO database with reference number ID: CRD42021255977 .
| S-EPMC8802489 | biostudies-literature
Project description:BackgroundFrailty, a syndrome resulting in heightened risk of negative outcomes for older adults, is increasing across the globe. However, little is known about the health service impacts of frailty in low-income countries (LICs), and in particular, sub-Saharan Africa (SSA). This study explores the relationship between frailty and health service 1) utilisation and 2) expenditure within Côte d'Ivoire.MethodsParticipants aged 50 years and over participated in the Living Condition, Health and Resilience among the Elderly study. Frailty was assessed using a 30-item Frailty Index (FI). The association between frailty and self-reported health service utilisation was analysed for general practitioners (GPs), specialists, overnight hospitalisations, traditional practitioners and self-medication. Expenditure over the previous month included consulting, medications, hospitalisations and total expenditure.ResultsAmong participants [n = 860, mean age (SD) = 61.8 (9.7) years, 42.9% female], 60.0% were frail, 22.8% pre-frail and 17.2% robust. The mean (SD) FI was 0.28 (0.17). Increased health service utilisation was associated with frailty for GP attendance, traditional practitioners and self-medication but not specialists or overnight hospitalisation. Pre-frailty and frailty were associated with increased total health service expenditure, with frailty also associated with aggregate consulting costs and medications.ConclusionsAlthough frailty is associated with health service utilisation and expenditure in a variety of contexts, the study results suggest that such impacts may vary across the globe. The experience of frailty in LICs is likely to differ from that experienced elsewhere due to cultural traditions, attitudes to the health system, and accessibility, with more research needed.
| S-EPMC8323268 | biostudies-literature
Project description:In Ethiopia, little is known about the extent of out-of-pocket health expenditures and the associated financial hardships at national and regional levels. We estimated the incidence of both catastrophic and impoverishing health expenditures using data from the 2015/16 Ethiopian household consumption and expenditure and welfare monitoring surveys. We computed incidence of catastrophic health expenditures (CHE) at 10% and 25% thresholds of total household consumption and 40% threshold of household capacity to pay, and impoverishing health expenditures (IHE) using Ethiopia's national poverty line (ETB 7184 per adult per year). Around 2.1% (SE: 0.2, P < 0.001) of households would face CHE with a 10% threshold of total consumption, and 0.9% (SE: 0.1, P < 0.001) of households would encounter IHE, annually in Ethiopia. CHE rates were high in the regions of Afar (5.8%, SE: 1.0, P < 0.001) and Benshangul-Gumuz (4.0%, SE: 0.8, P < 0.001). Oromia (n = 902 000), Amhara (n = 275 000) and Southern Nations Nationalities and Peoples (SNNP) (n = 268 000) regions would have the largest numbers of affected households, due to large population size. The IHE rates would also show similar patterns: high rates in Afar (5.0%, SE: 0.96, P < 0.001), Oromia (1.1%, SE: 0.22, P < 0.001) and Benshangul-Gumuz (0.9%, SE: 0.4, P = 0.02); a large number of households would be impoverished in Oromia (n = 356 000) and Amhara (n = 202 000) regions. In summary, a large number of households is facing financial hardship in Ethiopia, particularly in Afar, Benshangul-Gumuz, Oromia, Amhara and SNNP regions and this number would likely increase with greater health services utilization. We recommend regional-level analyses on services coverage to be conducted as some of the estimated low CHE/IHE regional values might be due to low services coverage. Periodic analyses on the financial hardship status of households could also be monitored to infer progress towards universal health coverage.
| S-EPMC7553759 | biostudies-literature
Project description:BackgroundAlthough people living with HIV in Côte d'Ivoire receive antiretroviral therapy (ART) at no cost, other out-of-pocket (OOP) spending related to health can still create a barrier to care.MethodsA convenience sample of 400 adults living with HIV for at least 1 year in Côte d'Ivoire completed a survey on their health spending for HIV and chronic non-communicable diseases (NCDs). In addition to descriptive statistics, we performed simple linear regression analyses with bootstrapped 95% confidence intervals.Findings365 participants (91%) reported OOP spending for HIV care, with a median of $16/year (IQR 5-48). 34% of participants reported direct costs with a median of $2/year (IQR 1-41). No participants reported user fees for HIV services. 87% of participants reported indirect costs, with a median of $17/year (IQR 7-41). 102 participants (26%) reported at least 1 NCD. Of these, 80 (78%) reported OOP spending for NCD care, with a median of $50/year (IQR 6-107). 76 participants (95%) with both HIV and NCDs reported direct costs, and 48% reported paying user fees for NCD services. Participants had missed a median of 2 HIV appointments in the past year (IQR 2-3). Higher OOP costs were not associated with the number of HIV appointments missed. 21% of participants reported spending over 10% of household income on HIV and/or NCD care.Discussion and conclusionsDespite the availability of free ART, most participants reported OOP spending. OOP costs were much higher for participants with co-morbid NCDs.
| S-EPMC8320983 | biostudies-literature
Project description:IntroductionGhana implemented a universal health coverage scheme aimed at attaining financial risk protection against catastrophic out-of-pocket health expenditures. The effort has yielded mixed benefits for the different socio-economic profiles of the population. The present study estimates the incidence of catastrophic payments among Ghanaian households.MethodsThe study analyzed the round seven dataset of the Ghana Living Standards Survey collected between 2016 and 2017. We estimated the incidence and intensity of catastrophic payments for total household consumption and non-food consumption for a range of thresholds. The analysis further weighted the measures of catastrophic payments to determine the distribution sensitivity.ResultsAs the threshold increased from 10 to 25% of total household consumption, the incidence of catastrophic payments dropped from 1.0 to 0.1%. At the 40% threshold of non-food consumption, the estimated incidence was 0.2%. For both total household consumption and non-food consumption, the concentration indices were negative at all the thresholds. The results were indicative of a higher concentration of financial catastrophe among the poorest households and significant inequalities in the incidence between the poorest and richest households.ConclusionThe study confirmed the declining trend in the general incidence of catastrophic health expenditures in Ghana. However, the incidence and risk of financial catastrophe remained disproportionately higher among the poorest households, which is instructive of gaps in financial risk protection coverage. The Ghana National Health Insurance Scheme must therefore strengthen its targeting and enrolment of this sub-population group to reduce their vulnerability to catastrophic payments.
| S-EPMC10012771 | biostudies-literature
Project description:ObjectiveTo assess the performance of QuantiFERON-TB Gold In-Tube (QFT-GIT) test for active tuberculosis (TB) in HIV adults, and its variation over time in patients on antiretroviral therapy (ART) and/or isoniazide preventive therapy (IPT).MethodsTransversal study and cohort nested in the Temprano ANRS 12136 randomized controlled trial assessing benefits of initiating ART earlier than currently recommended by World Health Organization, with or without a 6-month IPT. Performance of QFT-GIT for detecting active TB at baseline in the first 50% participants, and 12-month incidence of conversion/reversion in the first 25% participants were assessed. QFT-GIT threshold for positivity was 0.35 IU/ml.ResultsAmong the 975 first participants (median baseline CD4 count 383/mm3, positive QFT-GIT test 35%), 2.7% had active TB at baseline. QFT-GIT sensitivity, specificity, positive and negative predictive value for active TB were 88.0%, 66.6%, 6.5% and 99.5%. For the 444 patients with a second test at 12 months, rates for conversion and reversion were 9.3% and 14%. Reversion was more frequent in patients without ART and younger patients. IPT and early ART were not associated with reversion/conversion.ConclusionA negative QFT-GIT could rule out active TB in HIV-infected adults not severely immunosuppressed, thus avoiding repeated TB testing and accelerating diagnosis and care for other diseases.Trial registrationClinicalTrials.gov NCT00495651.
| S-EPMC4199568 | biostudies-literature
Project description:OBJECTIVE:In sub-Saharan Africa, HIV-infected adults who fail second-line antiretroviral therapy (ART) often do not have access to third-line ART. We examined the clinical impact and cost-effectiveness of making third-line ART available in Côte d'Ivoire. METHODS:We used a simulation model to compare 4 strategies after second-line ART failure: continue second-line ART (C-ART2), continue second-line ART with an adherence reinforcement intervention (AR-ART2), immediate switch to third-line ART (IS-ART3), and continue second-line ART with adherence reinforcement, switching patients with persistent failure to third-line ART (AR-ART3). Third-line ART consisted of a boosted-darunavir plus raltegravir-based regimen. Primary outcomes were 10-year survival and lifetime incremental cost-effectiveness ratios (ICERs), in $/year of life saved (YLS). ICERs below $3585 (3 times the country per capita gross domestic product) were considered cost-effective. RESULTS:Ten-year survival was 6.0% with C-ART2, 17.0% with AR-ART2, 35.4% with IS-ART3, and 37.2% with AR-ART3. AR-ART2 was cost-effective ($1100/YLS). AR-ART3 had an ICER of $3600/YLS and became cost-effective if the cost of third-line ART decreased by <1%. IS-ART3 was less effective and more costly than AR-ART3. Results were robust to wide variations in the efficacy of third-line ART and of the adherence reinforcement, as well as in the cost of second-line ART. CONCLUSIONS:Access to third-line ART combined with an intense adherence reinforcement phase, used as a tool to distinguish between patients who can still benefit from their current second-line regimen and those who truly need third-line ART would provide substantial survival benefits. With minor decreases in drug costs, this strategy would be cost-effective.
| S-EPMC4146647 | biostudies-literature
Project description:BACKGROUND:Within its reform efforts, the Government of Tajikistan is embracing the essential role of primary health care (PHC) in decreasing out of pocket (OOP) expenditures and increasing equity in access to health services. In the light of the increasing burden of disease relating to chronic conditions, we investigated OOP expenditures of patients with chronic conditions within a PHC setting; and if and how those expenditures are impacted by several interventions currently being implemented within Tajikistan. METHODS:A cross-sectional survey among 1600 adult patients who had visited a PHC facility was conducted. The data obtained through interviews were descriptively analysed, and logistic regressions and gamma generalized linear models were performed. RESULTS:The total OOP expenditures related to a patient's last visit to the PHC facility were 17.2 USD for those with chronic conditions and 13.9 USD for those visiting due to an acute condition. Adjustment for potential confounders reduced the discrepancy from 3.3 USD to 0.5 USD. This convergence of costs was only observed in districts covered by the Basic Benefit Package (BBP), a governmental pilot project, aiming to standardise exemptions for payment and formal co-payments for health care services. Hence, we found the BBP to have a protective impact for patients with chronic conditions. However, considering the demographics of these patients (older in age, with greater dependency on pensions and social aid, and lower socio-economic status) in combination with the 40% higher utilisation rate of PHC and the high rate of onward referrals to specialists; it is clear that patients with chronic conditions continue to face substantial long-term costs and disadvantages. CONCLUSIONS:After accounting for confounders, patients with chronic and acute conditions faced similar costs related to a single visit to a PHC facility in districts covered by the BBP. However, greater efforts are required to ensure that citizens are well informed about their rights to health care, the BBP and the services that should be provided at no cost at the point of delivery. Moreover, the needs of patients with chronic conditions warrant a more integrative approach that takes long-term expenditures and services beyond the level of PHC into account.
| S-EPMC7298845 | biostudies-literature
Project description:IntroductionThis study aims to determine the out-of-pocket health expenditures of households in Turkey where individuals with rare diseases are residing.MethodsThe research population consisted registered members of associations who are members of the Rare Diseases Network. In addition to the general analysis including all participants, expenditures based on characteristics of disease holders were also calculated.ResultsA total of 439 participants were included in the analysis. We determined that special nutrition was the highest expenditure group and emergency departments were the lowest expenditure group. When all the participants were evaluated, the average cost of rare diseases was found to be Ł22,743 (€2,877). A significant relationship was found between income status and out-of-pocket health expenditures (p = 0.012).DiscussionPolicy makers should consider inclusion of special nutritional products and medical/non-medical devices used in treatment of rare diseases within the scope of reimbursement and the development of orphan drug legislation as the first actions to be taken.
| S-EPMC10020592 | biostudies-literature