Journal
BMC HEALTH SERVICES RESEARCH
Volume 15, Issue -, Pages -Publisher
BMC
DOI: 10.1186/s12913-015-0682-x
Keywords
Financial health protection; Out-of-pocket payments; Catastrophic payments; Impoverishment; Uganda
Categories
Funding
- International Development Research Council (IDRC) for the Strategies for Health Insurance and Equity in Less Developed countries (SHIELD) project [106334]
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Background: Direct out-of-pocket payments for health care are recognised as limiting access to health care services and also endangering the welfare of households. In Uganda, such payments comprise a large portion of total health financing. This study assesses the catastrophic and impoverishing impact of paying for health care out-of-pocket in Uganda. Methods: Using data from the Uganda National Household Surveys 2009/10, the catastrophic impact of out-of-pocket health care payments is defined using thresholds that vary with household income. The impoverishing effect of out-of-pocket health care payments is assessed using the Ugandan national poverty line and the World Bank poverty line ($ 1.25/day). Results: A high level and intensity of both financial catastrophe and impoverishment due to out-of-pocket payments are recorded. Using an initial threshold of 10% of household income, about 23% of Ugandan households face financial ruin. Based on both the $ 1.25/day and the Ugandan poverty lines, about 4% of the population are further impoverished by such payments. This represents a relative increase in poverty head count of 17.1% and 18.1% respectively. Conclusion: The absence of financial protection in Uganda's health system calls for concerted action. Currently, out-of-pocket payments account for a large share of total health financing and there is no pooled prepayment system available. There is therefore a need to move towards mandatory prepayment. In this way, people could access the needed health services without any associated financial consequence.
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