Abstract
BackgroundDirect 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.MethodsUsing 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).ResultsA 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.ConclusionThe 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.
Highlights
Direct out-of-pocket payments for health care are recognised as limiting access to health care services and endangering the welfare of households
Household catastrophic out-of-pocket health payments As indicated in Table 1, a large number of households spend a substantial share of their total income on outof-pocket health care
The results indicate a lack of financial protection in Uganda’s health system
Summary
Direct out-of-pocket payments for health care are recognised as limiting access to health care services and endangering the welfare of households. Health systems are called upon to ensure universal access to health care for their populations [1] This requires that they ensure the availability of adequate and quality health services for everyone in need of them while protecting them from the accompanying financial burden [2]. In Uganda, user fees were introduced in 1993 as part of a package of economic reforms recommended by the World Bank to reduce the level of debt and macroeconomic stagnation [5]. The rationale for these restructurings was based on a theoretical argument related to the price inelastic demand for health care. The abolition was expected to increase access to health care but to reduce the financial burden on households
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