Abstract
Reducing health inequalities and inequities is one of the key goals that health systems aspire to achieve as it ensures improvement in health outcomes among all population groups. Addressing the factors contributing to inequality in catastrophic health expenditures is important to reducing inequality in the burden of health expenditures. However, there are limited studies to explain the factors contributing to inequalities in catastrophic health expenditures. The study aimed to measure and decompose socio-economic inequality in catastrophic health into its determinants. Data for the analysis come from the fourth integrated household survey. Data for 12447 households in Malawi were collected from April 2016 to April 2017 by the National Statistical Office. The secondary analysis was conducted from June 2021 to October 2021. Catastrophic health expenditure was estimated as a proportion of households whose out-of-pocket health expenditures as a ratio of non-food consumption expenditures exceeds 40% threshold level. We estimated the magnitude of socio-economic inequality using the Erreygers corrected concentration index and used decomposition analysis to assess the contribution of inequality in each determinant of catastrophic health expenditure to the overall socio-economic inequality. The magnitude of the Erreygers corrected concentration index of catastrophic health expenditure (CI = 0.004) is small and positive which indicates that inequality is concentrated among the better-off. Inequality in catastrophic health expenditure is largely due to inequalities in rural residency (127%), socio-economic status (-40%), household size (14%), presence of a child under five years old (10%) and region of the household (10%). The findings indicate that socio-economic inequality in catastrophic health expenditures is concentrated among the better-off in Malawi. The results imply that policies that aim to reduce inequalities in catastrophic health expenditures should simultaneously address urban-rural and income inequalities.
Highlights
Health inequalities are systematic differences, variations and disparities in health outcomes among population groups [1]
Majority of the socioeconomic inequality in catastrophic health expenditures is due to inequalities in residency in rural area, socioeconomic status, household size, having at least a child under five years old and region in which household is located
The findings of the study have shown that socioeconomic inequality in catastrophic expenditures is more concentrated among better-off households
Summary
Health inequalities are systematic differences, variations and disparities in health outcomes among population groups [1]. One of the goals of health systems in both developed and developing countries is to reduce health inequalities in a way that improves the condition of the worse-off [2]. A study in South Africa found that inequalities in social determinants of health such as social protection, employment, education and knowledge contributes greatly to inequalities in good self-assessed health [3]. This implies that policies that aim to reduce health inequalities should be designed to address inequalities in social determinants of health
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