Abstract
Despite the removal of user fees on public primary healthcare in Zambia, prior studies suggest that out-of-pocket payments are still significant. However, we have little understanding of the extent to which out-of-pocket payments lead patients to hardship methods of financing out-of-pocket costs. This study analyses the prevalence and determinants of hardship financing arising from out-of-pocket payments in healthcare, using data from a nationally-representative household health expenditure survey conducted in 2014. We employ a sequential logistic regression model to examine the factors associated with the risk of hardship financing conditional on reporting an illness and an out-of-pocket expenditure. The results show that up to 11% of households who reported an illness had borrowed money, or sold items or asked a friend for help, or displaced other household consumption in order to pay for health care. The risk of hardship financing was higher among the poorest households, female headed-households and households who reside further from health facilities. Improvements in physical access and quality of public health services have the potential to reduce the incidence of hardship financing especially among the poorest.
Highlights
IntroductionSome countries have experimented with a number of policies such as community-based health financing schemes, user fee abolition, prepayment schemes, social health insurance, or a mix of these [1, 2]
This study has examined the extent and nature of financial hardships experienced by patients due to unaffordable out-of-pocket healthcare payments in Zambia
Hardship financing was exemplified by borrowing money, asking someone else to pay for them, or selling personal or household items, and catastrophic health expenditure (CHE), which entails that of-pocket payments (OOPs) displaces basic household consumption
Summary
Some countries have experimented with a number of policies such as community-based health financing schemes, user fee abolition, prepayment schemes, social health insurance, or a mix of these [1, 2] These policies were intended to guarantee greater healthcare access and financial protection, especially to the poorest who were worst hit by user charges. The boldest of such policies has been the complete removal of user fees in the public sector, starting with primary healthcare which is seen to benefit the poorest more [3, 4] Despite these policy efforts, out-of-pocket payments (OOPs) associated with a visit to a health provider remain high, and in some cases prohibitive, in Sub-Saharan Africa [5, 6]. In Zambia, healthcare seeking is associated with significant OOPs at the point of use in both public and private facilities
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