Trends in out of pocket payments and catastrophic health expenditure in the Kyrgyz Republic post \u201cManas Taalimi\u201d and \u201cDen Sooluk\u201d health reforms, 2012\u20132018

Mariia Iamshchikova,Roman Mogilevskii,Michael Nnachebe Onah

doi:10.1186/s12939-020-01358-2

Mariia Iamshchikova, Roman Mogilevskii + Show 1 more

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https://doi.org/10.1186/s12939-020-01358-2

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Abstract

BackgroundOver the years, the Kyrgyz Republic has implemented health reforms that target health financing with the aim of removing financial barriers to healthcare including out-of-pocket health payments (OOPPs). This study examines the trends in OOPPs, and the incidence of catastrophic health expenditure (CHE) post the “Manas Taalimi” and “Den Sooluk” health reforms.MethodsWe used data from the Kyrgyzstan Integrated Household Surveys (2012–2018). Population-weighted descriptive statistics were used to examine the trends in OOPPs and CHE at three thresholds; 10 percent of total household consumption expenditure (Cata10), 25 percent of total household consumption expenditure (Cata25) and 40 percent of total household non-food consumption expenditure (Cata40). Panel and cross-sectional logistic regression with marginal effects were used to examine the predictors of Cata10 and Cata40.FindingsBetween 2012 and 2018, OOPPs increased by about US $6 and inpatient costs placed the highest cost burden on users (US $13.6), followed by self-treatment (US $10.7), and outpatient costs (US $9). Medication continues to predominantly drive inpatient, outpatient, and self-treatment OOPPs. About 0.378 to 2.084 million people (6 – 33 percent) of the population incurred catastrophic health expenditure at the three thresholds between 2012 and 2018. Residing in households headed by a widowed or single head, or residing in rural regions, increases the likelihood of incurring catastrophic health expenditure.ConclusionsThe initial gains in the reduction of OOPPs and catastrophic health expenditure appear to gradually erode since costs continue to increase after an initial decline and catastrophic health expenditure continues to rise unabated. This implies that households are increasingly incurring economic hardship from seeking healthcare. Considering that this could result to forgone expenditure on essential items including food and education, efforts should target the sustainability of these health reforms to maintain and grow the reduction of catastrophic health payments and its dire consequences.

Highlights

One of the principal goals of health reforms especially in developing countries is to ensure that households and individuals do not experience financial hardship from accessing and utilising healthcare [1]
Other health reforms have continued since the end of the “Den Sooluk” health reform and there might have been other non-health reform interventions which could have influenced household health expenditures, this paper focuses on a key objective of “Manas Taalimi” and “Den Sooluk” which was the protection of healthcare users from economic hardship from seeking healthcare
Outpatient costs increased from 480 Soms (US $7) to 633 Soms (US $9), inpatient costs increased from 519 Soms (US $7.5) to 940 Soms (US $13.6), and self-treatment costs increased from 257 Soms (US $3.7) to 737 Soms (US $10.7) between 2012 and 2018

Summary

Introduction

One of the principal goals of health reforms especially in developing countries is to ensure that households and individuals do not experience financial hardship from accessing and utilising healthcare [1]. Since health and healthcare are considered human rights and the demand for healthcare is largely inelastic to price fluctuations [9], households employ numerous strategies to finance healthcare and cope with the economic hardship resulting from healthcare expenditures [10, 11]. Government decree on Introduction of a New Health care Financing Mechanism in Health facilities of Kyrgyzstan since 2001. The Kyrgyz Republic has implemented health reforms that target health financing with the aim of removing financial barriers to healthcare including out-of-pocket health payments (OOPPs). This study examines the trends in OOPPs, and the incidence of catastrophic health expenditure (CHE) post the “Manas Taalimi” and “Den Sooluk” health reforms

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