Determinants of healthcare seeking and out-of-pocket expenditures in a 'free' healthcare system: Evidence from rural Malawi

Artikel

Background: Monitoring financial protection is a key component in achieving Universal Health Coverage, even for health systems that grant their citizens access to care free-of-charge. Our study investigated out-of-pocket expenditure (OOPE) on curative healthcare services and their determinants in rural Malawi, a country that has consistently aimed at providing free healthcare services. Methods: Our study used data from two consecutive rounds of a household survey conducted in 2012 and 2013 among 1639 households in three districts in rural Malawi. Given our explicit focus on OOPE for curative healthcare services, we relied on a Heckman selection model to account for the fact that relevant OOPE could only be observed for those who had sought care in the first place. Results: Our sample included a total of 2740 illness episodes. Among the 1884 (68.75%) that had made use of curative healthcare services, 494 (26.22%) had incurred a positive healthcare expenditure, whose mean amounted to 678.45 MWK (equivalent to 2.72 USD). Our analysis revealed a significant positive association between the magnitude of OOPE and age 15-39 years (p = 0.022), household head (p = 0.037), suffering from a chronic illness (p = 0.019), illness duration (p = 0.014), hospitalization (p = 0.002), number of accompanying persons (p = 0.019), wealth quartiles (p2 = 0.018; p3 = 0.001; p4 = 0.002), and urban residency (p = 0.001). Conclusion: Our findings indicate that a formal policy commitment to providing free healthcare services is not sufficient to guarantee widespread financial protection and that additional measures are needed to protect particularly vulnerable population groups.

Angaben zum Objekt

• Sprache: Englisch

Verweise und Beziehungen

• Erschienen in: Journal: Health Economics Review ; ISSN: 2191-1991 ; Volume: 10 ; Year: 2020 ; Issue: 14 ; Pages: 1-12

Klassifikation und Themen

• Klassifikation: Wirtschaft
• Thema: Health care seeking behaviour ; Health financing ; Costs ; Health care allocation ; (country of expertise: Malawi)

Beteiligte, Orts- und Zeitangaben

• Ereignis: Geistige Schöpfung
• (wer): Nakovics, Meike Irene ; Brenner, Stephan ; Kalmus, Olivier ; De Allegri, Manuela
• Ereignis: Veröffentlichung
• (wer): Springer
• (wo): Heidelberg
• (wann): 2020

Weitere Informationen

• DOI: doi:10.1186/s13561-020-00271-2
• Handle: http://hdl.handle.net/10419/285158
• Letzte Aktualisierung: 10.03.2025, 11:44 MEZ