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.

Object Details

• Language: Englisch

References and Relationships

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

Classification and Topics

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

Contributors, Places and Time

• Event: Geistige Schöpfung
• (who): Nakovics, Meike Irene ; Brenner, Stephan ; Kalmus, Olivier ; De Allegri, Manuela
• Event: Veröffentlichung
• (who): Springer
• (where): Heidelberg
• (when): 2020

Further information

• DOI: doi:10.1186/s13561-020-00271-2
• Handle: http://hdl.handle.net/10419/285158
• Last update: 10.03.2025, 11:44 AM CET