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Impact of out of pocket payments on financial risk protection indicators in a setting with no user fees: the case of Mauritius

BACKGROUND: Mauritius embraces principles of a welfare state with free health care at point of use in any public facilities. However, the health financing landscape changed in 2007 when Private Health Expenditure (PvtHE) surpassed General Government Health Expenditure. PvtHE is predominately out of...

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Autores principales: Nundoochan, Ajoy, Thorabally, Yusuf, Monohur, Sooneeraz, Hsu, Justine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6500054/
https://www.ncbi.nlm.nih.gov/pubmed/31053077
http://dx.doi.org/10.1186/s12939-019-0959-5
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author Nundoochan, Ajoy
Thorabally, Yusuf
Monohur, Sooneeraz
Hsu, Justine
author_facet Nundoochan, Ajoy
Thorabally, Yusuf
Monohur, Sooneeraz
Hsu, Justine
author_sort Nundoochan, Ajoy
collection PubMed
description BACKGROUND: Mauritius embraces principles of a welfare state with free health care at point of use in any public facilities. However, the health financing landscape changed in 2007 when Private Health Expenditure (PvtHE) surpassed General Government Health Expenditure. PvtHE is predominately out of pocket (OOP) with only 3.4% related to premiums for private insurance. In 2014, Household OOP Expenditure on health accounted for 52.8% of total health expenditure. OOP is known to be regressive and to impact negatively on households’ living standards. OBJECTIVES: This paper aims to examine trends in OOP in Mauritius, to assess its impacts through an analysis of key indicators of financial protection, namely catastrophic health expenditure (CHE) and impoverishment due to OOP health expenditure. It also aims to predict core determinants of CHEs. METHODS: Household Budget Surveys (HBS) of 2001/2002, 2006/2007 and 2012 were the primary source data. CHE and impoverishment were used to assess financial hardships resulting from OOP health payments. The incidence of CHE was estimated at three threshold levels (10,25 and 40%), using the budget share and the capacity to pay approaches. Impoverishment due to OOP was measured by changes in the incidence of poverty and intensity of poverty using the US$ 3.1 international poverty line. Logistic regression analysis was used to identify determinants of CHE. FINDINGS: Household CHE increased from 5.78% in 2001/02 to 8.85% in 2012 and 0.61% in 2001/02 to 1.25% in 2012, for 10 and 40% thresholds, respectively. The incidence of CHE was significantly higher in urban areas compared to rural areas. The highest levels of CHEs were among households’ heads, who are retired rising from 1.62% in 2001/02 to 3.71% in 2012, followed by households’ head who are widowed from 2.29% in 2001/02 to 2.63% in 2012 and homemakers from 2.12% in 2001/02 to 2.57% in 2012 at the 40% threshold. The share of households pushed below the poverty line due to OOP dropped from 0.4% in 2001/02 to 0.2% in 2006/07 before rising to 0.34% in 2012. In 2012, poverty gap occurred only among households under poorest quintile 1 (0.24%) and quintile 2 (0.03%). Overall poverty gap dropped from 0.08% in 2001/02 to 0.05% in 2012. Logistic regression analysis revealed that the odds ratio of facing CHE were significant only among households with heads being retired and with a presence of an elderly member in the household. CONCLUSION: Despite the rise in incidence of CHE between 2001 and 2012 the impact of OOP on the level of impoverishment and poverty gap has not been significant.
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spelling pubmed-65000542019-05-09 Impact of out of pocket payments on financial risk protection indicators in a setting with no user fees: the case of Mauritius Nundoochan, Ajoy Thorabally, Yusuf Monohur, Sooneeraz Hsu, Justine Int J Equity Health Research BACKGROUND: Mauritius embraces principles of a welfare state with free health care at point of use in any public facilities. However, the health financing landscape changed in 2007 when Private Health Expenditure (PvtHE) surpassed General Government Health Expenditure. PvtHE is predominately out of pocket (OOP) with only 3.4% related to premiums for private insurance. In 2014, Household OOP Expenditure on health accounted for 52.8% of total health expenditure. OOP is known to be regressive and to impact negatively on households’ living standards. OBJECTIVES: This paper aims to examine trends in OOP in Mauritius, to assess its impacts through an analysis of key indicators of financial protection, namely catastrophic health expenditure (CHE) and impoverishment due to OOP health expenditure. It also aims to predict core determinants of CHEs. METHODS: Household Budget Surveys (HBS) of 2001/2002, 2006/2007 and 2012 were the primary source data. CHE and impoverishment were used to assess financial hardships resulting from OOP health payments. The incidence of CHE was estimated at three threshold levels (10,25 and 40%), using the budget share and the capacity to pay approaches. Impoverishment due to OOP was measured by changes in the incidence of poverty and intensity of poverty using the US$ 3.1 international poverty line. Logistic regression analysis was used to identify determinants of CHE. FINDINGS: Household CHE increased from 5.78% in 2001/02 to 8.85% in 2012 and 0.61% in 2001/02 to 1.25% in 2012, for 10 and 40% thresholds, respectively. The incidence of CHE was significantly higher in urban areas compared to rural areas. The highest levels of CHEs were among households’ heads, who are retired rising from 1.62% in 2001/02 to 3.71% in 2012, followed by households’ head who are widowed from 2.29% in 2001/02 to 2.63% in 2012 and homemakers from 2.12% in 2001/02 to 2.57% in 2012 at the 40% threshold. The share of households pushed below the poverty line due to OOP dropped from 0.4% in 2001/02 to 0.2% in 2006/07 before rising to 0.34% in 2012. In 2012, poverty gap occurred only among households under poorest quintile 1 (0.24%) and quintile 2 (0.03%). Overall poverty gap dropped from 0.08% in 2001/02 to 0.05% in 2012. Logistic regression analysis revealed that the odds ratio of facing CHE were significant only among households with heads being retired and with a presence of an elderly member in the household. CONCLUSION: Despite the rise in incidence of CHE between 2001 and 2012 the impact of OOP on the level of impoverishment and poverty gap has not been significant. BioMed Central 2019-05-03 /pmc/articles/PMC6500054/ /pubmed/31053077 http://dx.doi.org/10.1186/s12939-019-0959-5 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Nundoochan, Ajoy
Thorabally, Yusuf
Monohur, Sooneeraz
Hsu, Justine
Impact of out of pocket payments on financial risk protection indicators in a setting with no user fees: the case of Mauritius
title Impact of out of pocket payments on financial risk protection indicators in a setting with no user fees: the case of Mauritius
title_full Impact of out of pocket payments on financial risk protection indicators in a setting with no user fees: the case of Mauritius
title_fullStr Impact of out of pocket payments on financial risk protection indicators in a setting with no user fees: the case of Mauritius
title_full_unstemmed Impact of out of pocket payments on financial risk protection indicators in a setting with no user fees: the case of Mauritius
title_short Impact of out of pocket payments on financial risk protection indicators in a setting with no user fees: the case of Mauritius
title_sort impact of out of pocket payments on financial risk protection indicators in a setting with no user fees: the case of mauritius
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6500054/
https://www.ncbi.nlm.nih.gov/pubmed/31053077
http://dx.doi.org/10.1186/s12939-019-0959-5
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