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What has been the progress in addressing financial risk in Uganda? Analysis of catastrophe and impoverishment due to health payments
BACKGROUND: Monitoring progress towards Universal Health Coverage (UHC) requires an assessment of progress in coverage of health services and protection of households from the impact of direct out-of-pocket payments (i.e. financial risk protection). Although Uganda has expressed aspirations for atta...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7425531/ https://www.ncbi.nlm.nih.gov/pubmed/32787844 http://dx.doi.org/10.1186/s12913-020-05500-2 |
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author | Kwesiga, Brendan Aliti, Tom Nabukhonzo, Pamela Najuko, Susan Byawaka, Peter Hsu, Justine Ataguba, John E. Kabaniha, Grace |
author_facet | Kwesiga, Brendan Aliti, Tom Nabukhonzo, Pamela Najuko, Susan Byawaka, Peter Hsu, Justine Ataguba, John E. Kabaniha, Grace |
author_sort | Kwesiga, Brendan |
collection | PubMed |
description | BACKGROUND: Monitoring progress towards Universal Health Coverage (UHC) requires an assessment of progress in coverage of health services and protection of households from the impact of direct out-of-pocket payments (i.e. financial risk protection). Although Uganda has expressed aspirations for attaining UHC, out-of-pocket payments remain a major contributor to total health expenditure. The aim of this study is to monitor progress in financial risk protection in Uganda. METHODS: This study uses data from the Uganda National Household Surveys for 2005/06, 2009/10, 2012/13 and 2016/17. We measure financial risk protection using catastrophic health care payments and impoverishment indicators. Health care payments are catastrophic if they exceed a set threshold (i.e. 10 and 25%) of the total household consumption expenditure. Health payments are impoverishing if they push the household below the poverty line (the US$1.90/day and Uganda’s national poverty lines). A logistic regression model is used to assess the factors associated with household financial risk. RESULTS: The results show that while progress has been made in reducing financial risk, this progress remains minimal, and there is still a risk of a reversal of this trend. We find that although catastrophic health payments at the 10% threshold decreased from 22.4% in 2005/06 to 13.8% in 2012/13, it increased to 14.2% in 2016/17. The percentage of Ugandans pushed below the national poverty line (US$1.90/day) has decreased from 5.2% in 2005/06 to 2.7% in 2016/17. The distribution of both catastrophic health payments and impoverishment varies across socio-economic status, location and residence. In addition, certain household characteristics (poverty, having a child below 5 years and an adult above 60 years) are more associated with the lack of financial risk protection. CONCLUSION: There is need for targeted interventions to reduce OOP, especially among those affected so as to increase financial risk protection. In the short-term, it is important to ensure that public health services are funded adequately to enable effective coverage with quality health care. In the medium-term, increased reliance on mandatory prepayment will reduce the burden of OOP health spending further. |
format | Online Article Text |
id | pubmed-7425531 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-74255312020-08-16 What has been the progress in addressing financial risk in Uganda? Analysis of catastrophe and impoverishment due to health payments Kwesiga, Brendan Aliti, Tom Nabukhonzo, Pamela Najuko, Susan Byawaka, Peter Hsu, Justine Ataguba, John E. Kabaniha, Grace BMC Health Serv Res Research Article BACKGROUND: Monitoring progress towards Universal Health Coverage (UHC) requires an assessment of progress in coverage of health services and protection of households from the impact of direct out-of-pocket payments (i.e. financial risk protection). Although Uganda has expressed aspirations for attaining UHC, out-of-pocket payments remain a major contributor to total health expenditure. The aim of this study is to monitor progress in financial risk protection in Uganda. METHODS: This study uses data from the Uganda National Household Surveys for 2005/06, 2009/10, 2012/13 and 2016/17. We measure financial risk protection using catastrophic health care payments and impoverishment indicators. Health care payments are catastrophic if they exceed a set threshold (i.e. 10 and 25%) of the total household consumption expenditure. Health payments are impoverishing if they push the household below the poverty line (the US$1.90/day and Uganda’s national poverty lines). A logistic regression model is used to assess the factors associated with household financial risk. RESULTS: The results show that while progress has been made in reducing financial risk, this progress remains minimal, and there is still a risk of a reversal of this trend. We find that although catastrophic health payments at the 10% threshold decreased from 22.4% in 2005/06 to 13.8% in 2012/13, it increased to 14.2% in 2016/17. The percentage of Ugandans pushed below the national poverty line (US$1.90/day) has decreased from 5.2% in 2005/06 to 2.7% in 2016/17. The distribution of both catastrophic health payments and impoverishment varies across socio-economic status, location and residence. In addition, certain household characteristics (poverty, having a child below 5 years and an adult above 60 years) are more associated with the lack of financial risk protection. CONCLUSION: There is need for targeted interventions to reduce OOP, especially among those affected so as to increase financial risk protection. In the short-term, it is important to ensure that public health services are funded adequately to enable effective coverage with quality health care. In the medium-term, increased reliance on mandatory prepayment will reduce the burden of OOP health spending further. BioMed Central 2020-08-12 /pmc/articles/PMC7425531/ /pubmed/32787844 http://dx.doi.org/10.1186/s12913-020-05500-2 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. 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 in a credit line to the data. |
spellingShingle | Research Article Kwesiga, Brendan Aliti, Tom Nabukhonzo, Pamela Najuko, Susan Byawaka, Peter Hsu, Justine Ataguba, John E. Kabaniha, Grace What has been the progress in addressing financial risk in Uganda? Analysis of catastrophe and impoverishment due to health payments |
title | What has been the progress in addressing financial risk in Uganda? Analysis of catastrophe and impoverishment due to health payments |
title_full | What has been the progress in addressing financial risk in Uganda? Analysis of catastrophe and impoverishment due to health payments |
title_fullStr | What has been the progress in addressing financial risk in Uganda? Analysis of catastrophe and impoverishment due to health payments |
title_full_unstemmed | What has been the progress in addressing financial risk in Uganda? Analysis of catastrophe and impoverishment due to health payments |
title_short | What has been the progress in addressing financial risk in Uganda? Analysis of catastrophe and impoverishment due to health payments |
title_sort | what has been the progress in addressing financial risk in uganda? analysis of catastrophe and impoverishment due to health payments |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7425531/ https://www.ncbi.nlm.nih.gov/pubmed/32787844 http://dx.doi.org/10.1186/s12913-020-05500-2 |
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