Cargando…
Factors related to excessive out-of-pocket expenditures among the ultra-poor after discontinuity of PBF: a cross-sectional study in Burkina Faso
BACKGROUND: Measuring progress towards financial risk protection for the poorest is essential within the framework of Universal Health Coverage. The study assessed the level of out-of-pocket expenditure and factors associated with excessive out-of-pocket expenditure among the ultra-poor who had been...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7666767/ https://www.ncbi.nlm.nih.gov/pubmed/33188618 http://dx.doi.org/10.1186/s13561-020-00293-w |
_version_ | 1783610195280134144 |
---|---|
author | Beaugé, Yvonne Ridde, Valéry Bonnet, Emmanuel Souleymane, Sidibé Kuunibe, Naasegnibe De Allegri, Manuela |
author_facet | Beaugé, Yvonne Ridde, Valéry Bonnet, Emmanuel Souleymane, Sidibé Kuunibe, Naasegnibe De Allegri, Manuela |
author_sort | Beaugé, Yvonne |
collection | PubMed |
description | BACKGROUND: Measuring progress towards financial risk protection for the poorest is essential within the framework of Universal Health Coverage. The study assessed the level of out-of-pocket expenditure and factors associated with excessive out-of-pocket expenditure among the ultra-poor who had been targeted and exempted within the context of the performance-based financing intervention in Burkina Faso. Ultra-poor were selected based on a community-based approach and provided with an exemption card allowing them to access healthcare services free of charge. METHODS: We performed a descriptive analysis of the level of out-of-pocket expenditure on formal healthcare services using data from a cross-sectional study conducted in Diébougou district. Multivariate logistic regression was performed to investigate the factors related to excessive out-of-pocket expenditure among the ultra-poor. The analysis was restricted to individuals who reported formal health service utilisation for an illness-episode within the last six months. Excessive spending was defined as having expenditure greater than or equal to two times the median out-of-pocket expenditure. RESULTS: Exemption card ownership was reported by 83.64% of the respondents. With an average of FCFA 23051.62 (USD 39.18), the ultra-poor had to supplement a significant amount of out-of-pocket expenditure to receive formal healthcare services at public health facilities which were supposed to be free. The probability of incurring excessive out-of-pocket expenditure was negatively associated with being female (β = − 2.072, p = 0.00, ME = − 0.324; p = 0.000) and having an exemption card (β = − 1.787, p = 0.025; ME = − 0.279, p = 0.014). CONCLUSIONS: User fee exemptions are associated with reduced out-of-pocket expenditure for the ultra-poor. Our results demonstrate the importance of free care and better implementation of existing exemption policies. The ultra-poor’s elevated risk due to multi-morbidities and severity of illness need to be considered when allocating resources to better address existing inequalities and improve financial risk protection. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13561-020-00293-w. |
format | Online Article Text |
id | pubmed-7666767 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-76667672020-11-16 Factors related to excessive out-of-pocket expenditures among the ultra-poor after discontinuity of PBF: a cross-sectional study in Burkina Faso Beaugé, Yvonne Ridde, Valéry Bonnet, Emmanuel Souleymane, Sidibé Kuunibe, Naasegnibe De Allegri, Manuela Health Econ Rev Research BACKGROUND: Measuring progress towards financial risk protection for the poorest is essential within the framework of Universal Health Coverage. The study assessed the level of out-of-pocket expenditure and factors associated with excessive out-of-pocket expenditure among the ultra-poor who had been targeted and exempted within the context of the performance-based financing intervention in Burkina Faso. Ultra-poor were selected based on a community-based approach and provided with an exemption card allowing them to access healthcare services free of charge. METHODS: We performed a descriptive analysis of the level of out-of-pocket expenditure on formal healthcare services using data from a cross-sectional study conducted in Diébougou district. Multivariate logistic regression was performed to investigate the factors related to excessive out-of-pocket expenditure among the ultra-poor. The analysis was restricted to individuals who reported formal health service utilisation for an illness-episode within the last six months. Excessive spending was defined as having expenditure greater than or equal to two times the median out-of-pocket expenditure. RESULTS: Exemption card ownership was reported by 83.64% of the respondents. With an average of FCFA 23051.62 (USD 39.18), the ultra-poor had to supplement a significant amount of out-of-pocket expenditure to receive formal healthcare services at public health facilities which were supposed to be free. The probability of incurring excessive out-of-pocket expenditure was negatively associated with being female (β = − 2.072, p = 0.00, ME = − 0.324; p = 0.000) and having an exemption card (β = − 1.787, p = 0.025; ME = − 0.279, p = 0.014). CONCLUSIONS: User fee exemptions are associated with reduced out-of-pocket expenditure for the ultra-poor. Our results demonstrate the importance of free care and better implementation of existing exemption policies. The ultra-poor’s elevated risk due to multi-morbidities and severity of illness need to be considered when allocating resources to better address existing inequalities and improve financial risk protection. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13561-020-00293-w. Springer Berlin Heidelberg 2020-11-14 /pmc/articles/PMC7666767/ /pubmed/33188618 http://dx.doi.org/10.1186/s13561-020-00293-w 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 Beaugé, Yvonne Ridde, Valéry Bonnet, Emmanuel Souleymane, Sidibé Kuunibe, Naasegnibe De Allegri, Manuela Factors related to excessive out-of-pocket expenditures among the ultra-poor after discontinuity of PBF: a cross-sectional study in Burkina Faso |
title | Factors related to excessive out-of-pocket expenditures among the ultra-poor after discontinuity of PBF: a cross-sectional study in Burkina Faso |
title_full | Factors related to excessive out-of-pocket expenditures among the ultra-poor after discontinuity of PBF: a cross-sectional study in Burkina Faso |
title_fullStr | Factors related to excessive out-of-pocket expenditures among the ultra-poor after discontinuity of PBF: a cross-sectional study in Burkina Faso |
title_full_unstemmed | Factors related to excessive out-of-pocket expenditures among the ultra-poor after discontinuity of PBF: a cross-sectional study in Burkina Faso |
title_short | Factors related to excessive out-of-pocket expenditures among the ultra-poor after discontinuity of PBF: a cross-sectional study in Burkina Faso |
title_sort | factors related to excessive out-of-pocket expenditures among the ultra-poor after discontinuity of pbf: a cross-sectional study in burkina faso |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7666767/ https://www.ncbi.nlm.nih.gov/pubmed/33188618 http://dx.doi.org/10.1186/s13561-020-00293-w |
work_keys_str_mv | AT beaugeyvonne factorsrelatedtoexcessiveoutofpocketexpendituresamongtheultrapoorafterdiscontinuityofpbfacrosssectionalstudyinburkinafaso AT riddevalery factorsrelatedtoexcessiveoutofpocketexpendituresamongtheultrapoorafterdiscontinuityofpbfacrosssectionalstudyinburkinafaso AT bonnetemmanuel factorsrelatedtoexcessiveoutofpocketexpendituresamongtheultrapoorafterdiscontinuityofpbfacrosssectionalstudyinburkinafaso AT souleymanesidibe factorsrelatedtoexcessiveoutofpocketexpendituresamongtheultrapoorafterdiscontinuityofpbfacrosssectionalstudyinburkinafaso AT kuunibenaasegnibe factorsrelatedtoexcessiveoutofpocketexpendituresamongtheultrapoorafterdiscontinuityofpbfacrosssectionalstudyinburkinafaso AT deallegrimanuela factorsrelatedtoexcessiveoutofpocketexpendituresamongtheultrapoorafterdiscontinuityofpbfacrosssectionalstudyinburkinafaso |