Out-of-pocket expenditure and its determinants in the context of private healthcare sector expansion in sub-Saharan Africa urban cities: Evidence from household survey in Ouagadougou, Burkina Faso

被引：19
作者：
Beogo I. [1 ,2 ]
Huang N. [3 ]
Gagnon M.-P. [2 ]
Amendah D.D. [4 ]
机构：
[1] École Nationale de Santé Publique, Ouagadougou
[2] Faculté des Sciences Infirmières, Université Laval, Pavillon Ferdinand-Vandry, 1050, Avenue de la Médecine, Quebec
[3] International Health Program, National Yang-Ming University, 155, Sec 2, Linong St., Taipei
[4] African Population and Health Research Center, APHRC Campus, 2nd Flore Manga Close, Off Kiwara Road, PO Box 10787-00100, Nairobi
来源：
BMC Research Notes | / 9卷 / 1期
关键词：
Burkina Faso; Expenditure; For-profit; Healthcare utilization; Not-for-profit; Out-of-pocket expenditure; Public; Urban;
D O I：
10.1186/s13104-016-1846-4
中图分类号：
学科分类号：
摘要：
Background: Conventional wisdom suggests that out-of-pocket (OOP) expenditure reduces healthcare utilization. However, little is known about the expenditure borne in urban settings with the current development of the private health sector in sub-Saharan Africa. In an effort to update knowledge on medical expenditure, this study investigated the level and determinants of OOP among individuals reporting illness or injury in Ouagadougou, Burkina Faso and who either self-treated or received healthcare in either a private or public facility. Methods: A cross-sectional study was conducted with a representative sample of 1017 households (5638 individuals) between August and November 2011. Descriptive statistics and multivariate techniques including generalized estimating equations were used to analyze the data. Results: Among the surveyed sample, 29.6 % (n = 1666) persons reported a sickness or injury. Public providers were the single most important providers of care (36.3 %), whereas private and informal providers (i.e.: self-treatment, traditional healers) accounted for 29.8 and 34.0 %, respectively. Almost universally (96 %), households paid directly for care OOP. The average expenditure per episode of illness was 8404XOF (17.4USD) (median 3750XOF (7.8USD). The total expenditure was higher for those receiving care in private facilities compared to public ones [14,613.3XOF (30.3USD) vs. 8544.1XOF (17.7USD); p < 0.001], and the insured patients' bill almost tripled uninsured (p < 0.001). Finally, medication was the most expensive component of expenditure in both public and private facilities with a mean of 8022.1XOF (16.7USD) and 12,270.5 (25.5USD), respectively. Conclusion: OOP was the principal payment mechanism of households. A significant difference in OOP was found between public and private provider users. Considering the importance of private healthcare in Burkina Faso, regulatory oversight is necessary. Furthermore, an extensive protection policy to shield households from catastrophic health expenditure is required. © 2016 Beogo et al.
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共 65 条
[1]  
Essue B.M., Kimman M., Svenstrup N., Lindevig Kjoege K., Lea Laba T., Hackett M.L., Jan S., The effectiveness of interventions to reduce the household economic burden of illness and injury: A systematic review, Bull World Health Organ, 93, 2, (2015)
[2]  
Atella V., Brugiavini A., Pace N., The health care system reform in China: Effects on out-of-pocket expenses and saving, China Econ Rev, 34, pp. 182-195, (2015)
[3]  
Wang Q., Brenner S., Leppert G., Banda T.H., Kalmus O., De Allegri M., Health seeking behaviour and the related household out-of-pocket expenditure for chronic non-communicable diseases in rural Malawi, Health Policy Plan, 30, 2, pp. 242-252, (2015)
[4]  
Barros A.J., Bertoldi A.D., Out-of-pocket health expenditure in a population covered by the Family Health Program in Brazil, Int J Epidemiol, 37, 4, pp. 758-765, (2008)
[5]  
Ridde V., Robert E., Meessen B., A literature review of the disruptive effects of user fee exemption policies on health systems, BMC Public Health, 12, 289, pp. 2-7, (2012)
[6]  
Paganini A., The Bamako Initiative was not about money, Health Policy Dev J, 2, 1, pp. 11-13, (2004)
[7]  
Lagarde M., Palmer N., The impact of user fees on health service utilization in low- and middle-income countries: How strong is the evidence?, Bull World Health Organ, 86, 11, pp. 839-848, (2008)
[8]  
Dong H., De Allegri M., Gnawali D., Souares A., Sauerborn R., Drop-out analysis of community-based health insurance membership at Nouna, Burkina Faso, Health Policy, 92, 2-3, pp. 174-179, (2009)
[9]  
Witter S., Fretheim A., Kessy F., Lindahl A., Paying for performance to improve the delivery of health interventions in low- and middle-income countries (review), Cochrane Database Syst Rev, 2, pp. 1-82, (2012)
[10]  
Meessen B., Soucat A., Sekabaraga C., Performance-based financing: Just a donor fad or a catalyst towards comprehensive health-care reform?, Bull World Health Organ, 89, 2, pp. 153-156, (2011)
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